IMCI Ages 1wk- 5y/o 3 Main Components 1. Improving Case Management Skills 2.

Improving Overall Health Delivery Systems 3. Improving Family and Community Health Practices Case Management Process Child 2mos-5y/o Young Infant 1wk-2mos 1. Assess child/young Infant 2. Classify Illness 3. Identify Tx 4. Treat the Child 5. Counsel the Mother 6. Give Follow up care When Mom arrives at HC 1. Note name and age of client (To know what chart to use) 2. Use color coding 3. Pag di kaya Condition Referrral form to Hospital 4. Counseling Feeding processes, etc. Assess 1. Name and Age of Client 2. Weight, Temp 3. Ask Chief Complaint (Childs Prob) 4. Danger Signs 5. Main S/Sx 6. Immunization Status 7. Assess other problems not included in IMCI Chart Main S/Sx 1. Cough/Difficulty Breathing 2. DHN/Diarrhea 3. Fever 4. Ear Problem 5. Malnutrition Color Coding System 1. Pink Severe Classification Maybe given Antibiotic IM, Parenteral Needs immediate attention and referral 2. Yellow Moderate Needs Appropriate Antibiotic/ Other Tx(RHU or HC) Maybe given Antibiotic Oral or Oresol (DHN) 3. Green Minimal/Mild No need for Specific med Tx such as Antibiotic Home Management Proper Feeding and Follow Up Danger Signs VCD Vomits everything Cannot tolerate anything per orem (if they can drink water, eatnot considered DS) Convulsion r/t current problem (if last 2yrs na hindi na DS) Difficulty Feeding Inability to suck, drink or feed Difficulty Awakening Dec LOC, Lethargic, Stuporous 2 mos 5 y/o

Pneumonia Pink Yellow Green Very Severe Disease Pneumonia No Pneumonia Severe Pneumonia Non-Severe Pneumonia Cough and Colds S/Sx 1. Danger Sign 1. Fast Breathing (except <2mos) <2 mos = > 6bpm 2-12mos = > 5bpm >1-5 y/o = > 4bpm 1. cough/cold 2. Chest Indrawing (Subcostal Retraction) 2. w/ or w/o wheezing 2. n Breathing Pattern 3. Stridor (narrowing of U airway passage) Listen for it when child breathes in *If expi-wheezing(not used in IMCI) If CI + S = Severe Pneumonia If CI+S+DS= VSD Tx 1. IM Antibiotic Procaine Penicillin- no need MDs Order <2mos200,00IU (or <5kg) 2-12mos400,00IU (6-9kg) 1-5y/o800,00IU(10-19kg) 1. Oral Antibiotic Old-5days New-3days 1.Amoxicillin BID 2. Cotrimoxazole BID (why not main choice?) 1.Resistance 2.Steven Johnsons Syndrome Abn immunity reactions (autoimmune) r/t use of Cotri and Dilantin S/Sx 1.Rashes 2. Tx Sore Throat w/ Safe remedies 3. FF2 days Cough >3days 1. Refer Child(baka ibang sakit) Alternative Parenterally 1. Benzyl Penicillin 50mg/kg q6h (if no hosp malapit q6h ibibigay 2. Gentamycin 7.5mg/kg daily Give BP and G 1 dose BP-masakit G-May anesthetic 2. Tx Sore Throat w/ Safe Remedies - Extra Fluids - Keep client warm 2. Give Vit. A dose +wheezing 3 trials of Bronchodilator 1. Salbutamol via Nebulizer/Puffer 2ml + 5ml H2(Sterile) -done q15min -after 3 trials may +wheezing padin 1.give oral antibiotic -if no wheezing 1. no need Oral Antibiotic 2.Baka Asthma lang 3. FF5 days

3. Tx/Prevent Low Blood Sugar- Breast Milk and Sugar H201 cup H2add 4 tsp of sugar If difficulty feeding dont give 4. Refer If Yellow + Pink coding = Pink except DHN yellow

DHN Pink Yellow Green Severe DHN Some DHN No DHN S/Sx At least 2 of ff: At least 2 of ff: No S/Sx of DHN 1. Abn Sleepy 1. Restlessness/Irritability 2. Sunken Eyes 2. Sunken Eyes 3. Inability to feed 3. Thirsty 4. Very poor Skin Turgor (check abdomen) (adult-lower area) N recoil 2-3 sec If >5sec very poor skin turgor 4. Poor Skin Turgor If 3-5 poor skin turgor

Tx PLAN C PLAN B PLAN A -start IVF -give Oresol in 4 hrs 1. Give extra fluids every after LBM 1. Lactated Ringers Soln - +cal <4 mos = 200-40ml in 4 hr 4mos-12mos = 400-70ml >1-2 y/o = 700-90ml >2-5y/o = 900-100ml -you can give as much as tolerated -dont use after 24 hr Infant = 50-100ml 1-2 y/o = 100-200ml >2y/o = As tolerated 2. NSS 0.(Plain) Isotonic Referral Center 1. If w/in 3min, bring to hosp IMCI 1 cup = 20ml 2. If more than 3min, manage first in HC, regulate IVF 100ml/kg FUNDA 1 cup = 24ml Infant 30ml/kg progress 7mg/kg -Modified ORS 30ml- finish in 1 hr 70ml- finish in next 5 hrs <9kg 1. If 1 cup only = 1 cup H2+ 2tsbp sugar + half tsp salt 2. If 1 L = 1 L H2+ 8 tbsp sugar + 1 tbsp Salt >1-5 y/o (10-19kg) 30ml/kg- 3min 70ml/kg- 2 hrs

Infant = 6 hrs 1-5 = 3 hrs Assess q2-3h for Improvement of condition then you can Inc regulate 2. + tolerate something = give food 3. tolerate = ORS (Oral Rehydration Salts) then NGT 20ml/kg in 6 hrs 4. Refer

Diarrhea passing out of stool at least 3x in 24 hr frequency, consistency loose watery stools Pink Yellow Green Severe Persistent Diarrhea Persistent Diarrhea 1. Diarrhea >14 days +S/Sx of DHN 1. Diarrhea >14 days - S/Sx of DHN Cause 1. Use of Formula Milk 2. Family Feeding Practice Tx 1. Tx DHN depends on classification 1. Instruct mother on feeding precautions 2. Refer client to Hosp 2. FF5 days Dysentery (Bacillary Dysentery) Blood in Stool Tx 1. Oral Antibiotic Old-5days New-3days 1. Ciprofloxaxin BID 2. Cotrimoxazole BID 2. Provide AntiHelminthic 1. Mebendazole 1 dose (500mg) -make sure client >12mos old If below = DONT GIVE -no dose given in past 6 mos, only 1 dose per 6 mos

3. FF2 days Tx 1. Zinc Supplement 14 days (2wks) Helps GIT to recover (proliferation of cells) Water Tolerated if 1-8 y/o 1ml/kg per hr

Fever A. Malaria Risk area endemic w/ malaria Pink Yellow Green Very Severe Febrile Dse Malaria Fever; Malaria Unlikely Very Severe Malaria S/Sx 1. + Danger Sign 1. + Blood Smear, Peripheral (get at peak of fever) 1. Blood Smear, other cause of fever present 2. Malaria Risk 2. No other causes of fever presents (no runny nose, coryza na baka measles lang) 3. Stiff neck Tx 1. IM Quinine 1. Oral Antimalarial Agent 1. Paracetamol q6hrs Never give if; 1. Less than 4 mos old 2. Tx not given >1wk = Cinchonism Neurotoxic, Cardiotoxic, Nephrotoxic 3. After giving, place in supine for 1 hr 4. Infant >4mos 0.6-08 ml 5. 1-5 y/o 1.0-1.2 ml 1. Chloroquine OD for 3 days 2. Sulfadoxine Pyrimethamine 1 dose only (1 day lang) 2. Tx cause of fever 2. Paracetamol q6h 3. FF2 days 2. IM Antibiotic 3. Paracetamol

4. Vit A 5. Refer Fever B. No Malaria Risk no reported Malaria case in community Pink Yellow Green Very Severe Febrile Dse Fever; No Malaria S/Sx 1. + Danger Sign 1. + Measles in past 3-6mos or at least 3mos 2. Stiff neck 2. Cough 3. Runny Nose (Coryza) Tx 1. IM Antibiotic 1. Paracetamol q6h 2. Vit A 2. FF2 days (if none, see measles) 3. Paracetamol 4. Refer All FF in yellow, always 2 days

C. Measles Pink Yellow Green Severe Complicated Measles Measles w/ Eye or Mouth Complications Measles S/Sx 1. Danger Sign 1. Pus from the eyes In past 3 mos orS/Sx 2. Cloudy Cornea 2. Stomatitis 1. Runny nose (coryza) 3. Deep Extensive Mouth Ulcers (inner cheek) expect secondary inf 2. Conjunctivitis 3. Rashes Tx 1. IM Antibiotic 1. Tetracycline Ointment 2-3x day 1. Vit A 2. Vit A 2. Paint Mouth ulcers w/ Gentian Violet 3-4x day 2. FF5 days if condition dont improve 3. Eyes provide eye care, Tetracycline eye ointment 3. Paracetamol if w/ fever 4. Provide Oral Care paint mouth ulcers w/ Gentian Violet 4. Vit A 5. Refer 5. FF2 days

D. DHF Dengue Pink Yellow Green Severe DHF DHF Unlikely S/Sx

1. Danger Sign 1. Tourniquet Test 2. Bleeding 2. Bleeding Gums Bruises 3. + Fever Blood in stool Vomitus, cough 4. Other Causes of Fever present 3. Severe Nausea/Vomitting 4. Abdo Pain Tx/ Dx Tourniquet Test 1. + Bleeding manifestation 1. Paracetamol q6h ASPIRIN (NEVER) PLAN C - IVF 2. Supportive Management 2. Bleeding Manifestation (1st 5 days) - Tx cause of Fever Grade I PLAN B 3. FF2 days 3. Refer If fever >7days; Refer the case

Ear Problem Pink Yellow Green Mastoiditis Acute Ear Infection r/t Otitis Media Chronic Ear Infection No Ear Infection S/Sx 1. Tender Swelling behind ears (painful swelling) 1. Ear Discharges/ Pus No S/Sx less than 14 days 14 days or more 2. Ear pain Tx 1. IM Antibiotic 1. Oral Antibiotics Old-5days New-3days Old-Cotri New-Amoxi 1. OTIC Antibiotics Ends w/ oxacin 1. Ciprofloxacin OTIC 3-4xday 2wks 1. Check Nutritional Status 2. Paracetamol Pain 3. Vit A 4. Refer 2. Paracetamol Ear pain q6h until pain is resolved 2. Dry Ears 3. Dry ears by wicking 3. FF5 days

4. FF2 days If <3y/o pinna down/back 3-5y/o pinna up/back

Malnutrition/Anemia Pink Yellow Green Severe Malnutrition Severe Anemia Anemia Very Low Wt. for Age No Anemia/ Not very low wt. for age S/Sx 1. Edema on both feet (ascending) (if 1 footinfection) KWASHIORKOR 1. Severe Palmar Pallor 1. Some Palmar Pallor 1. Below the 5th percentile (lowest growth monitoring curve chart 1. No palmar pallor 2. Visible muscle wasting 2. Very low wt. for age 2. Not very low wt. for age MARASMUS 3. Dec CHON,CHO,HCO Tx 1. Vit A 1. Oral Iron (Liquid) Supplements 14days Dropper 3-6 mg/kg/bwt/day 1. Instruct mom to proper feeding practices <6mos Exclusive BF 1. High Risk (mal) 2. Refer 2. FF5 days 3. Ask Immunization Status 2. FF5 days Another in 3days Start sa 1st check up in the 3days 2. 1 dose Mebendazole >12mos old (bulate) 3. FF5days Another 14thday End of supplements

1 wk 2 mos The Sick Young Infant Assess, Classify, Treat 1. Very Severe Dse/Local Bacterial Infection 2. Jaundice 3. DHN 4. Diarrhea 5. Feeding Problem/ Low wt. for age Very Severe Disease/ Local Bacterial Infection Pink Yellow Green Very Severe Disease Local Bacterial Infection Severe Disease/ Local Infection Unlikely S/Sx 1. Danger Sign 1. Reddish umbilicus w/ pus No S/Sx 2. Fast Breathing > 6bpm 2. Skin Pustule w/ pus 2. Severe Chest Indrawing 4. Fever 5. Low Temp (<35.5 C) Met. Acidosis 6. Stiff Neck 7. Sluggish Movement Tx 1. IM Antibiotic -Procaine Penicillin -HC/RHU 1. Supportive Home Care 1. Oral Antibiotic 3days -Amoxicillin -Cotrimoxazole 2. Tx Low Blood Sugar BF 3. Keep pt warm 4. Refer 2. Instruct Mom to Tx Local Infection Use alcohol

3. FF2 days Jaundice Pathologic 1st 24hr of life (sobrang bilis hemolysis) Physiologic after 24hr of life Pink Yellow Green Severe Jaundice Jaundice Jaundice Unlikely S/Sx 1. Jaundice in 1st 24hr of life 1. Jaundice after 1st 24 hr 1. - jaundice 2. Yellowish palmar area or soles 2. n palmar and soles color Tx 1. Keep Infant Warm 1. If >14 days w/ jaundice Refer 1. Proceed to next condition

2. REFER 2. Bring pt back after 1 day (if no >14days)

DHN Pink Yellow Green Severe DHN Some DHN No DHN S/Sx At least 2 of the ff: At least 2 of the ff: No DHN 1. Sluggish Movement (difficulty awakening) 1. Restlessness/Irritability 2. Sunken Eyes 2. Sunken eyes 3. Poor Skin Turgor 3. Very poor Skin Turgor Tx 1. PLAN C IVF 1. PLAN B ORS 1st 4 hr 200-400ml If able to solve no need to follow up except if condition worsens 1. PLAN A (w/diarrhea) After q LBM

Diarrhea Pink Severe Persistent Diarrhea Dysentery S/Sx 1. Diarrhea > 14 days w/o DHN 1. Blood in stool Tx 1. Tx DHN if + DHN 1. IM Antibiotic 2. If DHN, Refer 2. Refer Feeding Problems Yellow Green Feeding Problem Feeding Problem Unlikely or Not low wt for age Low wt. for age S/Sx 1. Poor Latch (BF practices) 2. < 8 feedings in 24 hrs Recommended 10-12 in 24hr BF 8xAM 2xPM 3. Wt. low for age Tx 1. Instruct Mom on recommended feeding practices 1. Praise mom for proper feeding practice (Reinforce) For making baby healthy 2. Tell mom to dec complimentary feeding and inc BF

Frequency (if no BF- bottle feeding) 3. FFif feeding prob- back after 2 days If low wt- 2days and another in the 14th day

Sick Child 2mos-5y/o Conditions Pink Yellow Green 1. Cough/DOB Very Severe Disease Severe Pneumonia Pneumonia No Pneumonia Cough or Cold 2. DHN Severe DHN Some DHN No DHN 3. Diarrhea Severe Persistent Diarrhea Persistent Diarrhea Dysentery 4. Fever Malaria Risk Very Severe Malaria Malaria FeverMalaria Unlikely No Malaria Risk Very Severe Febrile Disease Malaria Unlikely/ No Malaria

5. Measles Severe Complicated Measles Measles w/ eye or mouth complications Measles 6. DHF Severe DHF DHF Unlikely 7. Ear Problem Mastoiditis Acute/Chronic Ear Infection No Ear Problem 8. Malnutrition Severe Malnutrition Very Low wt for age Not very low wt for age 9. Anemia Severe Anemia Anemia No Anemia IM Antibiotics 1,4,5,7 Oral Antibiotic 1,3(dysentery),7(acute) CHN Levels of Prevention Entry Phase 1. Primary Promotion of Health = H.education, counseling, info. Dessimination(pamphlets) Prevent Illness Maintain OLOF Info. Dessimination mass approach mediamix strategy aka Telehealth Program 90-95% may electricity use of TV/Radio/Cellphone 2. Secondary may sakit na limit severity of dse -Fact Finding = contact tracing -Early Detection = pt suffers illness, admin meds -Prompt Treatment Screening not necessary + Ca (not Confirmatory test) TSE (M) 13y/o after warm bath every month BSE (F) 2y/o look changes from previous exam, 1wk after mens every month -TSE confirmatory Inc Alpha Feto Protein TSE HxCryptorchidism (undescended testes) -BSE kasama ang axilla sa pagcheck sa BSE most common site na makakapa = Tail of Spence

Mammography (F) 35-3y/o NC Before 1. Expect pain alleviate pain by teaching relaxation techniques 2. Suso maiipit ng 2 metal plate (vertical/horizontal) compression -Dont use any deodorant/powder or any thing baka magka false + result If may Breast Ca Hx Every yr magpa-BSE o Breast screening Trauma will not cause Ca 3. Tertiary Rehab bringing back to pre- or normal phase Prevent further complication maintain ADL even w/ disability Alcoholics Rehab Alcoholics Anonymous - individuals Al-Anon - family Alateen ranges 12-20y/o Family Planning Goals 1. Reduce Infants death Neonatal death Under-five death Maternal death Reproductive age 15-49y/o Spacing 3-5yrs for mom to recover for nutrition and edu. Prep At risk na pag 2nd birth dahil manipis na ang uterine lining Exec. Order 102 DOH Role 1. Leadership and Health Must protect rights/rehab in FP 2. Enabler and Capacity Builder Innovate new strat and program for FP 3. Admin of specific services FP METHODS 1. Female Sterilization/ Bilateral Tubal Ligation cutting of fallopian tube, no production of egg cell Single Tie reversible Double/Triple cut tie irreversible NC N vaginal spot -when next sex after BTL after 2-3days Disadv couple wanted no more child possible Adv kahit ilang sex no possibility of preggy 2. Vasectomy irreversible n SE SOB/Fainting Effectivity of sterility 6mos Sex after V after 2-3wks Complication If swollen/inflamed testes - +orchitis NC 1. Elevates testes w/ pillows (dec swelling) 3. Oral Pills contains hormones- Estro/Proges to prevent contraception Pag nakalimot pede magtake ng pills2 sa next day Pag 3 days hndi na pede magtake N wt gain Inc Appetite contraindicated pt w/ CVA dse DM thromboembolitic prob Bec. it contains E/P -causes viscosity in bld poor perfusion and circulation of bld = adds to occlusion Notify MD A bdo pain oversecretion of hormones C hest pan/SOB develop allergic response DISCONTINUE

H eadache (sudden/persistent) inc BP E ye Prob (retinal veins occlusion) Severe leg pain (thrombo) 4. Male Condom Contra Latex and Lubricant Allergy -saan dii dapat tinatago? wallet (baka magkabutas) -tip catch sperm 5. Injectibles Effectivity Depo-Povera/Medoxi 95-98% prevention N amenorrhea continuous 9mos after 24hrs of admin until 13wks 10mos + mabuntis Disadv may work punta pa HC para inject sa skin 6. LAM 6mos walang mens (amenorrhea) BF 6-8x day 7. Mucus Method Wk after mens go vaginal mucus, stretch out fertile avoid sex during peak pag kuha tanggal kagad safe 8. Basal Body temp CBQ instruction before going to bed (magpaBBT) -Get temp first Rest 30/1hr pag 1 hr nalimutan Iba pag 2-3hr 9. Syntothermal 10. Calendar Method -6 consequtive n mens flow Ex. Mens flow start at 27 and 31 days 7 days mens 2731 -18 -11 -2 fertile avoid sex 11. Standard Days method -pt n mens falls 26-32 days Use contraceptive beads Avoid sex day 8-19 Beads Red 1st day of mens (darker the safer) 27th day brown/dark brown rest period 12. Vaginal Patch, Foams, Gels Complication Toxic Shock Syndrome 6hrs prior pinapasok na pero right after di magtagal sa pepe more than 30hrs -non-purulent conjunctivitis H. Teaching - Alisin na agad un 13. Diaphragm Only contraceptive method indicated form DM -nilalagay ng professional -nakatakip sa cervix Complication PSEUrinary Tract Infection NCInc OFI 3L/more 14. Intra-Uterine Device A copper T device Main reason alters vaginal environment NC check tails after mens If dalawa nakapa at intact OK If dalawa nakapa at natanggal not Ok

PSEVaginal Spot Notify MDVague abdo pain Complicaiton - Endometritis

Note: Non-CD DM Type I Complication Acute DKA HHNK Chronic retinopathy, neuropathy, nephropathy Hallmark hyperglycemia insulin mapayat Type II OHA, Mataba N bld sugar New 60-100 Screening is FBS NC 1. NPO 8hrs 2. pede ang H2except mineral H20 Alternative HC 1. Lagundi (Vitex Negundo) Tx mild respi prob. But not respi infection -asthma, cough, fever, dysentery colds, and pain MRBronchodilator/Eases breathing (Salbutamol) PNCGive steamed H2as bronchodilator 2. Yerba Buena (Mantha Cordifelia) Tx pain MRAnalgesic 3. Sambong Tx anti-edema, diuretic, anti-urolithiasis (stress in kidney) -not remedy for kidney infection Helps to pass stones but not Tx kidney Infection -Risk for cardiac arrhythmias dahil diuretic kasi dec K (assoc. lagi sa heart) MROsmitrol (Mannitol) 4. Tsaang Gubat (Carmona Retusa) dec GI motility -Diarrhea, Stomach ache MRLomotil 5. Niyog-Niyogan -ginagamit ang seeds dito (pinapakain) Tx anti-helminthic Adult 8-10

6-8y/o 6-8 4-5y/o 5-6 Di pwede pag below 4 (metabolism purposes) NC 1. Bigyan muna ng sedative effect 2. Prevent eruptation (paglabas ng bulati) -Give Benadryl (sedate parasite) then give anti-helminthic MRMebendazole (Combantrin) If preggy give at 4th month of preggy, prevent congenital anomaly 6. Bayabas (Guava) Tx washing of wounds, diarrhea and tootache MRDebridement and Povidone Iodine SEcontamination (sa mga tuli) 7. Akapulko (Cassia Alata) Txanti-fungal Tinea Pedis Athletes Foot Tinea Flova Ring worm Scabies MRKetokenazole 8. Ulasimang Bato (Peperonia Pellucida) (Pansit-Pansitan) Txdec uric acid (liver, organ meats) MRAllopurinol 9. Bawang TxDec bld cholesterol level, Anti-HPN, Tootache MRAnti-Hyperlipidemia (Symvastatin) 10. Ampalaya Txlowers bld glucose level, DM MRMetformin Newborns, Infants and Child GoalTo reduce morbidity and mortality rates of children 0-y/o Breast Feeding Benefits To baby 1. Provides complete nutrition 2. Strengthen immune sys 3. Safety rehydrates 4. Inc IQ points If child has galactosemia bawal ang BF To mom 1. Reduce risk for excessive bld loss after giving birth 2. Provides natural methods of delaying preggy 3. Reduce risk of ovarian and breast Ca and osteoporosis To household/community 1. Conserve funds 2. Saves med. Cost to families and govt Law Milk Code EO 51 -not endorse any brand of milk product -promote BF RA 8976 child exceeds 6mos

-give STAPLE foods complimentary feeding -sugar, rice, flour, edible oil Newborn Screening Act 9288 Mandatory(lahat kelangan mag-undergo) Detect Met. Dse (mental retardation) If parent refuses it after explaining all = give refusal consent -give after 24hrs not later than 3 days -heel prick test(get bld from heel and put on special filter for screening) -2-3 days pede na result hosp -3-5 days pag community GOALGive all NB a chance to live n life 1. Congenital Adrenal Hyperplasi Sx ambiguous genitalia (not det. If girl or boy) Inc in glucose glucocorticoids Dec in salt Inc in sex androgens NC Mon BP -if left undetected no liabilities pag may refusal consent pero pag di inoffer pede magsampa kaso 2. Congenital Hypothyroidism Dec Hormones Dec LOC (Lethargy) Dec subs n temp 34-35C Notify MD -Give Zethroid Lifetime 3. Phenylketunuria inability to digest phenylalanine Low (phenylalanine hydroxylates) maintains pigmentation Leads to mental retardation NC Avoid foods rich in phenyl, meats, dairy products, nuts, egg 4. Galactosemia inability to digest galactose Food he can ear is Breast milk during Infancy but not indicated Give Soya Milk + Cataract and mental retardation 5. G6PD Glucose 6 -destruction of RBC (Hemolysis) -hemolytic Anemia -pt prone to infection Antibiotic for Life NC RBC Blood Transfusion For life EPI Obj reduce morbidity PD 996 Mandatory All NB undergo Imm Immunity state of being free from infection Types Natural Artificial -inherent in indiv. Body tissue or fluid Body able to produce antibody (AS) 2 types 1. Active Acquired Imm -Imm actual participation of the indivs body tissue on fluid 2 ways to produce AAI (Chickenpox) A. Naturally Acq.Active subclinical Imm -developed imm from previous attack of dse -body was able to produce antibody unintentionally (vaccines toxoids) 2. Passive Acquired Imm.

-presence of Antibody w/in cell 2 ways to produce 1. Naturally Acq. Pass body was able to produce unintentionally (placental transfer NB infant maternal Colostrum IgA 2. Artificially Acq. Pas given intentionally (Anti-serum, anti-toxin, immunoglobulins, Anti-globulins) Contraindications Permanent 1. Allergy 2. Encephalophatyw/o no cause of convulsion Temporary 1. Preggy women Life vaccine MMR, BCG 2. Immunosupressed pt 3. Severe pneumonia or very severe dse 4. Bld Transfusion (recent) If bibigyan, wait ng 2-3mos para bigyan Meds 1. BCG Birth deltoid part (R) birth 0.5ml (L) school entrant 0.10ml 1 dose -formation of wheal and scar -Prevent Primary TB 2. DPT 6wks DPT1 n DPT2 may seizure dont give mag-seizure kasi 3 doses 3. OPV Sabin Vaccine IPV-Salk Test for allergy Neomycin Sulfate (eggs) Inactivated PV Dont give if + allergy 4. Hepa B Mens in blood If adult na liver Ca Give Vastus Lateralis 3 doses 5. Measles 9mos SC -locally endemic area 6mos and vaccine in 15th mos. DPT, Hep,BCG +2 - +8 C Elements of EPI 1. Target Setting pop. 2. Cold Chain logistics mgnmt 3. Assessment and Evaluation of Overall Performance 4. Surveillance, Studies and Research 5. IEC Info, Educ, Comm HCDS 1. Pub. Sector trained by govt 2. Private Sector DOH Roles/Functions mandated by EO 102 1. Leadership in Health influences people 2. Enabler and Capacity Builder 3. Admin. Of specific services DOH Vision leader of health for all in the Phil Mission Guarantee, equitable, sustainable and quality health for all Filipinos Fourmula One Goal 1. Better Health Outcome 2. More responsive system 3. Equitable/Health Care Financing Elements 1. H. Financing fosters, greater, better and sustained investment in health

2. Good Governance enhances health sys. Performance 3. H. Regulation ensures quality and afford ability of h.goods and services 4. H.Service Delivery improves and ensures accessibility/availability of essential h.care Primary H. Workers 1. Intermediate -Physicians and its Assistant -PH RN -Midwives -Dentist -Rural Sanitary Inspector 2. Village H.W/BHW (Barangay H.W) -Folk Healers -Trained Hilots -TBA (Trained Birth Attendant) Environmental H. Sanitation Preventive Strategies Man to be able to attain good envi, must change peoples behavior Envi RA 9275 clean H2Act Dse Agent EPI 1. Change Peoples Participation 2. Manipulate Envi 3. Immunized Water Sanitation Program Policies Lvl1 (Point Source) safe to drink -protected well -developed spring w/ an outlet -15-25 households -not more than 250meters from farthest user -40-180L/day of H20 Lvl2 (Communal Faucet/Stand Post) -pipe distribution -outreach not more than 25 m -40-8L/day minimum of 10households Lvl3 (Waterwork System or Indiv. House connection) -urban areas (Manila-MWSS) -approved type of H2Facility Unapproved type H2from doubt sources 1. Open Dug Wells 2. Unimproved Springs 3. Wells that needs repair/priming Safe and Potable H2 -surveillance -permit from secretary of municipal Disinfection para mainom 1. Mga galling sa doubt sources 2. Newly constructed H2Supply 3. + sa bacteria 4. H2Facility that needs repair Proper Excreta Approved type of Toilet Facility

Lvl1 1. Non-H2Carriage Type H2System -di na kelangan tubig para iwash -cover lang toilet from flies -Pit Latrines, pang-cover 2. Need small amount of H2just to wash waste on receiving space -Aquaprivines -Flush Toilets Lvl2 H2carriage type connected to network distribution system Lvl3 H2carriage connected to distribution system connected to Tx Plant Proper Food and Sanitation 1. Inspection for Approval 2. Compliance 3. Certificate 4. Destruction of banning of food 5. Admin FECT -Formaline Ether Concentration Technique 6. Training 7. Rate of food establishment A Excellent B Very Satisfactory C - Satisfactory Triage sort out, outside Hosp -Establish safe environment BLS Basic Life Support ACLS Advance Cardiac Life Support START Short Time and Rapid Tx respi, circulation, mental status BEMOC Basic Emergency Obstetric Care Red critical Green ambulatory Yellow delayed Black lahat dying Pag patay na at tinakpan na NC wag aalis dahil respect Tag lower ext lagyan sa loob, takpan, lagyan pa outside Giving Instruction Green, Red, Yellow, Black Ex. Earthquake Red, Yellow, Green, Black CPR Rescuer Compression Ventilation Adult 1 30 2 Heel of palm, xiphoid process Establish airway Infant 1 30 2 1 to 2 fingers Children 2 15 2 Below nipple Jaw Thrust Good Samaritan Act Kahit wala pa ang duty pede na tumulong Chain of Survival 1st Telephone early access to emergency call 1st 3 links can be done by RN and bystanders 2nd Heart early CPR 3rd Thunder early defibrillation 4th Cross early Tx 4th trained professionals health care providers EMS Emergency medical Service

After/Onset Pag may nakita na Intervene at moment of chain of survival Dec 7-10% survival 7-10min delayed Possible brain death If Inc 10min Death Pag wala pa response in 5 cycle Tag na black Pag 3 meron na Stop na COPAR 1. Impt. Tool for comm. Devt and people empowerment 30% of total pop -basis, recommendation -prioritize based on research -teach comm. to self reliance 2. Prepares people/pt 3. Maximizes comm. participation and involvement Principles 1. People esp. the most oppressed, exploited and deprived sectors are open to change have capacity to change and able to bring about change 2. Based on interest of poorest sector of society 3. Lead to self-reliant community and society 2 Criteria -Poorest sector -Lack of services Comm. Organizing -Continuous and sustainance process of edu and people Ex. Health Teaching changing behavior -Linking w/ people mobilization w/ govt or NGO, student RN -Discover Problems Malnutrition, envi. Prob -Mobilize people become self-reliant PHC Objectives 1. To maintain self awareness 2. To form structures and process 3. Initiate responsibility action (di student RN ang kumikilos, role lang ay Community Immersion Organizer. Assistance lang) Emphasises of Comm. Org -The community works to solve their own problems -The direction is internal rather than external (identify 1st own prob in comm.. before going to next) -The development of the capacity to establish a project is more impt than the project -Consciousness raising to perceive health and med. Care w/in total structure of society COPAR PROCESS 6 phases 1. Pre-Entry establish self-awareness for comm. - most critical and difficult (dahil ditto nagstart lahat) 1. Comm. Consultation/Dialogues -Courtesy Calls BHW (Study Profile of Comm. Top 1morb/mort prob -Demographic/Geo. Profile 2. Setting Issues/Considerations r/t area selection mga magugulong site (remote area priority) - Underdeveloped area choosing of site for proj establishment 3. Preliminary Social Investigation 30% bigyan pansin alamin Top 1morb/mort prob, review of profiles 4. Networking linkages w/ govt agencies, NGO private sectors 2. Entry Phase establishing a group

1. Integration w/ comm. (1mos)/ Emviving/ Participation -Adapt life of family -Fiesta, B-day, Lamay Lifestyle 2. Coordination, dialogue, consultation w/ other comm.. org -Delegate task for promotion of health -Adults SK (Mabilis awareness) 3. Self-Awareness and Leadership Training (SALT)/ Action Planning Core Group mangunguna sa comm. for project implementation (pamphlet, meetings) 4. Sensitization of comm./Info campaign -Pamphlets, Mediamix strat, home visit 5. Continuuing Social Investigation morb/mort rates 6. Core Group Formations 1. Devt of criteria for selection of CG membes -poorest sector 2. Define roles/functions tasks of CG 3. Community Study/Diagnosis Phase 1. Selection of Research Team 2. Training on data collection methods and techniques -guide tao how to collect data 3. Planning for actual gathering data (delegate mga area) 4. Data Gathering 5. Training on Data Validation 6. Comm. Validation (confide sa previous research study) -Review of Rel. Lit -Compare sa previous 7. Presentation and Recommendation 8. Prioritization 4. Comm. Organizing Capacity Building Phase Comm. Action Phase implementation 1. Comm. Meetings gather all people 2. Election of Officers Team Leader 3. Devt of Mgmnt and Procedure (ex. Nutrition group, EPI group) delegate mga tasks for groups 4. Team Building (Action-Reflection-Action) ARA pagkain ng noodles weigh mo continue feeding If + weight gain ulitin mo 5. Working out w/ Legal Requirement 6. Organization of working committees or task groups 7. Training of comm. h. organizing officers or comm. leaders 8. Organization and training of comm. h. workers (CHWS) 9. Setting up linkages and network referral system -approved sa mga to (Rotary Club mag-assist) 10. Intervention Schemes and Comm Devt Project -vaccine, H. Promotion activities 11. Initial Identification and Implementation of resource mobilization scheme 5. Sustenance and Strengthening Maintenance Phase Outcome Evaluation or Evaluation 1. Formulation and Ratification of Constitution by laws 2. Identification and devt of secondary leaders, VIceP, Assistant Leaders 3. Setting up and institutionalization of financing skills -finance resources, solicitation for govt agency 4. Formalizing and institutionalization of linkages/networks and referral system 5. Devt and implementation of viable mngmnt systems and procedures, committees, continuing ed. Or training of leaders, comm. h. workers and comm. residents 6. Continuiing Education and Upgrading Comm. Leaders 7. Devt of medium and long term plans (bases previous study)

Laws that affect PHN RA 9173 Phil. Nsg Act of 2002 Revised edition of scope and services RA 7164 -Kelangan magIV seminar bago magIV admin RN -Pwede magtahi hanggang 2nd level skin, tissue -Practice IV w/o training (RN) -Bawal ang magtahi Scope of Nsg Responsibilities RA 6713 -Code of conduct and ethical standards for public officials and employees -Public office must be a Public Trust RA 7610 -Local Govt Code -delivery of basic health services -Decentralization services na pangDOH pede na din sa iba RA 7305 -Magna Carta for Pub.H.Workers -Social and Economic Well-being of employees RA 3573 -All CD must be reported to nearest H.Station RA 6578 -Standardized the salaries of govt employees PD 856 -Code of Sanitation Accompanied by PD 825 PD 825 -Penalty for Improper waste disposal RA 9255 -Illegitimate Children to use the surname of their father PD 651 -Birth Registration Law PD 9288 -Newborn Screening Law PD 1566 -NDCC Tetanus Toxoid TT1 Initial Protection Immediately after birth TT2 3yrs 80% At least 4wks TT3 5yrs 95% After 6mos TT4 10yrs 99% 1yr TT5 Lifetime 99% 1yr Methergine Bawal sa Eclampsia, Pre-Eclampsia, Hypertensive Pede sa persistent bleeding IMCI Preggy w/ malaria chlo, prima, sulfadoxine If may Hx ng Abortion Bawal ang home delivery dahil prone sa infection Ff3-5days preggy nanganak sa bahay Post-Partum after 6mos Post Partum Assessment Check B reast BF (firm or not) pag walang lumalabas relaxation technique, massage ulo U terus Contraction o boggy tell mom to play nipple or massage uterus B owels GI motility (during episiorapphy) B ladder Distention Catheterize L ochia E pisiotomy Transverse, Lateral, Laceration Bleeding Late Hemorrhage Retained Placental Fragment Early Hemorrhage Laceration 1st extends vagina to perineum 2nd perineal to anal 3rd anal to anal sphincter Lochia Rubra Dark red 14 and above days

Serosa Pink 10-14days Alba Whitish/Brownish 1-7days

Leadership and Management Management -Set of interactive and technical processes through w/c the efficient and effective utilization of resources resulted in the accomplishment of the objectives of the organization -Process by w/c indivs work w/ and through other people Nsg Informatics -Specialty that integrates nsg science, comp science, info science to manage and communicate data Skills for effective mgmnt Conceptual (prob. Solving) top mgmnt Human(people)skills middle mgmnt Technical skills first level Top mngmnt Responsible for setting the org. goals, objectives and policies -Nsg Director/Assistant -Chief RN/Assistant Middle mngmnt Develops necessary departmental objectives -Dept. Managers -Nsg Supervisors 1st Level(supervision)

Concerned w/ encouraging the members of a work unit to contribute positively toward accomplishing the orgs goal and objectives -Head RN -PHN supervisor of midwife w/ exception of Manila H. Dept Loc. Govt Code RA 7160 Civil Service Law PD 807 1. Recruitment and Selection of employees in govt service 2. Qualification standards 3. Personnel evaluation form 4. Personnel Discipline Disciplinary actions for 1. Dishonesty 2. Neglect of Duty 3. Oppression 4. Misconduct RA 6713 Code of Conduct RA 7041 Publication of existing vacant positions RA 6758 Salary Standardization Law RA 8344 Act penalizing hosp and med clinics to admin appropriate lnitial med. Tx and support in emergency cases RA 5901 Bed capacity BC 10and above 40hr/wk Less than 10beds, 1 mill pop 40hr/wk Less than 10beds, less than 1mill 48hr/wk RA 7305 Magna Carta for PHW Benefits duties and responsibilities RA 8282 SSS RA 8291 GSIS RA 8187 Paternity Leave act of 1996 EO 18Upholds the exercise of the right to organize of govt employees RA 7877 Anti Sexual Harrasment RA 7875 Phil-Health Nat. Health Insurance Act RA 4226 Hosp Licensure Law RA 6675 Generics Act RA 9165 Dangerous Drugs RA 9288 Newborn Screening Act RA 943Act Prohibiting Detention in hosp on grounds of non-payment Leadership Being able to influence independent and ones position on org Power Enable ones to accomplish goals Authority Legitimate power Sources of Power 1. Position 2. Ability to give reward 3. Ability to punish 4. Information 5. Personal or Referent Power Expertise

Connection Leadership Style 1. Autocratic coercive 2. Democratic participatory 3. Laissez Faire abdicating Scientific Mgmnt Presented systematic approach to the challenge of inc production Father of SM Taylor Fayol 14 principles mgmnt Weber father of theory Bureaucracy Bureaucracy Division of labor based on specialization 14 Principles of Mgmnt 1. Division of Work 2. Authority and Responsibility 3. Discipline 4. Unity of command 5. Unity of direction 6. Subordination of indiv. Interest to general interest 7. Remuneration of personnel fair and equitable sweldo 8. Centralization 9. Scalar Chain 10. Order 11. Stability of tenure of personnel 12. Initiative 13. Esprit de corps 14. Research Research Systematic collection of data for purpose of describing, explaining, predicting and controlling Nsg Research The scientific process that validates and refines and generates new knowledge that directly and indirectly influences nsg. Priorities Reasons Inductive moves from specific to general; particular instances are observed then combined into a general statement (qualitative) Deductive moves from general to specific(quantitative) BASIC vs APPLIED Basic (pure) research that aims to generate knowledge for the sake of knowledge production and theory construction, rather than for solving an immediate problem Applied (practical) research is concerned w/ finding soln to an immediate problem Quantitative vs Qualitative Quantitative researchis format objective, systematic process in w/c numerical data are used to obtain info about the world Qualitative systematic, subjective approach to describe life experiences and give them meaning Multimethod Research often used to designate studies in w/c both quanti/quali data are collected and analyzed QN vs QL Paradigm a worldview, a way of looking at natural phenomena that encompasses a set of philosophical assumption Assumptions ideas that we take for granted or accepted as being true w/o proof or verification Positivist Paradigm (Quanti) fixed or duly reality that can be objectively studied Naturalistic Paradigm (Quali) multiple interpretations of reality and the goal of research is to understand how individuals construct reality w/in their context Introduction to Qualitative Research

1. Phenomenology it is a qualitative research method used to discover and develop understanding of experience as perceived by those living experience(lived experience) Ex. Woman who lost breast 2. Grounded Theory aims to develop theories and theoretical propositions grounded on real world observations FOCUSsocial processes 3. Etnography is the work of describing culture -Participant observation observation of a group in w/c the researcher participates as a member -Emic the way members of a culture view their world Ex. RN observes RN same graduate -Etic outsiders view of the experiences of a cultural group -EthnoNsg Leininger, study of human cultures 4. Case Study involves in-depth exam 5. Historical Research narrative description or analysis of events that occurred in the remote or recent past -Hx of Restraints -Hx use of Nsg Cap 6. Qualitative, Research Process -sampling, data collection, data, analysis and interpretation takes place cyclically -tape and transverse interviews -participant observation -field notes -thematic analysis Theme recurring regularity emerging from an analysis of qualitative data Saturation collection of data to the pt where a sense of closure is attained bec. new data yield redundant info paulit ulit na 7. Prolonged Engagement the investment of sufficient time during data collection to have an indepth understanding of the group under study, thereby enhancing credibility 8. Triangulation use of 2 or more theories, methods, data sources, investigators or analysis methods in a study Outcomes Research - Research that examines the outcomes or results of pt care intervention Ex. cost benefit analysis -cost effectiveness analysis Ethics in Research 5 Rights to Human Subjects Right to; 1. Self Determination 2. Privacy and Dignity 3. Anonymity and Confidentiality 4. Fair Tx/Justice 5. Protection from discomfort or harm non-malifecence -Ethical Standards guide the efforts of researchers Nuremberg Code doing no harm Declaration of Helsinki distinguishes therapeutic from non-therapeutic research based on NC -Autonomy self determination Informed Consent implies; 1. Adequate info. About the research project 2. Understanding 3. Voluntariness Assent to agree and concur; in research reflects a lower level of understanding about the meaning of participation in a study then consent -Rights to Privacy

1. Anonymity even the researcher cannot link the participants w/ the info they provided anonymous 2. Confidentiality participants identifies will not be linked to the info they provided and will never be publicly divulged -Beneficence/Non-Maleficence 1. Beneficence implies benefits of the research to the subject participants 2, Non-maleficence means avoidance of harm or reduction of risks to the research subject -Social Justice -right to be represented in the sample -right of equal access to knowledge -right not to be discriminated against -Scientific Misconduct -is the intentional deviation from practices commonly accepted w/in the scientific community for population using conducting or reporting research Ex. Deception, fabrication, falsification, plagiarism Introduction to Quanti Research Characteristics of Scientific Research 1. Order systematic 2. Control imposing rules by the researcher to dec possibility of error and inc probability that the studys finding are an accurate reflection of reality 3. Empiricism rooted in object reality and gathered directly and indirectly through the senses 4. Generalization extension of the implications of the findings from the sample or situation that was studied to a larger population or situation 5. Rigor striving for excellence in research requires discipline, adherence to detail and strict accuracy detalyado Research Problem -is a situation that is in need of a; 1. Description 2. Quantification 3. Solution 4. Improvement 5. Alteration Criteria for evaluating Research Problems 1. Significance of Problem 2. Researchability 3. Feasibility 4. Interest to the researcher Delimitation scope of study Researcher says what it will study Replication Studies repeating study w/ all essential elements of original study intact Statement of Purpose a broad declarative statement of the overall goals of the study Secondary Source Literature Review -after reviewing empirical Lit write conceptual framework The Literature Review -overview of what is known about those variables -how those variables have been met CINAHL Cumulative index of Nsg and Allied Health Literature - commonly used index Review Rel. Lit -journals (empirical; print and electronics) -books (theoretical)

Sources 1. Primary researcher writes research article 2. Secondary writer of research article is not the researcher Critique objective, critical and balanced appraisal of research report Framework -abstract, logical structure of meaning that; 1. Guides the devt of study 2. Tested in Study 3. Enables researcher to link findings to RN body of knowledge Note -not all studies are based on a theory or conceptual model but every study has a framework -If based on a theory Theoretical Framework -If based on a conceptual model Conceptual Framework Concept -term that abstractly describes and names an object or phenomenon, thus providing it w/ separate identity or meaning Construct - self-efficacy/self-care -a concept that is deliberately invented by researchers for a scientific purpose Conceptual Framework -is less well-developed than a theoretical framework Conceptual Model -similar to theory, broadly explains phenomena of interest Theory -integrated sets of defined concepts and statements that present a view of a phenomenon and can be used to describe, explain, predict and control this phenomenon Proposition - a statement of the relationship between concepts Conceptual Map -graphically shows the interrelationships of concepts and statements in a theory Limitations -are restrictions in a study that may dec the credibility and generalitivity of findings Ex. Sample size Research Questions -is a clear, concise interrogative statement to guide the implementation of the study Hypotheses -statement of anticipated rel. bet. The independent and dependent variables -if study is descriptive, no need hypothesis -empirically testable contains study variables Types 1. Simple (1 IV and 1 DV) vs Complex(more than 2 variables) 2. Associative (collerational) vs Causal (experimental) 3. Research (alternative) vs Null (statistical) Null/Statistical Hypothesis -there is no rel. bet X and Y -used primarily in statistical testing as the hypothesis to be rejected Ex. No relationship followed by 2 variables

Research or Alternative Hypothesis 1. Non-Directional there is a relationship 2. Directional Positive/Directive, Negative/Inverse Variables -are qualities, properties or characteristics of persons, institutions or situations that vary or take on different values Independent Variable -presumed cause -Tx variable -predictor variable -manipulated in experimental research Dependent Variable -presumed effect -outcome variable -affected, influenced Extraneous Variable -is not the variable of interest to a researcher but may influence the results of a study -confounding Variable is a noun Conceptual Definition theoretical meaning Operational Definition (most commonly used) a specification of the operations that a researcher must perform to collect the required info -researcher intends to measure variable Measurement and Data Collection Research 1. Physiological/Biophysical -measurement techniques used to measure physiologic variables =objective Ex. BP, Temp, HR O2 Sat Crying episodes 2. Observational Method Observe behavior, interactions, characteristics, circumstances a. Structured Observation clear identification of what is to be observed and precise definition of how the observation are to be made, recorded and coded -parang CI checklist ng S.RN during ret.dem b. Unstructured Observation spontaneous observation and recording of what is seen, planning is minimal Overt participant/non-participant when people ya observes knows ya observe Covert participant/non-participant they dont know ya are a researcher Covert data collection Use of Rating Scale 1. Likert Scale Determine opinion or attitude of the subject, contains a # of declarative statements w/ a scale after each statement strongly agree Semantic Differential measures attitudes and beliefs -2 opposite adjectives w/ 7 pt scale bet. Them -the subject is to select one pt on the scale that best describes her view of the concept being

examined Ex. Pinoy RN askas USRN about what they feel about them Q sort the participants sorts statements into a # of piles according to some bipolar dimension -most like me_least like me -most impt to me_least impt to me Visual Analogue Scale Ex. Pain-use use pain scale Anxiety Stress Subject experiences Interviews -face to face -telephone Key Informants Interview Schedule -structured (1st to last) -semi-structured (sometimes may dagdag tanong) Interview Guide -unstructured (QandA, difference is what you have are topics lang) -double-barreled question -unstructured questions -closed ended question monthly income -open ended question Questionnaire -self admin -structured, standardized -open-ended -closed-ended Dichotomous do you agree w/ the president? Multiple choice -double-barreled no/no dalawang tanong sa QandA Interview (expensive) or use Questionnaire -Considerations -resources budget/time -literacy of respondents if illiterate - interview Focus Group Discussion (FGDs) -designated to obtain the participants perceptions of a narrow subject in a setting that is permissive and non-threatening Cognitive(very rarely used in clinic) and Neuropsychological measures -Intelligence -Aptitude -Gen. Mental Ability Content Analysis -qualitative analysis technique to classify words in a text into a few categories chosen bec. of their theoretical importance Projective Techniques -tell me a story about, method of measuring what, let you see, di clear -indivs responses to unstructured or ambiguous situations as means of describing attitudes, personality characteristics and motives of individuals Ex. Rorschach ink-blot test tintang pentel patulo sa papel pagdikit ung papel may blot Disadv 1 needs to be trained in interpreting this Tools

Validity and Reliability 1. Validity of a research tool is the extent to w/c accuracy actually reflects the variables being examined 2. Reliability concerned w/ how consistently the measurement technique measures the concept of interest Sensitivity and Specificity (Epedimioligical Studies) 3. Sensitivity ability of a screening instruments to correctly identify a case Case/Somebody w/ the disease = + maidentify na may sakit 4. Specificity ability of a screening instrument to correctly identify non-cases = maidentify walang sakit Non-case/w/o dse = Levels of Measurement in Research 1. Nominal Used when data can be organized into categories of a defined property but the categories cannot be compared 2. Ordinal Used when data can be assigned to categories of an attribute that can be ranked, degree of 3. Interval Have equal, numerical distances bet. Intervals in the scale, there is no absolute zero point 4. Ratio Highest form of measure, absolute zero pt. Research Designs for Nsg Studies Research Design -is the overall plan(Blueprint) for answering the research Non-Experimental -no manipulation of independent variable 1. Descriptive 2. Correlational or ex post facto 1. Has main objective the accurate portrayal and frequency w/c certain phenomena occur 2. Comparative Descriptive describes differences in variables in 2 or more groups in natural setting 3. Correlational/Ex post facto Purpose examine the relationship bet. Or among 2 or more variables (w/o any active interventions on the part of the researchers) Descriptive-Correlational = to describe and explore the relationship 2 examples 1. Retrospective Design(much better) A phenomenon is existing in present is linked to phenomenon occurred in the past, before the study was initiated Case Control Study research design typically found in retrospective research that involves the comparison of a care and a matched control 2. Prospective Design Starts w/ the presumed cause and then goes forward in time following the presumed effect Longitudinal designed to collect data at more than 1 pt in time

Cross Sectional it has ability to demonstrate changes over time -based on observations of diff. age or devt groups at a single pt in time for the purpose of inferring trends over time (minsanan lang) Research that are typically Non-Experimental 1. Survey self report Data are collected from samples w/ the purpose of describing pop. On some variables of interest 2. Evaluation Study Used to find out how well a program, treatment, practice or policy works 3. Process Implementation analysis 4. Outcome analysis 5. Impact analysis (usually using an experimental design) 6. Secondary Analysis data are analyzed that were gathered in a previous study 7. Methodological Studies concerned w/ the devt, testing and evaluation of research instruments and methods 8. Meta-Analysis technique for quantitatively integrating the results of a # of studies on a given topic 9. Delphi Technique method of measuring the judgments of a group of experts for assessing priorities or making forecasts 10. Participatory Action Research -research approach w/c an ideological perspective; based in the premise that the use and production of knowledge can be -research of community 11. Solomon 4group design (True experiment, least practical) R01 x 02 (experimental group 1) R01 x 02 (comparison group 1) R x 01 (experimental group 2) R 01 (control group 2) Experimental Independent(Experimental) variable is manipulated; it establishes cause and effect relationship (most powerful) bet. IV and DV under highly controlled conditions True Experiment highest form/Quasi 1. There is an intervention(manipulation) 2. There are at least two groups (experimental and control or comparison group) 3. Subjects are randomly assigned to groups Pretest01 Posttest02 Control Group Design R 01 x 02 (before-after design) R 01 02 R- randomization observation or measurement X Tx or intervention Post-test only control goup design (after-only design) R x 01 R 01 Double blind experiment experiment (such as clinical trial) in w/c neither the subjects nor those who admin the Tx knows who is in the experimental or control group

Quasi- Experimental 1. There is manipulation still ever present 2. May have only 1 group 3. May be no randomization 4. Both control and randomization may be absent Problem w/ experiments impractical, impossible, artificial Hawthorne effect a psycho response in w/c the subject change their behavior simply bec. they are subjects in a study, not bec. of research Tx Ex. Time and motion study of PHN Longitudinal malaki ang pagitan ng research Ex. Social weather station Sampling Process of soliciting a portion of the population to represent the entire population Respondents representatives Population vs Sample Population entire set of people or objects having same char Sample is a subset of a pop. Selected to participate in a research study Element/Sampling unit the most basic unit of a pop. From w/c a sample is drawn Probability random 1. Simple Random Sampling w/c is the mist basic probability sampling method achieved if the elements are selected at random from a sampling frame, table of random numbers 2. Stratified Random Sampling used in situations where researchers know some of the variables in the population are critical in achieving representatives -separate mo para mas madali 3. Proportionate Sample results when the researcher samples from different strata of the population in direct proportion to their representation in the pop. 4. Cluster Sampling (Multi-Stage Sampling) is used if the area being covered is big (the whole country) and resources are limited 5. Systematic Sampling can be used when ordered list of all members of the pop is available Non-Probability 1. Accidental/Convenience/Incidental Sampling is the selection of the most readily available persons as subjects in a study 2. Quota Sampling the researcher pre-specifies the characteristics of the sample to its representatives 3. Purposive (Purposeful/Judgmental Sampling researcher selects subjects for the study on the basis of personal judgment about the variables in the study 4. Network (Snowballing) subject that meet the sample (criteria are asked to assist in locating others w/ similar characteristics) Research Setting 1. Uncontrolled natural/field setting Ex. Descriptive/ Collerational 2. Highly controlled artificially constructed environment developed for the purpose of conducting research (Lab)

Ex. Experimental 3. Partially controlled environment that is manipulated or modified in some way by the researcher Ex. Collerational, QUASI Conduct a Pilot Study Pilot Study tests protocols, data collection, instruments, sample recruitment strategies and other aspects of the study in prep. For a larger study Before data collection 1. Research proposal approved by Ethics Committee 2. Informed Consent/Assent 3. Ensure completeness of data Descriptive Statistics used to describe and summarize data Inferential Statistics stat that permit interferences on whether rel. observed in a sample are likely to occur in the larger pop Central Tendency - a statistical index of the typicalness of a set of scores that comes from the center of the distribution of scores -Mean -Median -Mode Measures of Variations (spread of scores) 1. Range highest minus lowest score 2. Standard Deviation average deviation of all inset of data from the mean value of that considers all score 3. Percentile data pt. below w/c has a certain percentage of the values in a frequency distribution Test of Relationships 1. Chi-square -Spearman Rank-order correlation ordinal -Pearson Product moment correlation interval, ratio 2. Correlation Technique -Degree/Strength of relationship -From 0.0-0.1 Direction of rel. +Negative/Inverse Graphic Presentation Bargraph/Piegraph nominal, ordinal Histogram/Frequency Polygon/ Inferential Stat/ T test Used to compare 2 groups of people on a dependent variable Analysis of Variance (ANOVA) Used to test mean group differences of 3 or more groups Ex. Comparison of the effectiveness of the diff. instructional techniques to teach high school students about AIDS1. Film Group 2. Lecture Group 3. Control Group Statistical Significance

Results supporting the hypotheses are significant Means the result from an analysis of sample data are unlikely to have been caused by chance Internal and External Validity Internal extent to w/c the result of the study actually be attributed to the action of the independent variable External is the degree to w/c findings of the study are generalizable to the target pop(generativity) Communicate Research Findings Professional Journals Conferences Poster Sessions Journal Clubs Writing for Publication -Referred Journal prestigious Journal in w/c decisions about the acceptance Reviewed by peers (kapwa mo experts) -Blind Review di kilala ang nagrerebyu Evidence-Based Practice Integrate findings of research in nsg practice and education Strengthening Research Evidence 1. Meta analysis of experimental studies(strongest evidence) 2. Integrative reviews on experimental studies 3. Experimental studies 4. Quasi-experimental studies 5. Correlational Studies 6. Qualitative Studies 7. Descriptive Studies (Weakest evidence)

Prof Ad Hx Phases 1. Primitive/Ancient Dse due to evil spirits 2. Christianity monks, nuns cared for the sick 3. Medieval country collaborated to help one another w/ knowledge Egypt embalming and bandaging Rome housing the week Hebrews midwifery work China medicinal plants and herbal healing America hydrotherapy 4. Modern Florence Nightingale era

Florence Nightingale -born May 12, 1820 -worked Kaiserworth Hosp -opened St. Thomas School of Nsg -founder nsg work, hospital work -lady w/ lamp -hero of Crimean war -Medicine Week May 10-15 5. Technology in Nsg Millenium Nsg Advancement in Nsg Law Rule of civil conduct prescribed by the sovereign state of the country Commanding what is right and prohibiting what is wrong Purpose 1. As a guide for peoples right/wrong 2. Prevent people doing crimes 3. Protect civil right of people 4. For Justice to prevail 5. To avoid trouble, quarrel Kinds 1. Divine Laws made by God Ex. 1Commandments 2. Human Laws made by men Ex. Constitutional Administrative Political Criminal B. Private Laws Civil personal Marriages Divorces Family Life Court Venue/Place where justice is brought Kinds CFI Code of First Instant CA Court of Appeals Supreme Court Right is that w/c a man is certified to do Legal Right is a right protected by Law Summon/writ order of court to persons, suspects involved in the violation of law Warrant Search Arrest Subpoena order of court requiring a person to appear at a certain place to act as witness to enlighten a case Subpoena Duces Tecum order of court to appear at a certain time, place and bring evidence to court as needed to enlighten a case

S. w/o bringing evidence S.D.T bringing evidences w/ you = both served by police personally, not mailed Profession A calling or vocation that requires specialized knowledge, training and skills Prof. Nsg Practice of nsg w/in the meaning and intent of the nsg law who shall fora fee or salary take care of pts w/ phy, biological and social sciences Prof. Ad Growth of the whole individual and changes for better life and living Adjustment Fitting in or setting to a given situation Nsg Ethics Practice of ethical manners in the nsg. Profession Ethics Science or study of human duty or moral conflict w/c is concerned w/ the right or wrong, the good or bad Nsg Jurisprudence Dept. of law that compromises legal rules and principles affecting the practice of nsg Char. Of Nsg Prof Autonomy knowledge in Nsg Authority Skills to do nsg work Accountability answerable, responsibility for their acts and doings Altruism true, honest, loyal, committed Have specialized knowledge Have training and skills Service Motive Clearly defined Membership Classification of Nurses in General I. Accdng to type of duty Ex. A. General Duty AM/PM/NOC -Hospital, Clinic Duty B. Private Duty -Special RN -Baby Sitter -Your own Work II. Accdng to Field Nsg Ex. OB, Pedia RN, MS/CD, PHN, Psych RN III. Accdng to Prof. Status Ex. Active RN doing scope of RN work Inactivate RN not RN work

IV. Accdng to Position Held 2 Divisions A. Nsg Service Positions, most. Impt person in hosp is pt Staff RN Head RN As. Supervisor Supervisor As. Chief RN Chief RN B. Nsg Education Positions, most. Impt person in school is student CI CCAs. Dean Dean Professions Lecturers Researchers =1st/2nd yr Scope of RN Practice (RA 9173) Scope aka Intent, Core, Earmark, Coverage I. Independent Fxn do it on your own 1. Nsg Care and Supervision of pt 2. Observing S/Sx 3. Recording and Reporting 4. Doing Nsg Procedures 5. Supervision of all those doing Nsg care 6. Health Teaching and Education II. Dependent Fxn carrying MDs order Scope of Midwifery Practice (RA 7392) 1. Core and Supervision of n child bearing women from pregnancy, labor and delivery 2. Care and Supervision of n newborn infants and children Scope of Medical Practice (RA 2382) 1. Diagnosing 2. Prescribing 3. Examining 4. Operating 5. Treating Qualifying for RN Qualifications Filipino citizens 18y/o above Grad of BSN recognized school Completed Req Maj, Minor, Assist, Handle CC, Affiliated Duty all areas Good moral character Good physical health Apply at PRC Pay exam fee 900 Get board exam Pass 75% Gen. Average no grade below 6in the 5 exams Take Oath Get Registration Certificate Get Registered ID

Topics NLEX MCN CD/CHN MS Funda Psych 1st exam = if may bagsak repeat only that exam at least 3 exams ang pasado dapat, if only 2 passed exam, repeat all 2nd exam dapat 75% na ang exam na nafail sa first 3rd exam if bagsak padin dun, repeat all exam Qualifying for RN practice 1. By exam pass 75% for citizens only 2. By reciprocity aliens/foreigners -It isa reciprocal (same req) act between contries granting the same privileges as that of their own practitioner 3. By special permit BON PRC, DOH, Religious Order, H.Volunteer, Peace Corp PRC ID -renewed every 3yrs w/ continuing ed credit units of 60 -renew on birth month -annually c.ed. units 20/yr To get credits 1. Join PNA, seminar, meetings gives 6credits 2. Take Module Test Contract 1. Is the meeting of minds bet. 2 or more persons or parties to do something for the other 2. Is a Tacit agreement bet. 2 or more persons or parties to do service for the other -It creates obligation -It is binding -it is lawful -It is legal Purpose 1. For security 2. For proof of evidence 3. As a guide/reminder 4. To follow, obey stipulation of contract 5. To know legalities of contract Kinds I. Expressed -orally said -written -known to both parties II. Implied -taken for granted -presumed -understood from action -implying Essentials of a contract 1. Consent of both parties 2. Subject matter of the contract 3. Cause for w/c it is established Null/Void Contracts Wrong not effective

Defective not enforced Not Existing not valid Illegal 1. If against the law married, minor, insane 2. Does by Threat/Coercion 3. Does by deceit, falsehood 4. Not w/in the commerce of men 5. Imposing Irresponsibilities Breach of Contract Crime by not following, violation of contract Fine, adjustment both Will Declaration of a dying person as to how his property shall be dispersed of after his death Testator person making the will Decedent person receiving the property for testator Succession manner/mode of getting and receiving propriety from testator Importance of knowledge about will -To serve for the best intent of the dying person -To have legalities of wills Qualities of a Testator 1. Of legal age -18 2. Must own the property 3. Must be of sound mind of Testamentary Capacity at the time of making the will Essentials, Elements, Requisites, Requirement of a Will 1. Testator 2. Property to be given away 3. 3 witness except for holographic will 4. Date of the will last dated will. Would be followed 5. Signature of testator Kinds of will 1. Ordinary will written and typewritten by others for testator = Judge reads it sends to court 2. Holographic will special will not confirming to requirement of the law, it is a will that is purely handwritten by testator himself. No witness required Null and Void Wills 1. Testator not qualified under age 2. No Property 3. Done by threat or force 4. Done under influence of drug and liquor 5. Minor 6. Insane Felonies Acts of Omission of commission punishable by law How done? a. by fault culpa b. by deceit dulo Kinds of felonies I. Accdng to act of execution

How done? 1. Consumated Felony when all evidence are present to known doer 2. Frustrated Felony when the act was not committed for certain reasons 3. Attempted act not done but only an idea of the mind of doer II. Accdng to Degree of Punishment 1. Light Punishment few days, months, years (1-3yrs) 2. Less Grave 2 to 2yrs 3. Grave punishment a. Life imprisonment b. Death Penalty, Electrocution, Lethal dose, shooting Circumstances Affecting Criminal Liabilities 1. Justifying Circumstance act is justified right, good, does not answerable of his/her action 2. Exempting C. doer of act not answerable, not punishable Ex. Minors, insane 3. Mitigating C. acts and doings that lessen, decrease, minus, subtract, retake action punishment of doer Ex. Telling the truth, unintentionally (innocent) 4. Aggravating C. acts and doings that give severity to the case, add, increase, multiply Ex. Done intentionally premeditated acts, use of force and power. 5. Alternative C. finding others means to suit the case or office Crimes Involving Criminal Liabilities to RN Abortion Miscarriage Premature Birth Infancide Homicide Paricide killing w/in family members, kinship groups Suicide Violation of birth Illegal Detention Crimes Acts and doings against the law contrary to justice and human rights Persons criminally available I. Principal of Crime answer highest degree of punishment Direct Doer Performer Executor Perpetrator Mastermind II. Accomplice Help Assist Hide Facts Destroy FactsConceal Conspire III. Accessories Before Crime done After Crime done Have knowledge

Have idea Nsg Organization in Phil ANPHI Academy on Nurses in the Phil ADPCN Association of Deans of Phil College of Nsg ADNEP Association of Diabetes Nurses Education of the Phil ANSAP Association of Nursing Service Administrator of the Phil APDNP Association of Private Duty Nurse Practitioner NLPGN National League of Phil. Govt Nurses of the Phil CCNAP Critical Care Nurses Association of Phil OHNAR Occupational Health Nursing Association of the Phil ORNAP Operating Nurse Association of the Phil MCNAP Maternity and Child Nursing Association of the Phil MNAP Military Nurses Association of the Phil PONA Phil. Oncology Nurses Association PONS Phil. Orthopedic Nurses Society Legal Responsibilities Ex. Concerned, Accountable, Answerable, Responsible Admission of pt Operation of pt Narcotics aka Dangerous Drugs, Addictive drugs opium Abortions Charting Carryng MDs Order Burns Witness Privilege Comm. Discharge of pt 1. Well recovered 2. Home against medical advice 3. Death Criminal Negligence Acts and doings causing injury or death Kinds 1. Simple when it causes slight injury or an injury at all 2. Grave Reckless imprudence when it causes severe injury or death Test for Negligence 1. When it does not ordinarily happen 2. It is done by instruments there is causing the act 3. Somebody is responsible for the act Doctrines = Criminal Negligence 1. Res Ipsa Loquitor the thing speaks for itself 2. Respondent Superior let the master answer for its servant Let superior answer for its subordinate 3. Force Majeure is all irresistible force that is unforeseen, unexpected or naturally made -Any injury or death caused by F M, nobody is answerable, exempted from criminal liability Prudence A virtue of acting to right reason Think of priorities for the situation, use common sense Aim at prevention was not to aggrevate condition Do not panic, have presence of mind Bring/Refer to Hosp/MD

Somera Case Homicide through Reckless Imprudence = Cocaine + Adrenalin Citizenship 1. Act belonging to a given country 2. The nationality by w/c a person belongs Citizen A person naturally born in a given country A person granted citizenship of a country -Alien/Foreigner a person staying in a country but not a citizen of that country -Subject a person/citizen of a country but that country is owned by another country Doctrine of Citizenship 1. Jus Sanguines nationality of a person is determined by blood, parentage 2. Jus Soli nationality of a person is determined by soil, place of birth, location of birth 3. Election principle to choose, elect, select ones citizenship voluntarily to a country one prefers 4. Naturalization principles of adoption, adopting a person to a country if he/she meets requirements accdng to the law of that country Ex. Immigrant Taxes A lawful order paid to the govt required by law esp. for RN to obey 1. Professional Tax or Occupational Tax - P30per year to be paid on or before Jan 15 of the ff yr 2. Income Tax add all your income for the year pay to BIR on or before Apr 15 of the ff yr 3. Travel Tax P160to be paid before travelling to other countries 4. Realty Tax paid to BIR 5. Land Tax paid to BIR 6. Commercial Tax for any enterprise one have Evasion of Tax/Tax Evasion Crime if a person does not pay his/her taxes Punishable by 1. Fine 2. Imprisonment 3. Both Board of Nsg or Licensing Board for Nurses Board Examiners 1. Appointed by the office of the pres. 2. 3 year team of office, It still needed by hold-over doctrine may stay still as board examiner Hold-over = pres. Still let expired BON member to continue as long as no new one is appointed 3. There are 7 members 4. Honorarium compensation of Board Examiners Qualification of Board Examiner 1.Filipino Citizen 2.Registered RN 3.Masters Degree in Nsg 4. PNA member 5. 1yrs admin experience 6. 35 yrs above 7. Good moral character 8. Good physical health 9. Not connected w/ any nsg school or any nsg identity Duties, Functions, Powers of BON

1. To examine applicants 2. To register successful passers 3. Set and keep standards in Nsg 4. Enforce Nsg Ethics to all RN 5. Try, hear cases of erring RN 6. Revoke, Suspend Erring RN 7. Reissue revoked license 8. Interpret nsg law Qualification of Deans, Chief RN, CI Revocation and Suspension of Registered Certificate (License) -Revoke aka Remove, Withdraw, Get Back, Cancel, Suspend and stop practice of nsg Cause, Reasons, Basis, Grounds -Moral tuptitude -Immorality -Fraud -Deceit -Falsehood, including false charting -Incompetent -Criminal negligence -Malpractice PNA Phil Nurses Association =Nat. Org of Reg Nurses in Phil =Mother Org of RN in the Phil =National Org. of RN in the Phil Founded Oct. 22 1922 Founder Mrs. Anastacia Giron Tupaz 1st President Mrs. Rosario Delgado Managed by 15 Board of Director a. President b. VP c. Secretary d. Treasurer e. Auditor f. PRO PNA Chapter extension of PNA in provinces, cities and other countries PNA Magazine/Publication Phil. Journal of Nsg Address 1663 Benitez Ave, Malate, Manila PNA Hx 1st Nsg School Iloilo Mission Hospital 1906 1st Nsg College UST 1946 1st Board Exam for Nurses 1937 Objectives 1. Conduct meetings, seminars, convention for Nsg ICN International Council for Nurses - org. of all organization of nurses in the world MembersPNA joined 1929 HQ Geneva, Switzerland (Neutral country) 1. Assist National Org. 2. Disseminate info about Nsg to all members of the world 3. Conduct quadrineal convention (professional growth) Convention held q4yrs (1yr-notice, 1yr-

received, 1yr-plan, 1yr- convention) RA 539 RN week last week of oct 991 Voluntary Blood Donation 1030 Eligibility Law 1087 Rural Health Act 2382 Medical Law 2808 3/1/191 1st Philippine Nsg Law 3753 Birth be registered at LCR 3days after birth 4225 Narcotic Drug Law 4296 Hospital Licensure 5901 40hrs Labor Law 6136 IV Law RN not allowed to give IV, only if RN finished IV course or if supervised by MD 6425 Dangerous Drug Act 6758 Standardization of Salaries 6809 18 y/o is the majority age now 7305 Magna Carta for PHN 7392 Midwifery Law 7610 Child Abuse and Exploitation 7624 Promoting Iodization Nationwide(Overseas Contract Worker) 7846 Compulsory Immunization against HepB for Infant and Children below 3y/o 7876 Mandatory Random Drug Testing Law 7877 Anti-Sex Harassment 7885 Regulated Drug Donation 8191 2003- Tobacco Registered Act 8344 Penalizing Hosp Refusing pts 8423 Traditional Medicine Alternate Drug Act 8442 Promotion of Immigrant Workers 9173 Oct. 2002 Present Phil. Nsg Law Presidential Decree 79 Family Planning Law/Population Act 148 Nutrition Law 223 Creation of Law Registration/Licensing only at PRC 325 Cleanliness Drive 442 Labor Code of the Phil 491 Nutrition Program 528 Garbage Disposal 539 RN wk Last wk of Oct 595 PNA code of ethics 603 Child Youth Welfare Law = 14y/o below 651 Compulsory Birth and Death Registration Statistic Census 856 Code of Sanitation 965 Family Planning Course before Marriage 984 National Pollution Drive 996 Compulsory Immunization of children below 8y/o 6111 Medicine Law will not pay for beautification purposes EO 51 Milk Code CO 209 Family Code Terminologies 1 Mandamus Command for a higher court to a lower court Euthanasia Mercy killing Quantum Merit As much as one deserved Redress Receiving compensation for an injury Res Gestae Things done in a transaction

Res Judicata Matter settled by judgment Verbatim Word for words Motu Propio Ones own motion Placebo Mental Therapeutic made believe therapy, in reality is not Privilege Comm Statement said in good faith for the sake of justice Terminologies 2 Assault Attempt to do bodily harm Battery Unlawful body harm Bonafide Legitimate Breach Not following agreement Complainant/ Plaintiff One accusing in court Respondent/ Defendant Person being accused in court Litigent Any person involved in a court case Slander/ Oral Defamation/ Detraction False statement to destroy ones reputation Libel False accusation in writing Donato Mortis Causa Gift in anticipation of death Duress Unlawful restraint Forgery Deceitful/fraudulent/tampering of records and documents Perjury Telling a lie while under oath in court Misdemeanor Misbehavior move/misconduct People and their Contribution of health Hippocrates Father of Meds Joseph Lister Father of Surgery William Harvey Blood Circulation Jonas Salk Polio Vaccine Albert Sabin Oral Polio Vaccine Robert Koch TB genes Alexander Fleming Penicillin (algae) Rene Laennec Stethoscope Madame Curie Radium Therapy Crawford Long Chloroform Anesthesia Morton Ether Anesthesia Linda Richards 1st trained RN in America Lystra Gretta Formulated Nightingale Pledge Clara Barton American Red Cross Society Sofia Palmer 1st editor of American Journal Lilian Wald PH work Marian Sims Father of Gynecology Soranus Ephinus Father of Obstetric Asklepiades Father of Psych Christian Bernard 1st heart surgeon Code of Ethics 1. Nurse and Practice 2. Nurse and Profession 3. Nurse and People 4. Nurse and Co-worker/Colleagues 5. Nurse and Society/Community 5 Fold Responsibilities of RN 1. Promotion of Health 2. Restoration of Health 3. Prevention of Illness

4. Promotion of Spiritual envi. Of Pt 5. Alleviate Sufferings Bill of Rights of Pt 1. To receive respect and efficient care 2. To have continuity of care 3. To know his diagnostic 4. To refuse meds/tx 5. To know his bill (hospital) 6. To have privacy 7. To have consent if used for research, experiment/study 8. To have secrecy of Tx and health condition 9. To know hospital rules and regulations 10. To be heard Application Letter Format Short Sized Coupon Bond Margin 1 inch in sides/top 1. Purpose 2. Introduction of Self 3. Edu. Qualification 4. Experiences 5. References Personal Interview 1. Appointment Date, Place, Time 2. Attire - Simple 3. Behavior - Ethical 4. Thank Officer/Interviewer Curriculum Vitae outline of ones personal data and achievement 1. Biodata 2. Hx Sheet 3. Fact Sheet 4. Resume Resignation Letter give time 3days or 1 month before resigning and leaving job 1. Purpose 2. Effectivity of Resignation 3. Reasons for Resigning 4. Thanks and Gratitude CGFNS Commission on Graduate Foreign Nsg School 1. Apply to CGFNS office Philadelphia USA 2. Fill up CGFNS forms (2 forms) 3. Pay exam fee payable at CGFNS Philadelphia Bank Draft 4. Wait approval paper w/ date,place,seat no. TOEFL Test for English Foreign Language TSE Test for Spoken English NCLEX National Council Licensing Exam same as state board

Communicable Diseases Precautions accdng to CDC 1. Universal (Standard) -use all PPE (before) -avoid all types (body fluid) #1 blood except sweat 2. Transmission-based 1. Airborne 2. Droplet 3. Contact Airborne Droplet Contact MO Measures LT < 5um (microns) MT >5um Transfer >3ft LT <3ft 5 Dse associated 1. Measles 2. TB 3. Chicken Pox 4. Bird Flu 5. SARS All other respi dse not under Airborne 1. Diphteria 2. Pneumonia

3. Pertussis 4. Meningitis Avoid 1. Skin to skin contact Direct(direct touching) Indirect(via inanimate obj) 2. Enteric Precaution -feco oral NC 1. HCP PPE Mask w/ N-95 1. HCP Disposable Mask 2. Pt. going out room Surgical Mask 2. Pt. going out room Surgical Mask Pt no mask sa loob ng room Rashes 1. Varicella Chicken Pox 2. Variola Small Pox 3. Rubella Measles 4. Rubeola German Measles 6. Roseola infantum MOT/Causative agent Unknown Causes rash forming dse that lasts 24hrs then rashes mysteriously disappear 5th Dse Hungarian Measles SKIN 1. Measles Rubeola CA Morbilivirus (under Paramyxovirus) IP 8-13days MOT Airborne S/Sx 3Cs of Measles Catarrhal Stage (Contagious) 1. Cough 2. Coryza 3. Conjunctivitis PS 4. Kopliks Spots white blue rashes w/ red base -inner cheek only (found here) 5. Rash (distribution) -cephalocaudal(head to toe) varicella distribution central peripheral 6. Measles 7 days vs G.Measles 3days 7. Crust Formation PC 4-5days (communicable) before rash or 5th day all lesion, crust dried up, crusted Most communicable stage 4-5days b4 rash appearance = Catarrhal stage 2. Mumps Infectious Parotitis CA Paramyxovirus -can spread in blood = Viremia Complications of Viremia causes Sterility M orchitis(inflame testes) F oophoritis NC M 1. Inflammation Cold Compress Orchitis advice tight fitting underwear (Counteract effect of gravity) 3. Chickenpox Varicella CA Varicella Zoster Virus

MOT Airborne -causes 2 type of dse manifestation depends on age Di magkakapox ang adult Pedia Adult C.Pox Shingles (Herpes) Distribution from Central peripheral Lesions unilateral follows single line Rashes Midline to outwards ext Rashes are clustered (samasama) Lesions Unifocular each lesion, rash has central focus and occur singly (di magkakatabi) Itchy Itchy and painful NC 1. Pain 4. Rubella Causes CRS Congenital Rubella Syndrome -bawal magpa-vaccine at magka G. Measles 5. Chicken Pox Dx Tzanck Smear Culture of the lesion Same as herpes kasi pinches lang

6. Scabies CA Female Itch mite Sarcoptes Scabiei Skin to skin contact M Genital Area F wrist and breast PS Leaves burrowing tracks burrows under skin Appearance of thread like tracks under the skin NC Pediculoside -give PM after bath, b4 putting clothes -Kwell/Lindane Lotion -the whole family must use dahil communicable dse Pediculosis pubis like infestation 7. Leprosy Aka Hansens Disease, Hansens Bacillus Chronic dse of the skin and peripheral nerves CA Myobacterium Leprae MTB BCG MOT Droplet and Contact IP 9mos-20yrs PC 1 week S/Sx Early LEPROSY Late LATES L oss of skin Sensation E xtremities Paralysis P ainful or thickened nerves R edness of eyes O bstruction of nose S kin color changes Y our ulcer do not heal L arge Breast in male Gynecomastia A chronic ulcer; Contractures T oes, Fingers clawing E yebrows thinning(Madarosis), Cant close Eyelids (Lagopthalmos) NC Artificial Tears S inking nose bridge(Saddle nose) PS Leonne Face Lions Face Dx Skin Slit Smear

Paucibacillary 6-9mos non-infectious (mild type) TIP Tuberculoid indeterminate di pa halata Multibacillary 24-30mos infectious LBM Lepromatous Borderline may Sx CHN MDT Multi Drug Therapy Accdng to RA 4073 Anti-Leprosy Law R ifampicin Red orange secretions D apsone 1st line antibiotic DOC Photosensitivity L amprene/Clofazimine Skin discoloration (dark) Leprosy under CH2 2 types Paucibacillary Intermediate Tuberculoid Multibacillary L epromatous B orderline 2 drugs used Day 1 Supervised dose RHU 2 Day 1 RHU RDL 3 Day 2-28 Sa bahay kukunin 27 Day 2-28 House D,L 54 Day 1 Day 2 Rifampicin Dapsone Dapsone Only Rifampicin prevent resistance given every month Every 28 days go back to RHU for another round Pt not communicable after 1-2 wks Prevention 1. BCG 2. Healthy Lifestyle DERS Diet Exercise Rest Avoid Smoking Prevent Complication 1. Compliance 2. Protect against infection STD/GUT 1. HIV/AIDS Chances viral load 90% getting AIDS via bld transfusion 0.1-0.5% via sex 0.1-1% via needle stick injury 60% vertical transmission mother to baby MOT Sex = #1 (anytime) Inc in repeated sex CA Retrovirus HIV AIDS Pre-AIDS Post-HIV Happens first Happens 2nd - S/Sx + S/Sx Lab Dx 1. ELISA screening 2 + results 2. Western blot confirmatory 1 + 1. HIV + CD4 LT<200/ml 2. + opportunistic infection (Candidiasis) Tx no Tx, meds only AZT Azidothymidine Nucleoside reverse transiptase inhibitor =halts viral replication NC 1. Routine Screening of babie of HIV+ mothers 2. Isolation and Quarantine Diet 1. Vit/min

2. no fresh fruits/veggies (may bacteria) 3. no fresh flowers 4. Bacteria-Free Diet 5. bawal magbigay ng glass of H2under 5min Regular Consultation q2-3mos AIDS is Pandemic 2. Genital Warts CA HPV Human Papilloma Virus Types 1 and 3 neck warts 6 and 11 Genital warts PS Cauliflower-like formation in vagina -risk of 70% Cervical CA HPV Vaccine Gardasil age limit 9-26y/o HPV Pain Dysuria Dypareinia painful sex due to painful lesions 3. Syphilis CA Treponema Pallidum bacteria (spirochete) IP 1days 1wks 3 stages of Syphilis Primary Secondary Tertiary Chancre genital area -painless, moist lesion -after 2-6wks it disappears Condylomata Lata anywhere in body most contagious stage -mere touch can transmit -Alopecia -sore throat Gumma Lesions -CNS affected, NeuroSyphilis -lost control of sanity (insane) Dx 1. VDRL Venereal Dse Research Lab Screening Test 2. FTAgAbT Fluorescent Treponemal Antigen Antibody Test Confirmatory Test Tx Pen G(Penadur) isang area na tinuturukan lang ay Gluteal area Pen IV Syphilis gluteal area lang Rabies bawal sa pwet NC Contact Tracing list of sexual contact past 6mos Gonorrhea CA Nisseria Gonorrhea MOT Sex S/Sx M Dysuria F Asymptomatic Sx pag may cervix damage na Tx Erythromycin Tetracycline Circulatory 1. Kawasaki Dse MOT Unknown Generalized vasculitis(inflammation) (disruption in coronary artery) Viral infection S/Sx 1. Irritability affects CNS MT>2mos no need to notify 2. Strawberry tongue 3. Coronary Arrtery Abnormality 4. Rashes palms, soles, desquamation of hands 5. L Congestive Heart Failure SOB RCHF- anasarca

6. FVE 7. Inc temp spiking temp lasts for 5days -hypertermia 5 days straight Dx 1. PE strawberry tongue (shares w/ Scarlet Fever) 2. ECG Arrythmias (dec bld in coronary arteries) Tx 1. ASA (Aspirin) =ASA + flu = STOP baka magkaReyes Syndrome 2. Gamma Globulin 3. Corticosteroids Trivecta 3 mosquito vectors that transmit dse Aedes Aegypti Anopheles Flavirostis Aedes Poecilus AM PM (Duration 6pm-6am) (Peak9pm-3am) -wucheraria bancrofti -filarian worm -man made (tires,mineral bottles) -dengue -stagnant -nature (streams,rivers) -malaria -shifting mosquito -filariasis/elephantiasis PS pooling of lymph fluid Lymph fluid accumulates 2. Malaria MOT Plasmodium falciparun, vivax, ovale, malariae Via blood borne, needle, bite (IMCI Bld. T) 3 stages 1. Cold/Chill 2. Hot 3. Wet/ DIaphoretic Plasma destroys RBC membranes -collects bld. Plasma is in circulation Plasma removes from RBC infecting others Sweating Dx Malarial Smear pag ditto nagkuha not clear result NC Nutrition is impt Tx 1st line Chloroquine (not this anymore)NEW Artemeter - Lumefantrine 3. Dengue Aka Dandy, Breakbone DHF CA Dengue Virus Type I,II,III,IV -Onyonyong Virus Korea -Chikungunya Africa -Flavivirus Grades Manifestation I Fever II Massive Bleeding III Circulatory Collapse IV Shock Hypo,TachyP,TachyC Dx 1. Torniquet Test count GT/equal >2inc square 25cm 2. Guiac Occult Bld Test Confirmatory NC 1. Bleeding controlled dec platelet 2. Pain cold compress 3. Fever NO aspirin (dec platelet) TSB 4. Diet avoid dark colored foods interfere w/ Guiac Test 5. Mosquito Precautions RESPI 1. Pertussis

PS Whooping Cough CA Bordetella Pertussis via Droplet Catarrhal Most contagious -Mild fever and cough Duration 1-7days IP 1-7days Paroxysmal 4-6wks -most dangerous dahil ditto ang PS Whooping cough -multiple machine gun couhing + vomiting Saan naririnig ang cough? Inflow of air Complications 1. Rupture of Capillaries (sobrang lakas ng pag-ubo) -Subconjunctival hemorrhage = pagiyak ng dugo katulad sa shaken baby syndrome Convalescent/Latency Most serious compli of Pertussis at this phase - Bronchopneumonia NC 1. Stimulus dec (loud noises, fear, dust, smoke, pollen) 2. Bronchopneumonia provide w/ croup tent/mist tent 3. Fluid Precaution 4. Droplet Precaution 5. DPT give DT only Tx for both Dip/Per Ampicillin Penicillin Erythromycin 2. Diptheria CA Corynebacterium Diptheria Droplet PS Pseudomembrane Diptheria Toxin (Eats CHON) CHON destroys byproduct sludge formation IP 7-10days 2 most common 1. Pharyngeal 2. Laryngeal -classical sign Bullnecks appearance (only appears in Phar no in other) inflammation of cervical lymph -ps- pseudomembrane appears - killer diphtheria -connection to trachea (occlusion=Anoxia=DEATH) Tx for both Dip/Per Ampicillin Penicillin Erythromycin Complication Toxic Myocarditis -travels to systemic too 3. Tuberculosis TB Via MTB Mycobacterium Tuberculosis AM AFB (done AM only) B4 Breakfast, gargle plain H20 S/Sx Triad Sx Afternoon Afternoon fever hemoptysis sputum w/ blood and wt loss PM Night sweats Dx 1. CXR det. Extent of lung damage 2. Mantoux(PPD) det. Exposure, past/present TB 3. Sputum AFB communicability 4. Sputum Culture confirmatory test, best test RA 1135 Anti TB law Tx - DOTS Dosage SE Rifampicin 450 Red orange secretiom Hepatotoxic (Jaundice)

-give vitB6 Pyridoxine) Isoniazid (INH) 300 Peripheral neuritis Pyrazinamide 500 Hyperuricemia Inc uric acid NC give Allopurinol Ethambutol 400 Optic neuritis Streptomycin 1g Ototoxicity (ears) TB R Lung madalas affected (apex part) Shorter, wider R Lung lage una tinitignan Category I II worst III IV Classification Sputum + + lesion in lungs Tx Failure Relapse (bumalik TB) Sputum Minimal Lesion Resistant Di na magamot Intensive Phase RIPE 2 mos RIPES 3 mos 1st 2 mos RIPES Last mos RIPE RIPE 2 mos Refer to DOST facility Continuation Phase (Maintenance) RI 4 mos RIE 5 mos RI 4 mos

Sputum Exam Hemoptysis fresh blood TB (can happen in Pneumonia) Rusty Pneumonia (no pul.edema = stiffness lung consolidation- matigas lung dahil sa old dried up blood) Gelatinous Bronchitis Pinkish Pulmonary Edema White, Frothy Asthma 4. Pneumonia Accdng to CHN Categories 123 New Cases Severe/Cavitary Relapse Old Cases/ Not so severe Intensive Maintenance Intensive Maintenance Intensive Maintenance RRRRRRR IIIIIII P PPEP E EE S DOTS 2 phases Intensive/Maintenance -no ototoxicity (no Streptomycin) -no optic neuritis NC 1. DIET Inc CHON, cal (repair and energy) 2. Rest no exercise program 3. Airborne 4. Tx/ - S/Sx Prophylaxis + PPD

= INH 4-6mos If DOTS complete AFB q2mos for 1yr 6x CXR q6mos for 1 yr 2x 2 Classes Typical 80% Atypical 20% Living being cayses -Staph Aureus hosp acquired -Strepto Pneumoniae community acquired Inanumate lipid Pneumonia -Aspiration Pneumonia -Broncho Pneumonia CNS 1. Meningitis Inflammation of the meninges CA Staph Aureus N flora of skin enters via fractured clavicle easiest to break and easy portal of entry Strep. Pneumoniae Starts URTI travels Eustachian tube to middle ear infection Myo.TB Skeletal Potts Dse CNS TB meningitis Haemophilis Pneumoniae Neisseria Meningitidis Most dangerous CA of Meningococcemia MOT Droplet Bacterial meningitis mas worse than viral DIC Dessiminated Intravascular Coagulation only occurs in Bacterial Dx CSF Analysis det bacteria in CSF PS Hemorrhagic Skin Rash S/Sx CNS 1. Seizure 2. Inc ICP/Cerebral edema 3. Nuchal Rigidity 4. Stiff neck/ pain w/ neck flexion 5. Hemo. Skin rash/ DIC Tx 1.Rifampicin + Aq. Pen G = DOC Prophylaxis Tx 2.Dilantin + Pheytoin = Anti-Convulsant 3. Diazepam Musc. Relaxant 4. Mannitol Diuretics Meningitis affects CN VIII FF care Lab exam after meningitis - Audiology Testing Position 1. Side Lying Fetal 2. C Position open subarachnoid space 3. Shrimp Pos PNC 1. After Flat on bed 6-8 hrs prevent spinal headache DIC 2 Things that happen Clotting Bleeding 1st to happen 2nd to happen Inc PT, PTT, Fibrin Dahil ubos na Fibrin DOC Heparin Anticoagulant Counteract cause of DIC 1. Vit K

Prothrombin Factor II 2. Converted to III bec. of thromboplastin 3. Becomes Thrombin 4. #3 facilitates to Fibrinogen 5. Fibrin (clots) Rate of Prothrombin depends on Vit K amt Kea naginject ng vitk IM Vastus Lateralis Timeframe Prothrombin time 11-12sec Fibrin to Fibrinogen PTT 60-70sec INR (International Normalized Ratio) 24sec - max allowable time 175sec If 1 hr na PT = Bleeding Tx that prolongs PT Tx that prolongs PTT Pinapatagal/pinapataas production Warfarin/CoumadinAntidote Vit K Prothamine Sulfate 2. Tetanus CA Anaerobic Pasture Clostridium Tetany Puncture wound GT>2cm (no O2 in inner musc) S/Sx. PS 1. Spasm of masseter musc Lock jaw 2. Clenching of jaw Risus Sardonicus 3. Arching of back Ophistotonus 4. Flexion of U ext, Extension L ext Decorticate 5. DEATH

3. Polio Infantile Paralysis CA Poliovirus via feco- oral/droplet Resp Paralysis Most dangerous So magbigay ka pa Morphine dapat wag na Morphine NO bec. of SE of Resp Infection 4. Rabies CA Rhabdovirus PS Hydrophobia Negribodies via dog Observe 10-14days of dog dies submit to lab Rig Rabies Ig -bawal iinject sa gluteal Verorab Imovax Rabipur Rabuman GIT 1. Hepatitis Viral

A Infectious Hep B Serum Hep C Post-Transfusion Hep D Defective Hep cant survive above in host, needs previous HepB E Enteric Hep G Post-Hemo Dialysis IP HepA 2-6wks HepB 6wks-6mos Prognosis HepB Bad, shorter lifespan, chronic liver dse Patho 1. Inflammation of Liver congested liver, so di nakakalabas unconjugated bilirubin so lalabas sa systemic circulation 2. Conju/Unconju Bil (n yellowish/greenish color) goes to systemic skin, eyes, GIT, CNS S/Sx Skin jaundice Itch is caused by bile salts Eyes Icteric Sclera Renal bilirubinuria (kidney tea colored urine) GIT alcoholic stools grey colored stool CNS Hepatic Encephalopathy If Inc CHON = bacteria converts to NH4 goes to liver BUN Crea kidney = urea If may hepa liver compromised, NH4 build up goes to brain, toxic effect = Hepatic Encephalopathy PS Asterexix flapping tremor of hands NC 1. Rest 2-4mos liver regenerate, marked fatigue and tiredness Diet Acute Chronic Inc CHON(liver regenerate) Inc CHO Moderate fats Dec CHON Butterball diet Liver fails (Giordano Giovanetti) = kidney failure Blood A. RBC 90-12days B. If it dies Goes to spleen graveyard breaks down to Hgb C. Hemoglobin Heme = ferritin granules (iron) Globin = albumin (CHON portion) Bilirubin 1. Unconjugated Bilirubin 2. Conjugated Bilirubin Indirect Bil. I Direct Bil. II N body 0.8mg/dl D. unconjugated Bil transports liver = Glucoronyl Transferase becomes converted conjugated(inside liver) E. Conjugated Bil. Goes to common bile duct F. Intestine = bacteria = stercobilin = turns feces to that color n brown 2. Helminths Worms 7 worms Spread 1. Hook Ancylostoma Duodenale + Schisto Skin 2. Thread Stromyloides Steroralis Penetration 3. Pin/Seatworm Enterobiusvernicularis #1 transmit doorknob 4. Whip worm Trichuris Trichuria Via feco-oral route except pinworm (acquired also by inhalation) 5. Round worm Trichinella Spiralis

6. Giant Intestinal Round worm Ascaris Lubricoides 7. Tape worm Taena salium pork -saginata - beef PS Pinworm Nocturnal Pruritus Ani anus itchiness in night Ascaris Vomitting, passing out worms S/Sx 1. Abdo pain/enlargement 2. wt. loss 3. malnutrition 4. voracious appetite early 5. loss of appetite late (pag nag-grow na worms) Dx 1. Direct Fecal Smear -Scotch tape test (kato-katz) Pinworm and Schisto NC 1. Advice pt to go at (AM early) Habang di pa naliligo ang bata (para di pa nawash anus, para di matanggal eggs) Tx Metronidazole AntiHelminthics - Protozoa 3. Schistosomia CA Schistosoma Japonicum MC in Phil Enters body via snail vector Stages Lifecycle 1. Pupil 2. Myracidium Vector-snail onchomelania quadrasi 3. Cercaria Skin penetration in man PS Foot area itching aka Swimmers Itch S/Sx Bloated abdomen DOC Praziquantel/ Fuadin Conjunctivitis Prone to those who uses contact lens kahit walang infection namamaga OB Bag non dominant hand How many ft, above the ground = 3ft above ground (bec. of #1 bacteria in community = Clostridium Tetany) Umbrella dominant hand Black, non-folding Flexion of hand 30-45 avert stray dogs If crossing River Lagay sa ulo Umbrella ihook sa kwelyo sa likod ng damit Dapat sterile ang OB bag BP ap nasa labas OB Acetic Soln Proteinuria Benedict Soln Glucose Tetanus Neonatorum 1 Anytime at birth Primary Dose 2 4wks 3 5-6wks 1st booster 4 1 yr 2nd booster 5 1 yr 3rd booster If mom has FIC (Fully Immunized Child) DPT1,2,3 Next to take in TT is TT3,4,5 Pediatric AIDS AIDS Dementia Affectation of CNS of indiv

Food Poisoning 1. Salmonella 2. Staphylococcus (aureus enterotoxin) 3. Clostridium Botulinum deadliest 1 ug can kill 1people, most heat resistant of all 4. PSP Paralytic Shellfish Poisoning IP 1. Rich in CHON (egg) 6-8hrs 2. Rich in CHO 2-6hrs 3. Found in canned goods 8-36hrs 4. Found in seafood (baked tahong) 30min Typhus Fever Typhoid Fever RMSF Rocky Mountain Spotted Fever CA Rickettsia Rickettsi Akari Tsutsugamushi Salmonella Typhii Wood Tick Dermacentor Anderson MOT Via bites of fleas and ticks Feco-oral PS Rose Spots

Anatomy Neuro BRAIN R hemisphere L hemisphere R/L connected by corpus callosum Fxncoordinates fxn of R and L brain R brain I ntuition C reative Thinking A rtistic L anguage M ath W riting 4 Divisions Frontal Parietal pinakataas ulo Temporal gilid ng tenga Occipital batok TMo Paa TEMOTION Thoughts Memory Moral Behavior Movement Panlasa/Taste Pandama/Touch Panlugu/ Spatial Orientation Tenga/Hearing Elong/Smelling Memory Emotion Vision Cerebellum below Cerebrum 1. Postural Adjustment 2. Balance/Equilibrium Brainstem 1. Midbrain 2. Pons 3. Medulla 4. Locus Ceroleus 5. RAS Reticular Substantia nigra Main producer of dopamine (melanin) Bridge bet. Midbrain and medulla, cerebrum and cerebellum Decusation of pyramid = why R side of brain controls L side Produces norephineprine (Stress/Anxiety/

Impulsitivity) Activating System Responsible for Awakening and Sleeping Pag namutla depigmentation Resp center Inc CO2 Stimulant Screening device for stimuli Dec. dopamine = Parkinsons Dse Partially controls BP and HR

Limbic System Hyppocampus, Thalamus, Amygdala, Hypothalamus Hyppocampus Amygdala Thalamus Hypothalamus -emotional arousal Memory Emotion Activities Sensation Temp regulation Appetite control Endocrine Fxn Sexual Drive Impulsive Behavior Anxiety Dec GABA

Exanthem Skin Enanthem Mucus Membranes Enanthem Exanthem Disease Measles German Measles Chicken Pox AKA Rubeola Rubella Varicella CA Paramyxo/ Morbili Virus Togaviridae/ Rubi Virus Varicella Zoster S of Infection Nasopharyngeal secretions Same Vesicle painless (If herpes painful) MOT Airborne Droplet IP 1-2wks 2-3wks 2-3wks PC 9days 12days 7days 4 days before appearance of rashes, 5 days later nakakahawa na 7 days before rash, 5 days later nakakahawa na 1-2 days before onset of 1st vesicle and 6 days after S/Sx Start na parang may trankaso PS Koplicks Spot (3rd molar) - bluish lesion and red areola in center then raso appears (nakakahawa na) Lymphadenopathy then rashes Forsheimers Spot macules on soft palate Clear macule, papule (like dewdrops on a rose petal) Crust/scab Pattern Rashes start from back of ear, face to body going down Cephalocaudal +High Grade Fever Cephalocaudal

Rashes are confluent (dikit dikit) Centrifugal Konti sa mukha Tx Preventive Ok lang late wag lang early 1. Immunization 9mos (or 6mos if there is epidemic) AMV 1 dose, 5ml SC 1. Rubella Vaccine 1. Varivox MMR Measles, Mumps Rubella (Antigen) 12-15mos NC check for allergies (eggs/chicken/feather/ Neomycin) 2. Resp. Isolation (airborne) 3. Darken the room (photophobia, conjunctivitis) 4. Antipyretic High fever 2. Avoid sick and those who receive MMR (preggy moms) 2. Calamine Lotion (itchy) Cornstarch or Baking Soda + warm H2apply to skin (dry lesion) = cant cause scars 3. Cut fingernails short and apply mittens 4. Acyclovir slows down multiplication Complication POE 1. Pneumonia MC 2. Otitis Media 3. Encephalitis most fatal but rare 1. Congenital Cataract 2. Mentally Retarded 3. Heart Defect PDA PIES1. Pneumonia 2. Impetigo severe bacterial infection (Staph) Causes severe scarring + Honey Crusted Lesion 3. Encephalitis 4. Secondary Bacterial Infection - MCC Incubation Period Prodromal Period of Illness Convalescence Time it takes from entrance of MO to 1st S/Sx appearance Non-Specific S/Sx and impending attack of disease Pathogneumonic Sign Recovery Vaccination BANCO DE ORO Admin Route Dosage BCG Birth ID 0.05 BCG - 2 (under 5 and preschool) Hep B Birth IM 0.5 DPT 6,10,14 week IM 0.5 Hep B birth 0,6,10, OPV Oral 2-3gtts 14 week AMV mos SC 0.5 MMR *Mumps Measles Rubella 12-15mos Varivox 12-18mos EPI Program of BCG under 5 1 dose Ideal Vaccine above 5 2 (pre-schooler) If b.wt less than 2kg give additional Hepa B in the 10th week

Pedia Anthropometric Measurements N HC 33-35cm CC 31-33 cm Length 50-55cm Wt 2500-3500g Kelan magequal ang HC and CC = at 1 yr Kelan nagdodouble length/height = 4 y/o Kelan nagdodouble wt x2 = 6mos Kelan nagdodouble wt x3 = 1yr Kelan nagdodouble wt x4 = 2 yrs Contraindication of Vaccines Temporary Permanent -pt are 1. Severe Febrile Dse 2. Immunocompromised (Steroids) (Renal Transplant dahil sa Steroids) 3. Recent recipient of bld product 4. Pregnancy 2 vaccines that can be given a. Tet. Toxoid b. HepaB (the rest wag na) 1. Allergy if allergic bawal sa Flu egg Hep bakers yeast MMR eggs, aminoglycoside neomycin IPV neo/streptomycin Immunity Cell Mediated Humoral T cells Killer cells Suppressor cells Helpers (CD4) T-helper cells recognize dse B cells -Antibodies -Immunoglobulin -B cells produces antibody -Ig If may AIDS it attacks T-Helper cells Cannot stimulate B cells no Ig Production That is why they are at risk of opportunistic infection Opportunistic Infectons 1. Orovaginal Candidiasis # 1 infection 1,2,3 AIDS determining illness kung meron silang 3 infection eto na sure na + talaga 2. Herpes Zoster 3. Kaposis Sarcoma 4. Myobacterium Avium Complex PTB MAC Bird drops(fungus) pt needs further lab analysis MTB Airborne(bacteria)pag may PTB - AIDS Ig Immunology G 2nd type of Ig that react during infection/ cross placental barrier A Secretory Ig/ mucus secreting cells/ tears/ saliva/ colostrums M 1st type of Ig that react E Inc during parasitic infection/ allergy D Unknown Asthma Inc IgE

Types Natural Artificial Passive Active Passive Active Ab Ag Ab Ag 1. Placenta 2. Colostrum 1. Exposure 1. Ig Lab prep serum Ig 2. Lahat ng may anti-prefix (except AMV only) 1. Vaccines 2. Toxoid Isolation Quarantine Separate pt from outside environment (mass populace) During PC During IP Strict Reverse Protects Others -Diptheria -TB -Meningitis Pt AIDS Cushing Epidemiology Sporadic Seasonal Leptospirosis(rainy), Paralytic Shellfish Poisoning(Xmas Season) Epidemic Sudden Inc Meningo(Baguio) Endemic Constantly Present Malaria(Palawan) Pandemic Worldwide AIDS

Vaginal Secretions Yellow Gonorrhea Pinkish Chlamydia Greenish Trichomonas Vaginalis Cheesy/White Candidiasis/ Moniliasis Blood Mens, PID(Pelvic Inflammatory Dse) Painless Syphilis Dark Red and painful Abruptio Placenta Bright Red and painless Placenta Previa Coronary Artery supply blood to heart itself -pooling of bllod -regurgitates back to lungs Septic Shock Only shock w/o HyTATA Inc PR RR Dec BP Temp Tumataas temp DPT w/in 24 -convulsion/seizure -if crying (may problem) Diptheria Toxoid Pertussis subunit ability to cause CNS damage Tetanus 6,10,14 If 10th wk na DT na lang

Virulence Ability to stay/longer in body If inc resistance of MD against Antibodies of host so mas tatagal sila #1 Nosocomial Infection UTI (#1 cause is E.Coli) -acquired during hospital stay -48hr after admission to 30days of admission -if 15hrs may sakit na di ito Nosocomial NC 1. Avoid bathing in bath-tub(bawal moisture) 2. Cotton underwear (white) irate area, discern what color -if not may distortion sa color para alam what color lumalabas Phenylketunuria Blue eyes Dec phenylalanine hydroxylase Coz it converts phenyl to tyrosine become melanin So pag Dec Blonde hair Blue eyes Pag Inc Mentally retarded Jaundice Physiologic Pathologic After 1 wk w/in 1 wk Cataract - color perception/cloudy vision = red, green Glaucoma - peripheral vision/gun-barrel/tunnel vision Age Related Macular Degeneration - central vision Retinal Detachment Visual floaters/ flashes of light Cold Compress Hot Compress w/in 24 hr After 24 hr Blood Solid Fluid Component Component 45% 55% 93% H27% Vit/Min WBC RBC Platelet Dec Leukemia Dec Anemia 2 types 2 types Myegenous Lymphocytic Genetic Nutrition Adult only Pediatric only Dec Nutrient AML CML ALL CLL IDA PA FADA Immature Mature Immature Mature Iron Def. Anemia Pernicious Anemia Folic Acid Def An Dec Fe Dec Vit B12 Dec Vit B9 -chubby but pale baby -inc milk in diet (milk-poor source of iron) -recent gastric surgery -IF (Intrinsic factor) Mawawalad di mauutilize vitB12 -alcoholic, chronic, lactating, preggy, dec green leafy veggies NC 1. Inc FE PO/IM

PO before meals + orange juice IM Z tract 1. Inc Vit B12 Deep IM No PO walang IFC kahit kain ng B12 no effect padin 1. Inc green leafy veggies

Receptacle Coding Yellow Infectious Black Gen. dry wastes, non-biodegradable Green Wet, biodegradable Red radioactive Histoplasmosis Capsulation TB like S/Sx if pt lives inold houses due to bird droppings CA Fungi Tx Amphoteracin B Parenteral Itraconazole - PO Pain expansion NC 1. Chest Binder -pillow in affected lung lie affected area Contagious Dse Easily transmitted Decerebrate extensionUext,flexionLext Mas malala Decorticate flexionUext,extensionLext Glasco Coma Scale NR non-reactive Eye 1 NR 2 pain 3 voice 4 spontaneous Verbal 1 NR 2 inaudible(incomprehensible, di maintindihan) 3 inappropriate verbal response 4 disoriented 5 oriented Motor 1 NR 2 Decerebate 3 Decorticate 4 Withdraw from pain 5 Localize Pain (point out pain) 6 Obeys 3 dont save >7 coma 8 50/50 > awake 13 save OPV Sabin Vaccine PNI 1. Causes VIP Vaccine Induced Polio (Live Vaccine) -splashes of soln gets to hands of RN -touches immune pt (may finger na ganun) NC RN handwash NPO pt 30min

Anti-Cholinergic Lomotil -palpitation -dec BP -urinary retention

PSYCH NSG Therapeutic use of self MAIN TOOL Assist individuals, family, group or community Both sick and well Art Science Therapeutic use of self Self Awareness Theories used Core in Psych Nsg Joyce Travelbee Human to Human Rel. Virginia Henderson 14 basic needs Mental Health state of equilibrium. Social/emo/ psycho Mental Illness alteration in mental health Mental Hygiene science deals w/ measures regarding levels of prevention Factors Affecting Mental Health 1. Individual Genes, ability to achieve, max potential 2. Interpersonal Ability to communicate w/ others, help others, balance bet. Being separated and connected w/ others 3. Environmental Social factors Criteria - PRAISE 1. Positive attitude and self awareness 2. Reality Perception 3. Autonomous Behavior 4. Integrative and Capacity learning 5. Self Actualization 6. Environmental Mastery Early signs of Failing Mental Health Prolonged Anxiety Depression Sudden Change

Poor Performance 2 Major RF in Mental Illness 1. Poverty 2. Violence/Abuse

History 1. St. Mary of Bethlehem -1st Hosp. for the insane 1300-1600 2. Philippe Pinel asylum (protection, sanctuary) William Tuke - York Retreat 3. Dorothea Dix opening of 32 state hospitals 4. Freud Psychosexual/social/analytical 5. Emil Kraepelin classify mental dse 6. Paul Eugen Blueler coined schizophrenia 7. Psychototropic Drugs a. Thorazine (Chlorpomazine) 1st drug invented b. Lithium c. Imipramine(Tofranil) Community Mental Health 1. Deinstitutionalization depopulating of state mental hosp 2. caused revolving door effect coming in and out hosp Decade of Brain Research 1990 Xray, MRI, CTScan invented 1. Linda Richards 1st trained Psyche RN in USA/ 1st Directress of Mclean 2. Mclean Hosp Massachusets 1st Psyche RN Hosp in USA 3. Nsg Mental Dse by Harriet Bailey 1st Psyche Nsg Book 4. Johns Hopskins School of Nsg 1st school to include Psyche in Curriculum 5. Hildegard Peplau 1st Psyche RN theorist, Interpersonal model 3 Divisions of the Mind/ Level of Consciousness 1. Conscious focused on awareness, thoughts, perception, feelings, emotion NOW present in mind 2. Subconscious divided into 2 A. Preconscious memories, thoughts, emotions you can remember at will B. Unconscious never recalled, largest part, evil site of negative sight Id EGO (balance) Superego Pleasure Reality Conscience Sexual impulse Mature adaptive behavior Regard for rules Morals, values, ethics Develops at birth 5-6 mos 6 y/o Infants Toddlers Preschool/School Age =Antisocial =Mania

=Narcissistic =Schizo =OC Clean Obedient Organized Personality develops w/in 1st 6 yrs of life

Growth and Development Age Stage Gratification Psychosocial 1. 0-18 mos Infant Oral Mouth Trust vs Mistrust Smoker, alcoholic, chewing gum, binge eaters =Paranoid Personality NC 1. Dont have multiple care giving in baby only 1 to develop T vs M 2. 18mos 3yrs Toddler Anal Bowels Autonomy vs Shame and Doubt Holding on or letting go Prone to injury, gaya gaya, curious Negativism = OC Toilet Training relaxed. Wait for readiness Ok Independence Bad Anti Social Strict OC TOY push and pull Identify own needs 3. 3-6 y/o Pre-school Phallic Genitals Initiative vs Guilt Not indicated for circumcision, due to Castration Anxiety (fear of mutilation) Gender Identification and Genital Awareness Penis Envy Oedipus(boy to mom) and Electra(girl to dad) Complex Temper Tantrums School Phobia =Exhibitionist NC Circumcise before 3 or after 6 Castration Complex pag nasugatan feeling lahat lahat laman loob lalabas NC Cover with gauze or band aid NC Orient sa ari pag boy pakitang boy NC Ignore Behavior, Set Limits NC Send to school immediately 4. 6-12 y/o School Age Latency Industry vs Inferiority Institution of Superego Control of instinctual impulses School activities Competitive Cooperative I love you teacher

=Anti social (group games) NC Sexual energy diverted to play, SPORTS Divert Attention/Distract 5. 12 Young Adult Genital Reawakening of sexual drives If child ask what contraceptive used Crushes Menarche 1st mens Telarche breast budding Girls mature first Masturbation/ wet dreams n as long as not preoccupied(di nakakaapekto sa ADL) NC Ask if sexually active NC Love and Attention

Developmental Models Age Psychosexual Freud Psychosocial Erikson Cognitive Piaget 0-12 Oral Trust vs Mistrust 0-2 Sensorimotor 1-3 Anal Autonomy vs Shame and Doubt 2-7 Preoperational 3-6 Phallic/Oedipal Initiative vs Guilt 6-12 Latency Industry vs Inferiority 7-12 Concrete Operational 12-18 Genital Identity vs Role Confusion 12 - Formal Operation 18-25 Intimacy vs Isolation 25-65 Generativity vs Stagnation 65 and above Ego Integrity vs Despair Piagets Stages of Cognitive Development Age Stage 0-2 Sensorimotor Sense of being separated fromthe environment 2-7 Preoperational Expresss self w/ language 7-12 Concrete Operational Classify object 12-adulthood Formal Operational Abstract Thinking Age Plays Fears Infant Solitary Stranger peak 8mos range 6-8 Toddler Parallel Separation Anxiety Preschool Associative Mutilation School Age Competitive Dark, Ghost Adolescence Peer Pressure Age Psychosexual Freud Erickson Psychosocial Devt

0-12 Oral Trust vs Mistrust 1-3 Anal Autonomy vs Shame and Doubt Finger foods w/ variety - independence 3-6 Phallic Initiative vs Guilt 6-12 Latency Industry vs Inferiority Allow child if it volunteers on chores Dont help in assignments 12-18 Genital Identity vs Role Confusion 18-25 Intimacy vs Isolation 25-60 Generativity vs Stagnation Generate Self to a more productive community Most productive stage of life 6and above Ego Integrity vs Despair May mapagmamayabang Classification of Mental Illness Neurosis No reality Problem, Personality Intact All other dse are N except for 3 Psychosis - worse Reality Problem, Personality Loss Schizo-Catatonia, Mania, Dementia = not intact w/reality Axis 2 Personality Dis/ Mental Ret Axis 1 All other Dis Joharis Window represent how we perceive ourselves and others Open Social Mask Public Image Blind Cracks on the social mask Private Secret Zone Close ? Area of Unkonwn 1. Purpose make this larger and larger Open everything you know and others know about you 2. Blind you dont know others know Increase Self Awareness 1. Introspection Meditate, Contemplate 2. Discussion 3. Enlarging ones exp 4. Role Playing Crisis Response to hazardous events and is experienced as painful state Mobilize powerful reactions to help the person alleviate the discomfort, return to state of equilibrium Dec Coping Skills Lasts4-6wks Intervention6-8wks Resolved6 months Goal 1.Ibalik sa Pre-crisis state, OLOF RN active and directive Nsg Dx Ineffective Individual Coping

Types SAM 1. Situational rape 2. Adventitious/Social natural calamities, catastrophe 3. Maturational/Developmental expected painful events, DEATH, easy to cope Ex. 25-26 n age magasawa 65 age of retirement If age 14 nagasawa situational If age 58 nagretire - situational Classification of Family CrisisNDx Ineffective Coping 1. Dismemberment only Loss of family member 2. Accession New addition to family 3. Demoralization Degrading 4. Demoralization plus Dismemberment/accession or combined

Crisis Intervention 1. Authorative More ideal Rendered by good training (psychologist, social worker with training) Suggest plan of action 2. Facilitative Be w/ friends offer support Phases Phase 1 Initial or External Precipitating Rise in tension in response to initial aspect Phase 2 Intermediate or Perception of Threat Inc in anxiety in response to initial impact Pt may cope or resolve crisis Phase 3 Major Disorganization Failure of coping or no soln occurred S/Sx appear and theres is Inc disorganization Phase 4 Mobilization of Resources Resolution r/t pre-crisis functioning Functioning at a higher level, much better or stronger person than before Functioning at the same level NPR Nurse Patient Relationship Pre-Interaction Orientation Working Termination 1. Self Awareness 2. Review of Records 1. Trust Building 2. Mention Termination 3. NDx 4.Role Clarification 5. Self Disclosure (make yourself known) 6. Maintain Confidentiality 1. More/most/longest therapeutic phase 2. Identification/Resolution of problems

3. Flirtation/ Lateness 4. Transference Pt to RN 5. Countertransference RN to Pt 1. Gradual 2. Regression 3. Grieve/Sadness n reaction NC explore feelings 4. Review all learned 5. Refer to agency Therapeutic Comm. Indispensible tool used by RN Establish mutual rel. w/ pt. and help cope w/ problems Guidelines 1. Establish Rapport 2. Encourage pt. to verbalize feelings 3. Avoid asking with WHY 4. Avoid CLOSED ENDED questions (yes/no) 5. Avoid verbalizing your judgment, personal opinions 6. Focus on non verbal comm. Most Common Therapeutic Comm Techniques 1. Using Silence 2. Provide General Leads 3. Being specific rather than general 4. Open Ended Questions 5. Using Touch 6. Restating or Paraphrasing 7. Seeking Clarification 8. Acknowledging 9. Presenting Reality 10. Offering self 11. Focusing 12. Reflecting 13. Summarizing Non-Therapeutic Comm. 1. False Reassurance 2. Giving Advice 3. Rejecting 4. Belittling 5. Probing 6. Overloading 7. Use of clichs and jargons Classification of Mental Illness Neurosis No reality Problem, Personality Intact All other dse are N except for 3 Psychosis - worse Reality Problem, Personality Loss Schizo-Catatonia, Mania, Dementia = not intact w/reality Axis 2 Personality Dis/ Mental Ret Axis 1 All other Dis Defense Mechanism unconscious way to defend self from anxiety A. Narcissistic Defenses

1. Denial refusal to admit unacceptable behavior 2. Projection blaming somebody else 3. Identification mimics other behavior done consciously - conscious patterning of self from a respected person (Idol) Common- Toddler 4. Introjection mimics behavior but done unconsciously - incorporating values and attitudes of others B. Immature Response *12-18 Adolescence 1. Fixation result of premature termination of early devt stage 2. Conversion person develop psych S/Sx 3. Introjection 4. Passive-Aggressive Behavior 5. Regression return into an earlier developmental chase in the face of stress 6. Schizoid Fantasy C. Neurotic Defenses 1. Displacement discharging pent up feelings to less threatening object 2. Dissociation separation of painful feelings and emotions from an unacceptable situation/idea 3. Rationalization most common DM, scapegoat. Proves behavior are justifiable 4. Intellectualization focus on factual aspect, logical explanation of intellectual concepts w/o feelings (higher than rationalization) 5. Reaction Formation expressing behavior that is the exact opposite of unconscious feelings 6. Repression unconscious forgetting 7. Sexualization indulge in sex Dissociation Like temporary amnesia Overly abused Suppression Conscious forgetting Alam kunwari nakalimutan (sadya) Repression Unconscious forgetting Alam mong may nakalimutan (di sadya) Mature Defenses 1. Anticipation act before prob comes 2. Compensation overemphasizing strength to cover weakness 3. Sublimation out of something unacceptable you make it acceptable 4. Suppression 5. Undoing when you do something bad do something good Clinical Manifestation of Psych Dse Disturbances in Thinking Similarity Differences NC Common 1. Flight of Ideas Both jumps from 1 topic to another RN can find connection Seek Clarification Refocus Manic 2. Looseness of Association RN cant connect Schizo 3. Fantasy Systematic Disensitization/ Guided Imagery 4. Phobia 5. Obsession 6. Delusion

Disturbance in Perception 1. Macropsia malaki sa original size 2. Micropsia maliit 3. Hypochondriasis misperception of 1 Sx as worst problem 4. Illusion stimulus 5. Hallucination no stimulus Disturbance in Speech 1. Neologism new words 2. Verbigeration persistent repetition of words 3. Perseveration 1 answer to many questions 4. Clang Association rhyming of words 5. Word Salad sudden outburst of words 6. Echolalia Repetition of words, imitation 7. Aphaxia inability to speak

Disturbance in Affect - Schizo 1. Inappropriate malungkot pero Masaya 2. Flat same emotions to all 3. Apathy severe reduction 4. Depersonalization Dissociative 5. Derealization - Disorder 6. Ambivalence 2 opposing motivations (natatawa at naiiyak) Disturbance in Motor Activity 1. Echopraxia Imitation, assume same position 2. Waxy Flexibility (schizo Catatonia) NC check pulse, reposition qh, skin integrity 3. Compulsion repetitive action (handwashing) 4.Tic involuntary musc twitching 5. Ataxia - loss of balance 6. Apraxia loss of action Nsg Dx Altered Thought Process Pag may delusions na Ineffective Individual Coping Confused, disoriented Anxiety Headache Initial Manifestation Anxiety vague(Malabo) feeling of dread Fear afraid of specific object Stress highly individualized MILD MODERATE SEVERE PANIC 15-30min 1. Inc VS/ Sweating 1. Selective Inattention 1. Narrowed Perception 2. Inc VS 3. Chest Tightening 4. Palpitations 1. Personality Disorg. 2. PEAK1mins NC 3 S 1. Safety remove from stimuli 2. Sit

3. Stay remain w/ pt Selyes GAS General Adaptation Syndrome Alarm Resistance Exhaustion AutismDx 2 y/o S/Sx 1. Echolalia 2. Interpersonal Skill 3. Repetitive/ Spinning Bottles (paulit ulit) 4. Clean Appearance 5. Tantrums Headbang, ayaw ng cuddle during it NC - Safety, Give Helmet 6. Delayed Reaction 7. If nahospital NC bring security blanket(transitional toy) DOC Haldol Tantrums Ritalin Stimulants NC 1. Promote Socialization 2. Maintain OLOF Meds Goal 1. Prevent further regression 2. Provide adequate nutrition ADHD Dx 7 y/o prob in brain focus S/Sx 1. Dirty looking 2. Inattention 3. Hyper 4. Impulsive 5. Unfinished Activities *2-4 NC Safety DOC 1. Ritalin 2. Dexedrine SE GIAG rowth Suppression I nsomnia A ppetite Suppressor NC Give from AM to 12 nn only After meals Mental Retardation IQ less than 70 NC 1. Repetitive/slow in giving instruction 2. Restructure environment/ Mileau Therapy Eating Disorders Anorexia Bulimia 85% only ideal body wt.

Amenorrhea 3 mos Defense Mech Suppression (appetite) Denial Binge/Purging Slightly underwt. Or slightly overwt. Binge - In 2 hrs, 8 cal, in 24 hrs, 50,00cal Purge - vomiting, laxative, diuretic Tonsils red and inflamed Risk for Esophageal Tears Dec enamel Dental Caries =Metabolic Alkalosis Inpatient Pagpasok ER dehydrated Primary NC Nutrition, Rehydrate Most Impt Goal Insight in Eating Prob NC A. Weigh. pt 1. In AM same time 2. Wears light clothing 3. After Voiding 4. Done B4 Meals 5. Check Hands/Pockets (nakatago pampabigat) B. Dont let pt go to CR after eating (may purge) NDx 1. Altered Health Maintenance 2. Altered NutritionLess than body req. Anorexia 3. Altered NutritionMore than body req. Bulimia 4. Body Image Disturbance Tx 1. Family Therapy 2. Behavior Modification Tx 1. Behavior Modification 2. Diary/Manual writes thoughts Alcoholics -fixated oral stage -long term abstinence -last intake of alcohol (severity of withdrawal) 4-1hrs, Peak - 2nd day Delirium Trements near the RN station NC 1. Room well lighted Alcoholics Def Mechanism DRIP Denial Rationalization Isolation Projection Korsakoffs Psychosis RACK (def vit B1, B12) Wernickes Psychosis COAT Antabuse (Disulfiram) R etrograde Amnesia A nterograde Amnesia C onfabulation K orsakoffs C onfusion O pthalmoplegia A taxia T hiamine Mouth wash

After shave Lotions Cough Syrups Vinegar Cooked w/ wine Suicide Male successful Female more attempts (has outlets) Elderly first attempt successful, no use to live Nsg Dx HarmSelf Directed RF SAD PERSONS Sex Age Depression Previous Attempt Ethanol Abuse (Alcohol) Rational Thinking Social Support (lives alone) Organize Plan Number of Losses Sick (Med. Condition) RF Phil 1. Poverty 2. Abuse Physical/verbal/drugs 3. Neglect RF USA 1. Genetic Trait Depression Loss of loved ones, old age, Caucasian Warning sign 1. Giving of valuables 2. Changing of mood. Depression to Happiness Energy to execute suicide, enjoys the last minute NC 1. Restructure no strings, bottles, glasses, sharps 2. 1:1 RN:Pt 3. Near RN station 4. Visits are irregular, bulagahin 5. Remind pt w/ contract NO Suicide Contract Not commit suicide in institution Battered Wife Syndrome Cycle(paulit ulit) Tension Building Acute Battering Honeymoon session Honeymoon Session M Undoing F Hope Husband Wife Violent Family (Role Playing) Low Self esteem Dependent Influenced by alcohol/drug NC 1. Provision of Shelter 2. Report to Womens Desk Violent Family (RP) Low Self Esteem

Dependent (much dependent) RAPE No consent Oral, vagina, anal 50% knows the attacker, home Defense Mechanism 1. Calm intellectualization 2. Refuse to talk - repression Causes 1. Power Trip 2. Anger 3. Sadist ER 1. Offer yourself 2. Avoid Touching 3. Never leave during PE Major responsibility -Preservation of Evidences Schizoprenia -char. by bizarre thoughts, behavior, movements, emotions Hx Dementia Praecox coined by Morel Schizo split prenia mind coined by Bleuler + M/F Schizo =35% + Schizo son F- M+/F+ M= 35% /=35% - M/F = 1% + Schizo If 35% no stress = - Schizo If 1% w/ stress = + Schizo Type A personality more prone, dies early than Type B; competitive 4 As of Schiz 1. Autism preoccupation of self 2. Affective d/o 1Flat showing no facial expression 2Blunt showing low/little facial expression 3Restricted showing only 1 facial expression used by paranoid NC NO jokes/humor 4Incongruent facial expression kabaligtaran 5Broad -showing wide range of affect 3. Assosiative Looseness Walang katuturan Hoarding kung ano ano ang kinukuha para kolektahin 4. Ambivalence having 2 opposing feelings +Sx/Hard Sx - Sx/Soft Sx A llucinations D isorganized thinking D elusions Flat A nhedonia P overty of speech/ little amount of words w/o meaning A volition/apathy lack of will/motivation 3 Major Types Onset S/Sx DM NDx NC 1. Paranoid Abrupt -Suspiciousness -Sense of Reference Projection Harm-Others Safety Nutrition 1. Food Served sealed 2. Proximics 3-4 ft 3. Avoid Touching 5. Avoid Laughter/Whispering

RN Formal/Business Type - Develop Trust by Consistency 2. Catatonic Acute -Abn motor behavior-No movement -Waxy flexibility aka Catalepsy Repression RN Circulation 1. Reposition 2. Give pt enough time to rest/exercise 3. Nutrition 3. Disorganized Insidious -Bizarre behavior -Poor prognosis, -Disorganized speechand movement -ADL suffers Regression Impaired Social Functioning 1. Assist in ADL 2. Nutrition 3. Boards and Calendar arrange, remind pt everyday Other Types NC 1. Undifferentiated - Manifests signs of PDC 1. Depends on what it manifests 2. Residual - Medyo ok biglang babalik w/ Hx of Schizo Etiology 1. Genetics Identical twins 50% fraternal twin 15% biological parent 15% 2 BP 35% 2. Neuroanatomic glucose met, 02 supply, dec brain wt 3. Immunologic schiz precedes viral infection 4. Neurobiologic most acceptable, inc dopamine Tx Anti-Psychotic, ETC (Catatonia) DOC Antipsychotic 1. Typical Dopamine Antagonist targets + Sx 1. Haloperidol (Haldol) 2. Chlorpromazine (Thorazine) 2. Atypical Both Dopa/Serotonic Antagonist targets +/- Sx 1. Clozapine (Clozaril) 2. Resperidone (Resperdal) 3. Ariprazole (Ablify) Anxiety Disease Anxiety Somatoform Dissociative 1. Panic 2. GAD (Gen. Anxiety Dis) 6 mos NC assist in ADL 3. PTSD (Post Traumatic Stress Disorder) -flashback/nightmare -soldiers(long therapy) 4. Phobia -systemic disentisization -least anxiety to maximum anxiety 5. OC -washer -powerlessness -give enough time for rituals 1. Hypochondriasis misinterpret Sx 2. Body Dysmorphic 3. Conversion converted to phy. Sx 4. Somatization char. By recurrent, frequent and multiple complaints w/ no Physiologic cause 1. Psychogenic Amnesia 2. Psychogenic Fugue nakarating sa lugar pero di marecall kung saan Fugue usually travel 3. Depersonalization feels body is different

Relief Of Anxiety Due To Dear 1. Malingering faking sx pretending to have illness pt has control of sx hanggang gusto mo mwala 2. Somatoform may sx no pretention, pag pinadoctor no organic cause, cant control sx 3. Psychosomatic illness that has something to do w/ mind body, no pretention, w/ organic cause Real illness, no control Stomach ulcer, HPN, migraine asthma Primary gain absent Secondary affection of others, family Tertiary - attention of Health care p 4. Malingering aka Munchaussen syndrome have false serious Sx to get attention-para mapansin Ex. Di pinapansin, nagpapansin sa pagpapakamatay 4. Munchaussen syndrome by proxy sa iba pinalabas sx, tinakpan mo ilong ng anak, sinugod sa hosp napansin ka Personality Disorders Cluster A Cluster B Cluster C Paranoid Schizoid Schizotypal Borderline Histrionic AntiSocial Narcissistic Avoidant Dependent OC/perfectionist Paranoid 1. Suspicious - Dec Trust NC 1. Consistent (sa sasabihin) Nsg DxDisturbed Thought Content Borderline 1. Suicidal bec. Of Depression 2. Body Mutilation 3. Problems in expressing anger Avoidant 1. I avoid bec. I hate criticism 2. Dec Self Esteem NC 1. Inc Self Esteem 2. Let pt initiate proj and finish it Schizoid 1. Avoid there is no enjoyment, bored 2. Problem in maintaining rel. 3. no interest in sex 4. Anger di nagpapakita Histrionic 1. I love the attention NC 1. Divert Attention Dependent 1. I cant live if living is w/o you 2. Needs support from others 3. Dec self esteem NC 1. Inc Self Esteem Schizotypal 1. Can have traits of Schizoprenia sometimes but not Dx of Schizo (sumpong lang) 2. Prefers to be in fantasy world Antisocial 1. I disregard rights/laws/rules

NC 1. Set Limits 2. Inform pt consequences of behavior OC 1. perfectionist <Anxiety related OC> Rituals- relieve anxiety NC Dont stop pt Rituals NC Advise pt to start early 1.WasherNDx Impaired Skin Integrity, Powerlessness NC Offer Lotion, Moisturizers 2. Checker 3. Hoarding 4. Counting Narcissistic 1. I love myself 2. Conceited 3. Self Centered NC 1. Divert Attention Mood Discomfort loss of control over mood Depression Bipolar Manic NDx Harm Self Directed NDx Harm Others PF 1. Loss of loved one 2. Major Life events 3. Roles Strain 4. Dec Coping Resources 5. Physiologic Changes 1. Manic severe lasts for at least 1 wk 2. Hypomanic less severe, lasts for at least 4 dats 3. Bipolar I w/ Hx of Mania 4. Bipolar II w/ Hx of Mania, hypomanic episodes and MD 5. Cyclothymia episodes of Hypomania and depressed mood that lasts for at least 2 yrs Excess energy Give activity 1. Major Dep severe, lasts for at least 2 wks 2. Dysthymic Dep less severe, lasts for 2yrs or more 3. Depression not otherwise specified, 2 days to 2 weeks NC 1. Arrange Book Shelf -master of fast approach 2. Arrange rooms 3. No competitive sports 4. ROOM non stimulating 5. Nutrition finger foods High Cal - Cheese Burger DOC - Lithium Depression Major Depression Dysthymic Depression Severe, last 2wks Chronic, lasts 2yrs S/Sx At least 2 of the ff; A nhedonia inability to experience enjoyment on F eelings of worthlessness P revious pleasurable activities L ow energy I nsomnia/Hypersomnia I nsomnia/Hypersomnia

Insomnia 2 types; 1. Terminal pag nagising din a makatulog 2. Middle sa kalagitnaan nagigising ka Hypersomnia sleeping more than 2hrs as usual F atigue/ Energy loss P oor concentrations F eelings of worthlessness P oor appetite R ecurrent Suicidal Thoughts O vereating I nc/Dec Appetite S ignificant wt. change D iminished concentration Types 1. Atypical 2. Melancholic Younger population Elderly Etiology 1. Neurochemical Theory affected depression Serotonin/Norephineprine Dec 2. Genetic Theory heredity 3. Changes in Brain Anatomy Brain size Dec or Brain Atrophy 4. Psychoanalytic Theory 1. Dep results as response to significant loss 2. Dep results of anger turned inwards DM Introjection Tx - MEDS + ECT Delusions fixed false belief w/o basis in reality 1. Grandiose belief of capabling of great feats associated w/ popular indivs 2. Paranoid everybody thinks they will harm you 3. Referential magazine, radio, tv have some meaning for you 4. Religious says ako si kristo 5. Somatic unrealistic belief in body process fxn Somatic Depersonalization body process, function ex. Cant eat my stomach is gone body parts I feel like a log NC Dont argue or challenge delusions NDx Altered thought process Hallucination false sensory perception w/o external stimuli Illusion may external stimuli NDx of both Disturbed Sensory Perception Hallucination 1. Auditory most common, command- most dangerous type 2. Visual 2nd most common, nc provide a well lit room 3. Olfactory Smell Pahiwatig seizure = Aura 4. Gustatory Taste 5. Tactile Touch 6. Anesthetic Feels body processes that are usually not felt ex. I feel blood is gushing in me, I feel urine is forming in my bladder 7. Kinesthetic Feeling of moving even if not NC 1. Acknowledge feelings ex, im hearing voices I know the voices seems real for you, but Im not hearing other voices 2. Reality orientation 3. Distraction aka Diversional Activities give activity lets go for a walk 4. Assess contents of command hallucinations Bipolar Disorder/ Mania Manic Hypomanic Depressive Episodes Severe Less severe form

Pt sobrang elated Inc energy level Expansive mood, Grandiose -requires hospitalization -no hospitalization required S/Sx 1. Colorful, exaggerated dress 2. Spending free 3. Sexual Indiscretion Manic --------------------------------------------------Bipolar I ------------------------------------------------------------------Depression __l___________________________________________________________________________ _________ l___ l ---------------------------Cyclothymia----------------------------------l (Sadness) l Hypomanic--------------------------------------------Bipolar II--------------------------------------------------------l Mania Objective Signs -Flight of Ideas -Looseness of Association Etiology 1. Psychodynamic Theory Attempt to cover up for underlying depression Underlying Hostility Dep/Mania 2. Neurotransmitter Inc Serotonin, Norephinephrine 3. Genetic Hereditary Tx 1. Mileu Tx 4. RN Consistency 2. Safety of Pt and RN 5. Nutrition finger foods, Inc cal, CHON provide vit. Supplements 3. Mon pts wt Sleep Promotion 1. Provide Quiet Environment RN Role Manager 2. Limit Stimulating activities at night 3. Avoid Stimulants Caffeine, Chocolate 4. Mon pts amount of sleep Somatoform Disorder 1. Somatization Disorder complains of multiple s/sx 2. Pain Disorder char by pain unrelieved by analgesic 3Conversion Disorder sudden unexplained neurologic deficit biglang nabingi para di makarinig Lack of concern, La belle indifference 4. Hypochondriasis 2 types Disease conviction simpleng sx ginawang malalang sakit na Disease phobia fear of having a severe illness NC- focus on feeling of pt 5. Body Dysmorphic Disorder imagined or exaggerated physical defect NC 1asses pt complaint (regardless if its not true) Alzheimers Disease S/Sx 5 As NC 1. A phasia 1.1 Expressive di masabi gusto sabihin, 1.2 Receptive di maintindihan sinasabi 1.3Global both 1. Use simple easy to understand instructions 2. A nomia - inability to move object

3. A gnosia inability to recognize obj and demonstrate use 1. Always introduce self 2. Label object and demonstrate its use 4. A praxia inability to perform ADL 1. Use step by step instructions 5. A mnesia memory loss 1. Do not challenge pt memory NDx - Altered Thought Process Meds CARE C ognex cognition R eminyl reminisce A ricept isip E xelon memory Tx 1. Reminiscence therapy 2. Time away una inaaway ka pagbalik bati nakalimutan Substance Abuse Substance Abuse illegal use of drugs Substance Dependence subs abused char by tolerance and withdrawal Intoxication maladaptive behavior caused by use of subs, lasing bangag Blackout episode wherein pt has no knowledge of what it did Conscious awareness No memory after Tolerance inc amount of subs used to produce desired effect Tolerancebreak little amount of subs will get you intoxicated Withdrawal syndrome physical, psychological Sx experienced once you stop, kabaligtaran tolerance Detoxification process of safe withdrawal NC priority in rehab detoxify Spontaneous Remission biglang nawala pag-naadict Dual diagnosis having psych illness and subs abuse Codependence maladaptive coping pattern on the part of the family Ex. Enabling aka rescuing or superficial helping Common DM DRIP Denial Rationalization Isolation Projection Alcohol intoxication Inhibition is loss Slurred speech Lack of coordination Unsteady gait Relaxation Overdose Alcohol induced hypontension Vomiting Respi depression Unconsciousness Death Tx of OD (overdose) 1lavage 2dialysis Common withdrawal Sx AHITS Anxiety Hallucination tactile Inc vs Tremors Sweat/seizure Meds for withdrawal Valium

Ativan Librium Withdrawal Syndrome NC 1. Delirium trements faulty metabolism 1. Inc VS 1mon vs 2. hallucinations 2.1 provide well lit room, minimal stimuli, far from RN station 3. tremors Onset Major cause Sx 2. Korsakoffs Psychosis Chronic dec thiamine niacin NC1. Supplements Retrograde Anterograde Confabulation Korsakoff 3. Wernickes Encephalophaty Chronic dec thiamine NC1. Supplements Confusion Opthalmoplegia = paralysis of eye Ataxia Thiamine def Aversion therapy Disulfiram (antabuse) disgust w/ alcohol -throbbing, sweating, dizziness, weakness -wait 12 hrs b4 admin if pt drank alcohol HT NC avoid alcohol Read labels b4 using any product Avoid M outh wash O TC drugs cough syrups elixir F ruit flavored extract all extract w/ alcohol F ood source w/ wine A fter shave lotion V inegar S kin product Self help groups 2 members have same problem Help Groups 1. A Anonymous Alcoholics 2. Al anon friends, families, spouse 3. ALATEEN children of alcoholics 4. Narcotics Anon narcotics, drugs, heroin 5. SAA sex addict anonymous -pedophile, zoophilia Tx for OD -barbiturates - phenobarbital -anxiolytics Tx Activated charcoal, Lavage and Dialysis Stimulants -cocaine, methamphetamine, ampethamines -coke,crack,rack -speed, crystal, crank, ice, shabu Cocaine Phy Sx - nasal septum deterioration, perforated nasal septum Intoxication Wt loss Hyperactivity/hallucination

Inc VS Loss of appetite Euphoria Overdose Seizure Comatose Tx for OD Chlorpromazine (Thorazine) Withdrawal (crushing) Sx Dysphoria Irritability Psychomotor agitation Unpleasant dreams Cannabis Satira (MJ) Mary jane, MJ, joint, weed, pot, jumbo, damo -dronabinol (marinol) legal used in chemo -nabilone (cesamet) Intoxification Relaxation Euphoria Appetite inc Loss of inhibition Blood shot eyes aka conjunctival injection CBQ Anxiety Distortion of perception of time Narcotics aka Opioids morphine, meperideine, codeine SE= pinpoint pupils H eroine H atsing rhinorrhea H ikab H uhu iyak Intoxification Pinpoint pupils Agitation Incoordination Drowsiness Overdose Constricted pupils Uncosciousness Resp dep Death TX OD 1. Narcotic antagonist -Naloxone, Narcan. -Waltrexone, Revia If stimulant SE dilated pupils , madali masilaw Detoxification Methadone Hallucinogen -ecstasy PCP angel dust -psychedelics, psychominetics Intoxification Hallucination Delusion Depression Dangerous behavior/activites

-belligerence nakikipagaway -aggression Inhalants - gasoline, glue, rubber cement, paint thinner, spray paint S/Sx Brain damage liit utak Resp dep Aggression Inability to fxn Dysrrhythmia Terms1 1. Vaginismus Involuntary spasm of vagina 2. Paraphilia Sexually preoccupied NC 1. Not should be focused 2. Set Limits 3. Exhibitionism Showing ari NC 1. Set Limits 4. Fetishism Using non living objects 5. Frotteurism Touching, rubbing against non counseling person 6. Pedophilia Bata 7. Masochist Gusto masaktan 8. Sadist Nananakit 9. Necrophilia Dead 10. Zoophilia Animals (actual and fantasies) common dog 11. Scatolophilia Phone calls 12. Partialism Focused on a particular body part 13. Climaphilia Involving enema 14. Coprophilia Feces 15. Urophilia Urine 16. Masturbation Self gratification 17. Voyeurism Observation Terms 2 1. Echopraxia imitating movement of others NDx Impaired Motor Activity NC Nutrition, - feeding, circulation 2. Verbigeration aka Palilalia 3. Slilted Language f lowering, excessive words and phrases - malalalim na salita 4. Echolalia parrot like talking 5.Circumstantial thinking giving unnecessary detail before answering the question. Sinagot tanong 6. Tangential thinking wandering off from a topic and never giving info. Di sinagot tanong 7. Confabulation gumagawa kwento DDx Altered Thought Process 8. Synesthesia combination of 2 senses, feeling sounds, hearing food

Therapy Play Socialization Real Condition of child in Home (know if +child abuse) Behavior Modification Correct wrong behavior Group Feedback Ideal 8-1minimum of 3 RN - Observer Token Rewards Desentisization Phobia Least anxiety to max anxiety provoking (paunti unti iexpose sa takot) Flooding Phobia

Bigay kaagad (RN dont give Panic Attack) Mileau Therapy Change environment RN Flexibility Remotivation Insight (good or bad) 1. ECT to induce grand mal seizures Tx for Depression, Mania, Schizo-Catatonia AUnknown 75-15volts Tx 6-12 sessions 0.5-2sec long, 48 hrs interval, if after 15 no effect padin = STOP ECT give MAOI Prep- NC 1. NPO 8-12hrs (start NPO 12midnight) If consent ayaw pirmahan ng pt or no relatives to sign 2. Just like pt undergoing Gen. Anesthesia preps NC Reschedule (if there is willingness) 3. VOID, Consent On the Day 1. Remove hairpins, dentures, any metals, nail polish After ECT 1. Check gag reflex 2. Reorient pt Meds used prior to ECT; A trophine Sulfate (SO4) .08mg Dec Bronchial/Tracheal secretions B revital (Methohexital Na) Anesthesia, Induce sleep A nectine (Succinylcholine) Muscle relaxant SE Complication, Resp. Depression Contraindications 1. Inc ICP 5. TB w/ Hx of hemorrhage 2. Fever 6. Retinal Detachment 3. Fracture 7. Pregnancy w/ complications (PIH, Eclampsia) pag w/o complications pede mag ECT 4. Cardiac Dysrhytmmias Meds 1. AntiPsychotic Chlorpromazine (Thorazine) 2. Anxiolytics Diazepam (Valium) 3. Anti Parkinsonian Amitriptyline (Elavil) 4. Anti Depressant Imipramine (Tofranil) 5. Lithium Eskalith

Anti-Psychotic aka Neuroleptic aka Ataractics aka Major Tranquilizers 1. Dec Delusions, Hallucinations, Looseness of Associations, 6-wks A1. Antagonizes Dopamine receptor in CNS 2. Blocks Cholinergic receptors Common Indication - Schizoprenia Take after meals Typical Tx + signs of schiz 1. Haloperidol - elderly 2. Chlorpromazine 3. Serentil 4. Mellaril 5. Thioridiazine (Meclanic) retinal pigmentation Atypical Tx + and signs of schiz 1. Clozapine agranulocytosis (sore throat) 2. Risperidone 3. Olanzapine acute mania 4. Quetiopine 5. Ziprasidone Heart toxicity/ QT interval lengthening

Anti Psychotic SE Inc Potency = EPSE Dec Potency = Anti-Cholinergic SE SE BLUEPANTS NC B p Monitor Orthostatic Dangle feet L eukopenia CBC monitor, WBC U rinary Retention, constipated Inc H20 E PS, eyes blurring Anti Parkinson, Safety P hotosensitivity Sunblock, Shades A kathisia, agranulocytosis Report Sore Throat, Fever N MS, nausea, erratic BP, high fever, headache Pull out meds T ardive Dyskinesia, Tremors S ome dizziness Safety NC Agranulocytosis 1. Stop Med 3. Report to MD 2. Assess pt (VS) 4. Mon. WBC 1xwk/2xwk/once a month New Generation/DSS (Dopamine System Stabilizer) 1. Aripiprazole (Ablify) Inc Dopamine in brain where it is Dec, vice versa SE Photosensitivity NC 1. Shades 4. Lotions w/ SPF protection 2. Wide Brimmed Hat 5. Avoid sunlight 3. Long Sleeves/Jacket Other SE of Anti-Psychotics NC 1. Sedation 1. Monitor Orthostatic Hypotension 2. PRIORITY FALL Precautions Orthostatic Hypotension - dugo mo pantay pagtulog, pagtayong bigla punta dugo sa paa, kulang ang supply ng dugo sa utak kaya magpump heart = Reflex Tachycardia Orthostatic Hypotension 1. Gradually rise from bed 2. While laying in bed elevate HOB 3. After 2-3min, dangle feet 4. After 2-3min, stand again for 2-3min. ask if able to walk 2.Anti-Cholinergic SE ABDUCT NC B lurring vision 1. Avoid driving D ry mouth 2. Provide sugarless hard candy (bec. of wt. gain) U rine Retention 3. Maintain fluid balance, promote mobility Mon. IO dont Inc fluid intake C onstipation 4. Inc Fiber T achycardia 5. CBQ- If change in VS Mon VS 3. Extrapyramidal SE serious neurologic S/Sx due to noncompliance APPA A cute Dystoria P seudoparkinsonism P isa syndrome A kathisia, Akinesia NC 1. Teach about SE 3.1 Acute Dystoria TOOL Abnormal muscle tonicity T orticolis -Twisted head and neck O cculogyric Crisis -Upward drooling of eyeball (The Undertaker) O pisthotonus -Arching of back L aryngeal-Pharyngel Constriction NC Maintain patent Airway 3.2 Pseudo-Parkinsonism Parkinsons Disease Cause is taking anti-psyche meds Cause is depigmentation of substantia nigra Same S/Sx as Parkinsons Dse Pseudo-Parkinsonism Meds Parkinsons Disease / Congentin / / Artane / X Parlodel / / Akineton / / Benadryl /

X Inc Dopamine Levodopa / / Ectaprel / DOC Symmetrel / 3.3 Pisa Syndrome Leaning towards 1 side of body (like leaning tower of pisa) 3.4 Akathisia Akinesia Inability to sit still (galaw ng galaw) Di gumagalaw DOC Beta Blockers Propanolol NONE 4. Neuroleptic Malignant Syndrome NMS FATAL S/Sx NC SMN 1. High Fever 1. Stop Meds Now 2. Motor/Muscle Rigidity If may Hx of NMS pede pa ba magtake uli ng Anti-Psyche in the future? Yes, 2 weeks after S/Sx disappears 5. Tardive Dyskinesia Permanent, Lifetime manifestation except if sleeping -Late appearing Sx, Cause Hypersensitivity of meds S/Sx NC 1. Blinking 1. Mon for early S/Sx Prevention AIMS 2. Grimaces Acute Involuntary Movement Scale 3. Lip Smacking (malala pag may tunog) 4. Tongue Protrusion

Anti-Anxiety 1. Dec Anxiety 2. Adequate sleep and musc relaxant A1. Inhibits GABA Benzodiazepines immediate, take before meals 1. Diazepam (Valium) 2. Lorazepam (Ativan) 3. Oxazepam (Serax) 4. Chlordiazepoxide (Librium) = Alcohol Withdrawal Non-Benzodiazepines 1. Buspirone (Buspar) 1st line agent AdvantageCan be taken w/ alcohol DisadvantageInitial Effect7-1days Full Effect3-6wks SE DACOT NC D rowsiness Driving not allowed. Dont stop abruptly A lcohol Cut intake C BC Monitor O rthostatic Hypotension T ranquilizer not allowed Dependence Psychological Physical Fear Sx will reappear if stop taking meds Sx reappear if you stopped taking meds Note 1. Dont combine w/ alcohol + meds Cause CNS and Respi Depression

2. Dont combine w/ stimulants No effect 3. Dont combine w/ Kava and Valerian Herbal meds for anxiety Synergistic effect-Inc effect lalo 4. Dont use in everyday stressor of life 5. Dont stop abrupty Even if switching to Non-Benzo TAPERING gradual seizing drug use Anti-Parkinsonian 1. Prevention of PseudoParkinson Best taken after meals Anti Cholinergic ABC 1. Akineton 2. Artane 3. Benadryl 4. Congentin Dopamine PLSE 1. Parlodel 2. Levodopa 3. Symmetrel 4. Eldepryl REMEMBER HALOS GAP NC H epatotoxicity Liver profile. SGOT, SGPT A void Alcohol L eukopenia O rthostatic Hypotension S eizures Safety, Side Rails G I Irritation A void Vit B6 affects absorption P rotein rich foods - avoid

Anti-Depressant SSRI, TCA, MAOI Common Indication Depression 5-1days onset Full Effect 2-4 wks After discontinuing 1-2 wks 3 types 1. SSRI 2. TCA 3. MAOI 1. SSRI (Selective Serotonin Reuptake Inhibitor) 2-3 wks 2. TCA (Tricyclic Anti-depressant) 2-3 wks Ainhibits serotonin reuptake and destruction of serotonin to prolong its action ABlocks reuptake of norephineprine and serotonin at presynaptics neuron 1st Line Anti-Dep, safest Sertraline (Zoloft) causes Impotence (after 2-3 days mawawala) Fluoxetine (Prozac)+Olanzapine = Bipolar D/O Citalopram (Celexa) Paroxetine (Paxil) = Panic Fluvoxamine (Luvox) Imipramine (Tofranil) Anticholinergic SE, Urinary Retention = Enuresis, Bed Wetting) Clomipramine (Anafranil) + Luvox = OCD Amitryptylline (Elavil) most sedating cardiotoxic SE Wind SE W t loss Urinary Retention

I nsomnia SWAP DOC N ervousness S edation D ifficulty Voiding D iarrhea W t Gain Orthostatic Hypotension A nxiety Cardio Disturbances P hotosensitivity Note 1. Drug to Drug Interactions No to Trytophan -St. Johns Wort herbal med for Dep -SSRI bawal isabay sa MAOI kasi it could cause Serotonin Syndrome (parang NMS, also FATAL) 1. Inc Risk for Suicide Check if Pt is taking meds not storing it for possibility of suicide 2. Drug to Drug Interactions TCA + MAOI = Hypertensive Crisis, washout period = 14 days 2. Pag di effective SSRI, MAOI next pero may wash Out period aka Interval = 5-6wks

3. MAOI Monoamine Oxidase Inhibitor Parmate Marplan Nardil AInhibits monoamine oxidase SE NC Insomnia 1. No fermented (Alcohol, Beer) Causes Hypertensive Crisis* WOWGIRL 2. No Rich in Tyramine Foods W t gain 1. Cheese esp aged cheese 5. Bread Bears O rthostatic Hypotension 2. Avocados 6. Overripe Fruit W eakness 3. Bananas 7. Red Wine, Beer G I upset 4. Papaya 8. Preserved foods I nc Appetite White wine pede inumin R estlessness L ethargy *Hypertensive Crisis Hypertension sudded inc Dilated Pupils Occipital Headache radiating frontally Palpitations, Tachycardia/Bradycardia Neck Stiffness and Soreness Constricting Chest Pain Antidote Phentolamine 5-1mg Regitine IV inj Lithium Carbonate Aunknown Manic Pt Never taken by Preggy, Teratogenic Salt, not metabolized so Nephrotoxic n/therapeutic level0.5-1.5 meq/L Maintenance level0.6-1.2 meq/L Elderly n level0.5 -<1 meq/L Lithium Carbonate (Eskalith, Lithane, Lithoboid) Lithium Citrate (Cibalith-Si) If < 0.2 Lithium Manic Attack If 2.2 Toxicity NAVDA N ausea A anorexia V omitting D iarrhea A bdo cramps + CAC

C oarse Tremors A ltered Mental State C onvulsion NC 1. IFI malabas Lithium H22-3 Liters (wag sobra baka madilute) 2. Diuretics(Mannitol) 3. Fluid + salt 3-6 g per day Note Initial effect 10-14 days Full effect 3-4 wks Adverse Effect ALITH L eukocytosis Tremors/ Teratogenesis I nc Urination Hypothyroidism REMEMBER LITHIUM L evel .5-1.5 I nc Urine T remors, fine hand H 22-3 L/day + 6 g salt I nc Thirst U uu diarrhea M outh dry Toxicity DOCDiuretics Mannitol, Diamox Therapeutic Communications 1. Offering Self -Ill sit w/ you for a while. Ill stay w/ you 2. Elaboration/Exploration - Tell me more 3. Active Listening -open posture -eye to eye contact -face patient -be open and alert -respond appropriately 4. Silence -maintain eye contact -convey interest and concern in facial expression 5. Questioning -avoid WHY -open ended questions achieve relevance -what, when, what did you say, what happened 6. General Leads -go on Im Listening, I hear what you are saying 7. Restating PtI cant sleep, I stay awake all night RNYou cant sleep at night? 8. Presenting Reality -I know the voices seems real to you, but I dont hear them. I dont see it in the same way you do. Ex. Nakakita spider sa bed, NC, ipagpag ang kama Non-Therapeutic Communications 1. Advising -telling the pt what to do, I think you should 2. Belittling feelings expressed -misjudging the degree of pts discomfort PtI have nothing to live for, wish I was dead RNEverybody gets down in the dump sometimes 3. Challenging -demanding proof from the pt 4. Defending -attempting to protect someone or something from verbal attack, ex. Avoid defending MD 5. Giving Literal Response -responding to figurative comments as though it were a statement or fact 6. Introducing an unrelated topic -changing the subject 7. Making stereotyped comments -offering meaningless comments 8. Reassuring -indicating no reason for anxiety/discomfort 9. Rejecting -refusing ideas on pts concern 10. Requesting an explanation -asking pt to provide reasons for thoughts, feelings, behavior and

emotions 11. Using Denial -refusing to admit that a problem exist Others Non-Thera 12. Agreeing and Disagreeing 16. Underloading 13. Approval and Disapproval 17. Focusing on self 14. Overloading 18. Laughing nervously 15. Incongruence