Ward Class

An Online Resource Site For Student Nurses

Welcome

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.




Things To Remember During Operating Room Rotations

If I remember correctly, my operating room rotations were the most nerve-wracking.  During my first day of exposure in the operating theatre, I was so fidgety that I managed to break a glass syringe. I also ripped a pair of surgical gloves to the chagrin of my clinical instructor.

Although we were made to perform return demonstrations on gowning, gloving, scrubbing as well as do advanced reading on common surgical instruments before O.R. rotations, what preparation I had prior to the exposure didn't lessen my anxiety.  I was a total klutz that day and  was more than happy to assist with just one procedure.  In fact, considering how I felt during that time, I would've opted to just clean the soiled surgical instruments without thought of accomplishing my O.R. completion forms. 

Since we all know that nursing students have to compete for very limited slots in the operating theatre, it is best to make the most out of each and every rotation in the O.R. And since it has been quite sometime since my last entry in Ward Class' Nursing School 101 category, here are a few things to remember during  operating room rotations:
  • Observe punctuality.  Always report early for your clinicals.  Arriving  in the nick of time will only heighten your anxiety.
  • As much as possible, familiarize yourself with the O.R. setup and the procedure you are about to assist.  Ample preparation will boost your confidence.
  • Conduct yourself in a respectful, professional manner.  Be courteous to the O.R. staff, even to the orderlies.  
  • If unsure of a particular task, ask for guidance.  Even if you have prepared for your O.R. rotation, you might forget how to go about the most simple things like scrubbing or gloving.  If this happens, do not hesitate to ask for supervision.  Ask help from your clinical instructor or from the O.R. nurse.
  • Do not make  unnecessary comments in the presence of a patient, even those under general anaesthetic.  Basic courtesy dictates that you respect the patient, anaesthetised or not.  If possible, even if the O.R. staff engage in it, keep the unrelated social banter to a minimum.
  • Avoid bringing cellular phones inside the O.R. theatre.  Also, if you know what's good for you and the patient, you won't even consider bringing a camera inside the operating room.
  • Report for your O.R. rotation on a full stomach and an empty bladder as the procedure you are about to assist may take a couple of hours.
  • Take extra effort to hydrate yourself before the start of your O.R. rotation to reduce the risk of fainting while assisting during a surgical procedure.
  • Periodically contract your leg muscles to reduce venous pooling.  This is effective in preventing hypotensive episodes due to long periods of standing.

Microbiology: Methicillin-resistant Staphylococcus Aureus (MRSA)

Methicillin-resistant Staphylococcus Aureus (MRSA)
  • a strain of Staphylococcus Aureus, a gram-positive coccus
  • a very dangerous and easily transmitted nosocomial pathogen-->transmitted from healthcare worker to healthcare worker, healthcare worker to patient, and patient to patient
  • accounts for 40% of nosocomial staphyloccus aureus infections (note: resistant strains develop esp. in hospitals due to the large amounts of antibiotics given to patients)
  • spread by contact, usually by the hands of healthcare workers (25% of healthcare workers are suspected to be carriers of MRSA)
  • colonizes in the anterior nares, axilla, perineum, and inguinal area
  • community-acquired MRSA--> not as aggressive as hospital-acquired MRSA; susceptible to many antibiotics
High-Risk Groups for Methicillin-resistant Staphylococcus Aureus (MRSA) Infections
  • Newborns
  • Elderly clients
  • Breast-feeding women (may develop mastitis)
  • Clients with skin disorders
  • Clients with surgical incisions
  • Clients with a poor immune system
  • Clients with chronic medical illness
  • Clients with invasive, in-dwelling devices (foley catheters, IV catheters)
  • Clients in the ICU
  • Clients on prolonged hospitalisation
  • Clients on prolonged antibiotic therapy
  • Clients exposed to MRSA carriers

Tests for Methicillin-resistant Staphylococcus Aureus (MRSA)
  • urine culture
  • wound culture
  • sputum culture
  • blood culture
  • CSF culture
Clinical Presentations of Methicillin-resistant Staphyloccus Aureus (MRSA) Infections
  • Pneumonia
  • Surgical site infections
  • Line sepsis
  • Intra-abdominal infections
  • Osteomyelitis
  • Toxic shock syndrome
  • Septic Arthritis
  • Meningitis
  • Endocarditis
Medical Management for Methicillin-resistant Staphylococcus Aureus (MRSA) Infections
  • Vancomycin (drug of choice)
  • Teicoplanin (if strain is resistant to Vancomycin)
  • Bactrim, minocycline, and clindamycin
Infection Control and Prevention for Methicillin-resistant Staphylococcus Aureus (MRSA)
  • screening of patients and staff
  • isolation of patients infected with MRSA
  • use of contact precautions
  • wearing gloves at all times esp. when caring for patients with MRSA
  • meticulous handwashing after gloves are removed
  • use of dedicated stethoscope, bp cuffs, and thermometers
  • environmental cleaning
Related Nursing Download:
Mode of Transmission of Common Communicable Diseases

PRC Registration Schedule for November 2008 Nursing Board Exam CEBU Passers

Below is a copy of the PRC Registration Schedule for November 2008 Nursing Board Exam CEBU Passers.

Click Here to Enlarge PRC Registration Schedule for CEBU Nursing Board Exam Passers



Related Articles:
PRC Registration Schedule for November 2008 Nursing Board Exam MANILA Passers
Oathtaking Schedule for November 2008 Nursing Board Exam Passers
Registration Requirements for November 2008 Nursing Board Exam Passers

PRC-BON Reschedules June 2009 Nursing Board Exam

The PRC-BON rescheduled the date of the June 2009 Nursing Board Exam. The June 2009 Nursing Board Exam will be on June 6 & 7, 2009 (Saturday and Sunday). Below is a copy of the PRC- Board of Nursing memo on the updated June 2009 Nursing Board Exam schedule.

Click Here to Enlarge Document


Those who intend to take the June 2009 Nursing Board Exam are reminded that the deadline for filing of applications is on April 17, 2009.

Endocrine Disorders: Pheochromocytoma

  • a rare catecholamine-secreting tumor usually found in the adrenal medulla that secretes excessive amounts of epinephrine and norepinephrine
  • typically benign, less than 10% of cases are malignant
  • occurs in men and women, usually during the middle age but rarely after age 60
  • cause is unknown but some cases appear to be hereditary
  • complications include cerebral hemorrhage, cardiac failure, and even death
Assessment Findings
  • hypertension (may be persistent, fluctuating, intermittent, or paroxysmal)--> principal manifestation
  • pounding headaches
  • hyperglycemia and glucosuria
  • tachycardia, apprehension, palpitations
  • profuse sweating, cold extremities
  • nausea, vomiting
  • dilated pupils
  • diagnostic tests:
  1. increased levels of plasma catecholamines
  2. increased levels of urinary catecholamines and urinary vanillylmandelic acid (VMA)--> normal levels of urinary catecholamines is up to 14 mg per 100 ml urine while normal urinary VMA levels is less than 7 mg in 24 hours.
  3. presence of tumor on CT and MRI
Medical Management
  • medications are given to patients with pheochromocytoma to control hypertension
Surgical Management
  • the primary treatment of a pheochromocyoma is adrenalectomy or the removal of one or both adrenal glands (depending on tumor location)
Nursing Management
  1. monitor vital signs, especially blood pressure changes-->severe hypertension can precipitate a cerebrovascular accident and/or sudden blindness
  2. administer antihypertensive medications as ordered
  3. promote rest and decrease stressful stimuli--> acute attacks may be precipitated by emotional stress, physical exertion, and change in position
  4. monitor urine tests for glucose and acetone--> clients with pheochromocytoma may present with manifestations of diabetes mellitus
  5. for clients on 24-hour VMA testing--> instruct to avoid vigorous and prolonged exercise and intake of coffee, tea, chocolate, bananas, and vanilla-flavored food at least two days prior to and during urine collection (note: clincians may also order client to stop taking medications like methyldopa, L-Dopa, paracetamol at least three days prior to urine collection as well)
  6. provide high-calorie, well-balanced diet
  7. instruct patient to avoid smokinga nd stimulants like coffee and tea--> may influence catecholamine release
  8. for clients with an adrenalectomy, observe for BP changes-- clients are at risk for shock due to a drastic drop in catecholamine levels
  9. provide client teaching on possibility of lifeslong steroid replacement (for bilateral adrenalectomy)
Prognosis

If pheochromocytoma is discovered early, it can be usually removed surgically. Without early interevention, patients with pheochromocytoma are at risk for cerebral hemorrhage and cardiac failure.

Prevention

There are no known ways to prevent pheochromocytoma. But with early diagnosis and intervention, complications may be prevented.