Ward Class

An Online Resource Site For Student Nurses


Ward Class is an online resource for student nurses. Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.

Site Announcement

The December 2012 PRC Nursing Board Exam Result is already available here at Ward Class and at Pinoy R.N.

Dealing with Difficult Instructors

I was a student not too long ago so I know what every nursing student goes through as he or she struggles to survive nursing school. Long school hours, nerve-wracking exams, backbreaking clinical rotations, time-consuming projects-- I went through all that.

Did I miss something out? Well, like any other Jane or John in nursing school, I also had to deal with a number of difficult instructors.

Your esteemed college instructors come in different shapes, sizes, and temperament. Students are not so concerned with the physical attributes of their instructors (or am I mistaken?) so for the purpose of this entry, let us focus on instructor behavior.

The well-loved instructors are those who are understanding, good-natured, and nurturing. Sweet as saccharine, so to speak. They come to class prepared; providing new learnings without being fault-finding. Really, you never ever have problems with these instructors. Heck, they even receive the most number of cards/bouquets during Teachers' Day.

However, at the other end of the spectrum lies another breed of instructors. Toxic, Difficult, Irresponsible, Inconsiderate, Rude, Insensitive, and Corrupt are but few of the adjectives you attach to these instructors' names. And since I know there is no escaping these difficult instructors, here are some tips to help you deal with them:

  1. Be rational. Think of the reasons why you say your instructor is difficult and analyze if your reasons are valid. Do not fall into the trap of disliking your instructors for the wrong reasons. Always be objective.
  2. Be respectful. While your instructor may be utterly despicable, never lose your cool in class. Never bad-mouth or give your instructor dagger-looks. It is okay to voice out your concerns but it is always wise to do so in a respectful manner.
  3. Be positive. Even if you are stuck with an instructor who have the penchant for giving loads of requirements, ditch the whining and the eyeball-exercise. Nobody said that nursing school is a no-brainer so you might as well do what is expected of you and accomplish any assigned tasks. Furthermore, no matter how difficult your instructor may be, keep in mind that you won't have to deal with the person forever and bidding him or her adieu is something to look forward to.
  4. Be prepared. Earn your instructors' respect by coming to class prepared. Review your notes and as much as possible, read your books in advance. Difficult instructors pick on unsuspecting (unprepared) students so don't give them that advantage.
  5. Make use of consultation hours. If you have a problem or questions regarding some topics previously discussed, the computation of your grades, or with course requirements, approach your instructor during consultation hours and ask for assistance. Going the extra mile to clarify things will communicate to your instructors that you take your studies seriously and will definitely leave a lasting good impression.
  6. Use appropriate channels. Sometimes, you are the stuck in the worst scenario ever. If you are being singled out, harassed, and you feel that you have exhausted all logical means to deal with a difficult instructor, it is time to tell your parents or a school counselor. Also, schedule for a conference with the instructor concerned in the presence of a parent and/or counselor and express your concerns politely. This will help open communication lines between you and your instructor and hopefully resolve existing differences.
Difficult instructors may really be unyielding at times but remember that in order to survive nursing school, you will have to face bigger challenges. Your goal is to make the most out of your nursing education and finish nursing school with flying colors. You are almost there so do not allow the least bit of distraction, not even the most difficult of instructors, dampen your spirit.

Genitourinary Disorders: Wilms' Tumor

  • also called Nephroblastoma, the most common malignant tumor of the kidneys affecting children
  • a large, encapsulated tumor that rises from the metanephric mesoderm cells of the upper pole of the kidney
  • usually unilateral, usually develops in the renal parenchyma of the left kidney
  • occurs in association with congenital anomalies such as aniridia, cryptorchidism, hypospadias, pseudohermaphoditism, cystic kidneys, hemangiomas, and talipes disorders
  • peak age of occurrence is between 1-3 years, rarely occurs in children older than 8 y.o.
Assessment Findings
  • firm, non-tender abdominal mass, usually midline near the liver--> usually discovered when a parent dresses or bathes child
  • hematuria (blood in urine)
  • low-grade fever
  • hypertension-->due to increased renin production
  • possible anemia, weight loss, malaise, anorexia, stomach pain, nausea, and vomiting
  • diagnostic tests
1. intravenous pyelogram--> will reveal a mass displacing normal kidney structure
2. chest CT Scan, chest MRI, sonogram, bone scan, and chest X-ray-->may be ordered
to determine spread beyond kidneys
3. kidney function studies (e.g. GFR and BUN)--> done prior to surgery
  • staging:
-Stage I (tumor confined to kidney and completely removed surgically)
-Stage II (tumor extending beyond the kidney but completely removed surgically)
-Stage III (tumor has spread to the nearby lymphnodes and to other areas within the
abdomen and it can't be completely removed surgically)
-Stage IV (the tumor has spread to distant structures such as the lungs, liver, or bone
-Stage V (tumor is in both kidneys)

Medical Management
  1. Postsurgical radiation--> for stages II, III, and IV; stage I may require radiation depending on histologic studies
  2. Postsurgical chemotherapy--> dactinomycin, vincristine, or doxorubicin may be used and usually given at varying intervals for as long as 15 months
Surgical Management
  • Wilms' tumor is removed by nephrectomy (surgical removal of kidney tissue). It is usually performed 24-48 hours after diagnosis as Wilms' tumor metastasizes rapidly owing to the large blood supply of the kidneys and adrenal glands.
  • Nephrectomy may be simple (entire kidney is removed), partial (removal of tumor and kidney tissue surrounding it, or radical (removal of the kidney, surrounding tissues, and neighboring lymph nodes).
Nursing Management
  1. do NOT palpate the abdomen as palpation and handling aids in metastasis
  2. instruct caregivers to bathe and dress child with care
  3. provide care for a client with a nephrectomy--> focus on urine output assessment, avoidance of pulmonary complications, signs of complications (flank pain on unoperative site, unexplained weight gain, decreased urine output)
  4. provide care for client receiving chemotherapy and radiation therapy--> avoidance of infection, promote nutrition and hydration, and care of radiation site

Overall five-year survival rate is 89.5%. Patients with tumors of mostly differentiated epithelial cells have a long-term survival rate of 93%. Prognosis is best for patients below 2 years old with stage I small-sized tumors.


Wilms' tumor is not preventable

The Latest on the Vicente Sotto Memorial Medical Center Scandal

A couple of months after controversy rocked the Vicente Sotto Memorial Medical Center because of an infamous video clip which found its way to YouTube documenting the agency's OR personnel having fun at the expense of a surgical patient, I wondered what happened to those who were involved in the fiasco.

Much has been written and said about the 'canister scandal' but the thing is, after all the hype and brouhaha, what's next? Having written entries on it in my other blog, I decided to use Inquirer.net's search feature to find out the latest on it and here is an excerpt of an article by Jhunex Napallacan dated May o6, 2008:

CEBU CITY, Philippines -- The Office of the Ombudsman-Visayas has approved the upgrading of the complaint against 14 persons involved in the rectal surgery scandal to criminal and administrative cases.

In a resolution released Monday afternoon, the Ombudsman Visayas found reasonable ground to charge seven doctors, five nurses and two clinical instructors, with violation of Section 3(e) of the Republic Act 3019 (Anti-graft and Corrupt Practices Act).

The section holds a person liable for "causing any undue injury to any party, including the Government, or giving any private party any unwarranted benefits, advantage or preference in the discharge of his official administrative or judicial functions through manifest partiality, evident bad faith or gross inexcusable negligence. This provision shall apply to officers and employees of offices or government corporations charged with the grant of licenses or permits or other concessions."

Any person found guilty of an offense defined by RA 3019 faces a prison term from one to 10 years.

Out of the 14 charged, 6 are registered nurses: 2 clinical instructors, 1 circulating nurse, 1 on-call nurse, and 2 nursing supervisors. Only the circulating nurse is part of the surgical team. Another person who is facing charges is a nursing attendant. Although not a licensed nursing personnel, the said ancillary personnel was allegedly part of the surgical team and was apparently functioning as a nurse. Whoever delegated his or her nursing function to the nursing attendant is also legally responsible for the wrongdoing committed by the said ancillary nursing personnel.

Being very familiar with the doctrine of respondeat superior and the legal responsibility of clinical instructors for the behavior or work rendered by nursing students during clinical rotations, I understand why charges were also filed against the nursing supervisors and clinical instructors.

Respondeat superior (also called the master-servant rule) literally means "let the master answer". This doctrine implies that superiors are responsible for the actions done by their subordinates when the latter are doing such actions during their assigned duties. The nursing supervisors may argue that they did not actively take part in the merriment during that fateful day but as direct superiors of the nursing personnel involved, the liability is expanded to include them.

As for the involvement of the clinical instructors, Republic Act 9173 is very clear: Nursing students do not perform professional nursing duties. They should ALWAYS be under the supervision of their clinical instructors and they should be oriented to the policies of the nursing unit or area of exposure during clinical rotations. Although the nursing students involved were already referred to their respective schools for disciplinary action, their clinical instructors will have to face criminal and administrative charges.

As would-be nursing professionals, nursing students should also be responsible for their actions when caring for their patients. Quality nursing care, although supervised, is expected of student nurses when attending to patients during clinical rotations.

Integumentary Disorders: Impetigo

Impetigo Contagiosa
  • Impetigo is a superficial bacterial infection of the skin usually caused by group A beta-hemolytic streptococcus or Staphylococcus aureus
  • mainly affects infants and children
  • highly contagious and transmitted by direct contact with lesions; incubation period is between 2-5 days and the period of communicability is from outbreak of lesions until lesions are healed
  • may be caused by poor sanitation and hygiene but Impetigo can also occur in perfectly healthy skin
  • three types of Impetigo have been identified:
>impetigo contagiosa -most common; often around nose and mouth; itchy and painless
>bullous impetigo - fluid-filled painless blisters in arms, trunk, and legs
>ecthyma- more serious; infection penetrates the dermis; causes ulceration and scarring

Assessment Findings
  1. papulovesicular lesions surrounded by local erythema which become purulent, oozing, and form yellowish-brown crusts (note: most reference books call it honey-colored crusts)
  2. spreads peripherally, most commonly found in face, axilla, and extremities
  3. lesions may be itchy; painful if ulceration is present
  4. swollen lymph nodes (if lesions are numerous)

Medical Management
  1. oral administration of penicillin or erythromycin for ecthyma or severe cases of impetigo contagiosa to avoid complications such as acute glomerulonephritis, rheumatic fever, and MRSA --> mild cases often do not require antibiotic therapy as they resolve on their own in 2 to 3 weeks with hygienic measures
  2. topical application with mupirocin (Bactroban) for a full 10 days--> use with caution around eyes; causes stinging and irritation
  3. hygienic measures --> crusts need to be washed daily with soap and water to promote healing and better absorption of topical medications

Nursing Management
  1. follow contact precautions until 24 hours after initiation of antibiotic therapy
  2. administer oral antibiotics as ordered.
  3. apply Bactroban as ordered--> use caution when applying ointment around eyes
  4. observe patient for signs of complications such as periorbital edema, decreased in urination, painful joints, and high blood pressure
  5. wash skin daily with soap and water -->will soften the crusts and help prevent secondary infections
  6. apply Burrow's solution (aluminum acetate) compresses to skin crusts -->dries weepy skin infections
  7. cover draining lesions lightly with gauze to prevent the spread of infection--> note: impetigo is spread by direct contact with lesions
  8. remove dried crusts gently
  9. provide client teaching and discharge concerning medication regimen, contact precautions, and proper hygiene
  • Instruct parents to let child finish the entire course of medication even if a child gets better. School-aged patients may return to school 24 hours after initiating oral antibiotic therapy. When applying ointment to lesions, gloves should be worn and hands should be washed before and after applying the ointment to prevent spread of infection.
  • Patient's clothes, linens, and towels should be washed everyday and should not be shared with other members of the family.
  • Encourage parents to keep patient's nails short to prevent scratching and to teach child proper handwashing technique.


Impetigo typically isn't dangerous, but may lead to serious complications if left unattended.


There is no immunity to Impetigo but it can be prevented by keeping the skin clean and healthy. Cuts, scrapes, rashes, and insect bites should be washed regularly with soap and water to prevent infection.

Telephone Reports and Orders

Nurses often communicate with physicians and other healthcare professionals by telephone. Oftentimes, telephone communication is the swiftest method of accomplishing tasks such as reporting changes in the client's condition to the physician, obtaining client data, and facilitating client transfers from one unit to another. Since there are legal risks involved when reporting or receiving orders through telephone, measures to ensure client safety should be instituted.

When reporting via telephone, the nurse must demonstrate courtesy and professionalism. It is also important to organize information beforehand to ensure that reports made by telephone are brief and clearly understood by the receiver. For instance, when reporting changes in the client's condition to the attending physician, it is prudent for the nurse to review his/her notes and have assessment data ready before placing the call. The nurse should also document in the nurses' progress notes the following: the date and time of the telephone report, the name of the physician the nurse spoke with, the data reported, and any order given by the physician in relation to the telephone report accomplished by the nurse.

Another aspect of telephone communication involves receiving telephone orders from the client's attending physician. Since telephone orders may be subject to misunderstanding and misinterpretation by the receiving nurse, the following must be taken into consideration:
  1. The attending physician determines that the client needs intervention and that telephone communication is the fastest method of communicating the medical order.
  2. Only in extreme emergency should a nurse receive telephone orders and when no resident is around to receive the said order.
  3. Telephone orders should be brief and the person receiving it should read the order to the physician verbatim. When taking medication orders, the nurse should spell the name of the drug to the physician to avoid errors. The use of abbreviations such as "U" for units and "mcg" for micrograms is also avoided.
  4. When writing down telephone orders in the physician's orders sheet, the nurse should accomplish the following: record the date and time the order was given and write the order as dictated by the physician. The nurse also signs the order beginning with a t.o. (telephone order), the physician's name followed by her (the nurse's) name and signature and the signature of another nurse who witnessed the telephone order.
  5. The nurse should ensure that the physician countersigns the telephone order within 24 hours (or within an hour for orders of seclusion/restraint or emergency psychiatric medications).
  6. For physician's orders transmitted via fax, the order should bear the physician's name and signature. The nurse should also call the physician to verify if he or she initiated the order.
  7. The nurse documents the telephone order in the nurses' progress notes immediately after the call.

To avoid misunderstanding and misinterpretation that may harm the patient, hospitals should enforce clear-cut policies regarding reporting or taking orders by telephone. Ergo, in line with every agency's intention to ensure client safety, only experienced, licensed , and duty-bound personnel should be allowed to make reports or receive orders by telephone.

An Open Letter to a Very Difficult Clinical Instructor

Dear Ma'am,

Let me start by this online letter by saying, "Good Day!", because by the time you finish reading my honest account of the kind of teacher you really are, your face will be a distorted figure of what it once was.

I never thought I would resort to this but you drove me nuts each time you showed up in class. You hurt my feelings and the feelings of the entire class with your insensitive choice of words. I remember the first time you entered the classroom (that was during my NCM 100 class), you introduced yourself as Ms. XXX, and ranted about your achievements as a student and a nursing professional. The whole class cheered and applauded you until you looked at us sternly and asked, "Are you having a good time? If you are, then nursing school is not for you. Kasi sa nursing school, pahirapan. Walang puwang sa nursing school ang mahilig sa good time!"

Ma'am, I beg to disagree. Nursing school is not a slaughterhouse. In fact, with you as a clinical instructor, nursing school has to be a no-brainer. Do you remember that day when you came to class and we reminded you on the quiz scheduled for that day and you threw a fit saying, " Ang yayabang n'yo. Saka na kayo magyabang kung nurses na kayo..." What the? It is not your students' fault that you forgot to prepare the questions for the quiz. Basing on what you said, are we right to assume that your being "mayabang" is justified by your license to practice nursing issued by the PRC?

I thought that one semester is all I had to endure and I didn't have to suffer anymore but due to a shortage in 'quality' clinical instructors (in your own words), the clinical coordinator tasked you to give us the baptism of fire during our first day of clinical exposure. I know you saw chagrin register in our faces so you had the time of your life that day. You maligned us the entire shift, commenting on how incompetent and lazy nursing students are nowadays. You yakked to the nursing staff about your offers here and abroad but since being a nursing educator in your beloved hometown is your true calling, you have to follow your heart's desire. Yakkety-yak.

I'm sorry, Ms. XXX. The whole school knows that you're a fake. You are not the model instructor you claim to be. We know that you can't even make your own lecture notes. You always borrowed Mr. XO's notes, didn't you? What self-respecting nursing educator would even do that? Geez, you can't even give a decent lecture on any nursing topic. You just give out loads and loads of requirements without even bothering to give lectures beforehand. If told that your students can't comply with the requirements as the topic hasn't been discussed yet, you always say this: " Be resourceful. I don't spoon-feed my students."

Worse, you played favorites. You gave a very high mark to that good-for-nothing jock of a classmate of mine. Why? Because you were textmates. I wonder what a movie date or an afternoon spent at McDonald's or KFC would've gotten him.

But gladly for me, I graduated from that nursing school, out of your clutches. I no longer have to suffer from the countless IRs you issued in a frenzy. I no longer have to sit through lectures which my classmates branded as "walang katuturan". It is a good thing that I took the Nursing Board Exam last June and I am confident that I did really well. And as for you Ms. XXX, well, I believe in karma. A very good friend from the nursing faculty said that your employment agency gave up on you as you flunked the NCLEX-RN exam for the third time. Good for you.

Ma'am, please do not think that I did this because you were strict. I did this because you have no idea what mentoring is all about. If you are reading this now, then you read that text message I sent, leading you to this blog in the hopes of making you realize how unfit you are for your chosen profession.

And oh, before I forget, you might as well thank me for not writing down your real name here. I was tempted to do that but goodness prevailed. Until here, Ma'am. And I hope we do not meet again.


Your Favorite Student Nurse

Note: Ward Class is very much willing to listen to the side of Ms. XXX. If you are or you think you know Ms. XXX, write to us at hodgepodgemail(at)yahoo(dot)com.

Nursing Trivia: The Patient-Centered Nurse

Faye Glenn Abdellah is a nurse researcher and educator best remembered for her efforts to transform the nursing profession from being disease-centered to patient-centered. She developed the list of 21 unique nursing problems which helped distinguish the focus of nursing practice from the practice of medicine.

Born on March 13, 1919 in New York City, Faye Glenn Abdellah earned her diploma in nursing at the age of 18. Believing that her nursing education is not enough to deliver quality nursing care to patients, she earned three degrees from Columbia University. She earned her bachelor of science degree in nursing and in 1947, her master of arts degree in physiology. Eight years after, in 1955, Faye Glenn Abdellah completed her doctorate in education.

It was Faye Glenn Abdellah who transformed the focus of the nursing profession from disease-centered to patient-centered. As a nursing educator and researcher, she endeavored to include caring for families and the elderly in the many duties and responsibilities of the professional nurse. She also advocated for continuing education in nursing, believing that a diploma in nursing isn't sufficient to prepare nurses for the rigors of the nursing profession. She was among the first nursing educators to focus on theory and research.

In 1957, Faye Glenn Abdellah headed a research team in Connecticut which successfully laid the groundwork for progressive patient care. It is through the research team's efforts that home care is now widely accepted as an essential part of long-term health care. Abdellah is recognized as the person who influenced public policy on nursing homes and it is through her efforts that standards for nursing homes has been established.

Apart from being active in nursing research and education, Faye Glenn Abdellah also served in the military, under the U.S. Public Health Service Commissioned Corps, for 40 years. She actively served during the Korean War and was the first nurse officer who became a two-star rear admiral.

In 1981, Faye Glenn Abdella became the first nurse and woman to be named Deputy Surgeon General. Under the said position, she developed countless educational materials on public health including AIDS, violence, caring for the mentally handicapped, hospice care, smoking cessaion, alcoholism, and drug addiction.

In 2000, Faye Glenn Abdellah was inducted into the National Women's Hall of Fame in New York in recognition of her efforts to improve public health and the nursing profession.

Nursing Informatics and the June 2008 Nursing Board Exams

Flashback June 1, 2008.

This blogger was lazing around and leisurely chatting with the regulars of the Pinoy R.N. virtual community (online chatroom) when an irate visitor asked the question, "What is Nursing Informatics and why did they ask us that in the June 2008 Nurse Licensure Examination?"

Having read the new BSN Curriculum which is currently infamous with most nursing schools and colleges in the Philippines, this blogger answered, "Nursing Informatics is the application of Information Technology to nursing. The New BSN Curriculum is big on this subject as they want nursing education in the Philippines to be more globally competitive. Maybe this is the reason why they included questions on Nursing Informatics in the nursing board exams." A couple of exchanges ensued on the topic at hand and the visitor left the chatroom.

End of Flashback.

What exactly is Nursing Informatics? Nursing Informatics, according to the 1999 National Nursing Informatics Project discussion paper, is the application of computer science and information science to nursing. Nursing Informatics (NI) promotes the generation, management, and processing of relevant data in order to use information and develop knowledge that supports nursing in all practice domains.

Simply put, since information is integral to nursing practice, Nursing Informatics is the application of the current advances in information technology to nursing practice. Examples of the applications of Nursing Informatics include the use of electronic health records and electronic charting, online distance learning and teaching, the use of Pocket PCs, PDAs, and other wireless devices in accessing and recording data, and the use of various softwares in nursing administration and research, to name a few.

In desiring to be really globally competitive, the Filipino Nurse should keep abreast with the current trends in nursing and information technology to be able to deliver quality and timely patient care. Thus, competencies in Nursing Informatics should be integrated into nursing education and nursing practice in the Philippines.

Looking back, this blogger has come to the conclusion that the irate visitor who asked that question wasn't really pissed off because the recently-concluded nurse licensure examination included items on Nursing Informatics or because he or she thought that the application of information technology to nursing practice is irrelevant. Rather, that person must have been flabbergasted to find out that after four years of nursing school and having spent months and thousands of pesos reviewing for the June 2008 NLE, he or she still couldn't answer questions on Nursing Informatics correctly.

So, for those who will be taking the November 2008 Nursing Board Exams, think like Forrest Gump (or was it Kim Sam Soon?) and think of the NLE as a box of chocolates. You'll never know what questions you'll be asked until you actually sit for the exams.

Unless, of course, another stupid bigwig sells handwritten cheat sheets to equally stupid takers in the fashion of the June 2006 Nurse Licensure Examination controversy (Hope not!).

Musculoskeletal Disorders: Osteogenesis Imperfecta

deformities and femoral fractures in an infant with OI

  • Osteogenesis Imperfecta (OI) is an inherited disorder affecting collagen formation and characterized by the formation of pathologic fractures
  • occurs in two main forms: osteogenesis imperfecta congenita (autosomal recessive, with poor prognosis) and osteogenesis imperfecta tarda (autosomal dominant less severe, occurs later in life)
  • severity of symptoms decreases during puberty due to hormone production and ability to prevent injury
  • classic picture includes fragile bones, blue sclera, and early hearing loss due to otosclerosis

Assessment Findings

1. osteogenesis imperfecta congenita
> multiple fractures at birth
> intrauterine fracture may lead to skeletal deformity
> soft bones of the skull
> intracranial hemorrhage

2. osteogenesis imperfecta tarda
> limb and spinal column deformities
> multiple fractures especially in the lower limbs
> hypermobility of joints
> development of dental caries

Medical Management
  1. magnesium oxide supplements
  2. growth hormone and calcitonin--> stimulates growth and promotes bone healing, respectively
  3. reduction and immobilization of fractures--> alignment and casting
  4. application of lightweight leg braces and intermedullary rods--> strengthens bones

Nursing Management
  1. ensure child safety -->raise side rails, keep floors dry, remove objects that could cause falls
  2. administer medications as ordered
  3. position child with care--> use blankets when moving child, lift child gently
  4. instruct patients in bathing, dressing, and diapering--> focusing on how to support limbs to prevent further injury
  5. provide for emotional support to parents--> parents may have been wrongly suspected of child abuse due to symptoms associated with the disease


Osteogenesis Imperfecta in very severe form may lead to death in the first year of life. Some patients may be wheelchair-bound and have shortened life spans.


Osteogenesis Imperfecta is not preventable.

Gastrointestinal Disorders: Hirschsprung's Disease

  • also called Aganglionic Megacolon
  • absence of ganglionic innervation to the muscle of a section of the large intestines, often the the lower portion of the sigmoid colon just above the anus
  • causes an absence of peristaltic waves to further the passage of stool through the affected part of the large intestines-->results in chronic constipation or small, ribbon-like stools
  • a familial disease diagnosed during infancy; occurs more often in males than in females
  • caused by an abnormal gene on chromosome 10; incidence is 1 in 5000 live births
  • associated with Down Syndrome
Assessment Findings
  • failure or delay in passing meconium within the first or second day of life
  • anorexia, nausea, and vomiting (vomitus may contain bile)
  • constipation and abdominal distension
  • ribbonlike stools (Note: often emphasized in most reference books)
  • diarrhea as only liquid can pass through impaction
  • lack of weight gain
  • problems absorbing nutrients-->leads to weight loss or growth failure
  • infections in the colon especially in newborns or very young children--e.g. enterocolitis due to fecal stagnation
  • anemia in older children--> due to blood lost in the stool
  • diagnostic test: rectal biopsy shows lack of innervation by the presence of aganglionic cells
Medical Management
  1. stool softeners--> usually given daily
  2. isotonic enemas-->prescribed to achieve daily bowel movements; normal saline (.9% NaCl) is instilled into the bowel
  3. dietary regimen-->low-residue diet with vitamin supplements
Surgical Management
  • surgery is the only proven and effective treatment for Hirschsprung's disease-->involves a pull-through surgery; the section of the colon that has no ganglia cells is removed and then remaining healthy end of the colon is connected to the rectum
  • for palliative surgery (for relief of symptoms only), a loop or double-barrel colostomy is performed
Nursing Management

1. administer enemas as ordered
  • mineral oil or isotonic saline (.9% NaCl) is used
  • never use tap water as it is hypotonic-->causes water intoxication leading to cardiac congestion or cerebral edema and resulting deaths
  • use volume appropriate to child's weight: 150-200 ml for infants and 250-500 ml for children
2. do not treat loose stools
3. administer TPN as ordered-->usually prescribed to offer another source of nutrition
4. provide a low-residue diet-->omits irritants from the intestinal tract
5. instruct caregivers on colostomy care and low-residue diet to prevent complications
  • discuss omission of milk, fried and highly-seasoned food from diet

Overall prognosis is very good. Most infants achieve good bowel control after surgery.


Hirschsprung's disease is a congenital abnormality and is not preventable.

Day 1 of the June 2008 Nursing Board Exams Over; Candidates Toughen Up for Day 2

Candidates trooped to designated testing sites for the first day of the June 2008 Nurse Licensure Examination. And as they prepare for tomorrow's final installment of the Nursing Board Exams, we can't help but wonder what's their take on the said examinations.

We have been receiving word that examinees found the first half of the June 2008 Nurse Licensure Exam really difficult. This remains to be validated, though. Still, we are optimistic for them as some of those who took the nursing board exams for the 2nd time say that the June 2008 Nurse Licensure Examination is better than last year's as to the number of typographical errors and the way the questions were formulated. Tee-hee!

On a side note, since we started this blog last April 23 (believe it or not, Ward Class is a baby blog!), part of the grand plan is to provide timely nursing-related news and updates. Therefore, as soon as the PRC releases the results for the June 2008 Nurse Licensure Examination, you will find it here in Ward Class. Just don't forget to subscribe to our mailing list by entering your email address in the space provided above.