Oncology-study of cancer cellular abberation

-unknown cause

Risk factor:

1. Age (65 y/o) significant risk factor

Decrease immune system
Hormonal imbalance
Free radicals
2. Gender
Male
Prostate
Lung
Colon

Female

Breast
Lung
Cervical
3. Geographic Location
4. Race (african,american)
5. Radiation exposure
6. Viruses (HPV,HSV, HepB,EBN)
7. Chemical agent (killer triad of ca)
Alcohol,smoke,asbestos
8. Diet low fiber high fat
Nitrates
Over cooked food
Over used oil

Prevent cancer

high fiber low fat

green/yellow vegetable
lycopein
carotenoid

Chemotherapy- kills/disrupt rapid dividing cells

Cell cycle * GO- Restling Phase

G1- RNA,CHON synthesis

S-DNA synthesis

G2-pre mitosisy

M- mitosis/division
Note: cell cycle specific-focus on 1 phase cell cycle non specific-effect on any phase

I. Alkylating Agent (non specific)

Cyclophosphamide (cytoxcin)
Cisplastin (platinol)

Adverse effect

Hemorrhagic cystitis(cytoxan)
Increase fluid intake

Tinnitus,nephrotoxic,ototoxic(platnol
II. Anti Merabolities (cell specific) (s)
Florouracil (5fu)
Methotrexate-(folic acid anntagonist)
Antidole:Follic acid (leucovorin/nelkovin)

III. Anti Tumor Antibiotic (non speifec)

Adviamycin
Bleomycin

Adverse effect

Cardiotoxicity: check cardiac status

IV. Plant (vinca) alkaloid : (cell specific) (m)

Vincristine (vxr)
Viaplastin (velban)
V. Cortico steroid sone drugs (non specific)

Side effect:
Wt gain
Hyperglycemia

Radiation Therapy

I. To kill tumor
II. Reduce size
III. Relieve obstruction
Luternal radiation / brachytherapy

2 types :

Sealed (implanta)
Unsealed (IV/oral)

Body fluid
Factor :

Shield: made of lead shield

Apron made of lead

Time: Nurse30 mins/shift=

6 visit x5 mins/per visit

Visitor: 10-15 mins

Distance: 6ft

Not allowed :

Pregnant
Infection
Children
Newly vacinated ind.

Nursing responsibilty

Sealed: CBR without BRP

Confined in Bed (Private room)

Increase fiber diet or low residue

If dislodge: Seen: Long forcep

Lead line container

Unseen: Leave the room

Close the door

Notify rad. Dept

Unsealed: flush toilet 2-3x after use

Private room

External Radiation/ Teletherapy

Beam of high energy ray
Pt no raadioactive
No radioactivein body fluid

15-30 mins/day (session)

5 days a week
2-7 week
No need shield, time, distance
Nursing care

Dont wash off skin marking

Clean with plain water/ pot try
Avoid constrictive cloth
Avoid extreme temp.

Side Effect of radiation therapy

Bone marrow suppression

(pan cytopenia)- fatigue

Decrease: WBC-leukepenia
RBC- anemia
Platelet- thrombopenia
Ovaries/testes (infertility/stevility)

Orchyopexy
Dophorexy: replacing testis/ovaries

Mucosal lining (N/V)

Prechemo-No feeding (4/6 hour)
Antiemetic
Phenergan
Reglan
Tigan

Postchemo-small frequent feeding

Nursing care
Anemia-fatigue-rest
Leukopenia-immuno suppression-isolation
Thrombocytopenia-bleeding safety
Skin-radio therapy-radiodermatitis( burned skin) (4-6 wks)

Chemotheraphy (extravasation)

-leak of chemo drug from the vein chemical burn

Sx:

Redness on IV site-monitor
Pair/burning sensation
Slowing of infusion
Stop chemotherapahy
Do cold compress except vinca alkaloid
 Hair-alopecia-recommended use og wigs, capsar scarf
-hair loss is temporary

Oral cavity stomatitis (mouth ulcer)

- Serostomia(dryness of mouth)

Oral care:
-NSS
-increase Ofi
-Avoid spicy, alcohol drinking
-KY Jelly
-Lip Balm
-popsicles
-ice chips

Vagina-dryness
Ky jelly
Perineal care

Pain what ever.whenever

Assesment-acceptance

Provoked-activity
Quality-own description and avoid close ended
Radiation- locate using finger

Severity-pain scale (numerical)

Time- duration/interval

Pain mgt:
 1) Opiods
Morphine SO4(morepain pancreas in MS 10th use again 12th edition
Meperidine (demerol ) (seizure)
Fentanyl

CNS problems SE
1st sx of Adverse
Eff.resp.depression
Check RR
(narcan)
Drowsiness (1st 24o of taking SAFE) safety offf pt.
Nausea
pruritus
Constipation (common SE)
Urinary retention

2) Non-opiods (NSAIDS)

Acetaminophen + Ibuprofen

Anargesic/antipyreric

SE: GI irritation/ heart burn

With meal/milk 1 glass

Opiod + Non-Opiod = YES can give !

No addiction but tolerance (kozier)

3) Adjuvant (co-anal gesic)

Diazepam relax smooth muscles

-Anxiolytics
-Anti seizure
-Anti Histamine
-Anti-convulsant

WHO: Terminally ill pt. Ladder Of rain

Breast cancer

-Risk factors:

Late menopause
Obesity
Nulli parity
Generic
Female/forty
Oral contraceptives
Early menarche

Late menopause
Early menarche
Obesity= increase fats (increase estrogen)-fat soluble-hormone- increase libido
Nulli parity = /not or never pregnant

Estrogen used in pregnancy

-not expose to estrogrn

Genetic
Female/forty-94% female
1% transgender
Oral contraceptives (estrogen)

Prevention:

Breast self-exam
20y/o /month (7 days after mens)
Same day each month
Irregular/menopause/post hysterectomy
Breast health worker exam/ breast exam
24-30y/o (q 3yrs)
40 and above yearly
 Inspect/palpate

Asymmetric breast
Venous prominence
Orange pill skin ( de orange)
- Advance stage of breast ca.

Lump/mass

Discharges

Arcular

Nipple dimpling

Common sit of lump: upper outer/outer to inner

-
- Malignant
Fixed
Non-movable
Irregular
- Check discharges

Mamography:

- Xray of breast (for 25 y/o and above )

- Sched: Baseline (35-39)y/o)
- (Yearly 40 and above)

Grand mom: (44)

Mom: (34)

Auntie: (42)

10 yrs old for the youngest

No any chemical
 H2O wash

Cancer

Breast: confirmatory
Biopsy

FNA- fine needle aspiration

CNA- core needle aspiration

Surgical
Incision(portion)
Excision (mass whole+ surrounded tissue)
Mgt:
Chemotherapy
Radiation therapy
Meds ( Tamoxafen Nolvadex)
-20 mg 1 day
-hormonal med (anti-estrogenic)
-s/e: menopausal syndrome
Hot flashes
Surgery: lumpectomy/excision
- Quadratectomy
- Simple mastectomy/total mastectomy
- Radical mastectomy-breasts/ lympnodes/pectoralis
Complication after mastectomy
Lymph edema (semi fowlers affected arm)
No procedure on the affected arm
Arm exercise

Prostate cancer-unknown cause

STD (HX)
Testosterone
African/American
Fat/increase fat
Forty increase

SX: Assymptomatic
Enlargement of prostate gland
Dysuria
Hematuria
Urinary retention
Perianal/rectal pain
Low back pain
Sx of metastasis
DX:
Prostate specific antigen
 -40 above (yearly)
-cancer marker
DRE- digital Rectal exam
-40 above (yearly)
-clean gloves/ pos. lateral recumbent
Biopsy- confirm

Mgt:
Chemotherapy
Raduation
Meds
o Gonadotrophin releasing hormone increase testosterone(-) feedbach
mechanism)

-LRH
-lupron
-zoldex(subcutaneous every 1-3 mons)

o Diethyl istebesterol
(DES)
-Estrogen med that antagonize testosterone.
Testiscular cancer- unknown
Male- 100%

RF:
Cryptorchidism- <50%
Age- 15-35 y/o
Trauma
DES (maternal use)
-pills
Orchitis
Genetics
SX:
Testicular self exam
-before 15 y/o / month-sameday
Inspect/auscultate/ - bruit (doctor)
-inspect : mirror
Size/shape/symmetry
SX:
Painless enlargement (affected)
Heaviness/dragging
Pea size lump
Low back pain
Palpation- thumb/forefinger/index/middle finger/done after warm bath

ROLL

Normal palpation- smooth/round

Laboratory:
AFP-alphaferoprotein
B-HCG- human chorionic donatrophy
LDH- lactic dehygrogenase
-liver
Biopsy after orchiectomy

Unilateral
One remove
No imporence
No sterility
Bilateral
Both remove
With impotence
With sterility

Cervical cancer

RF:
HPV- strongest factor for cervical cancer
Multiple sexual partner
35-45 y/o
Multi parity (above 5 preg.)
Early coins (below a6 y/o)
Long term oral contraceptives
Smoking
SX:
Early signs
Post coital bleed
-painless bleeding
Methorrhagia
Menorrhagia
Discharge
Late signs
Bleeding
-dark.foul smell
Anemia
Wt. loss
Pap smear.

18 y/o sexually active

-yearly
3(-) consecutive every 3 yrs
Sexually active
Hx (+)
40 above
YEARLY PAP SMEAR
 Mgt:
Chemotherapy
Radio therapy

Colorectal cancer

RF:
Polyps
Hx of irritable bowel dse.(ulcerative colitis)
Increase fat- obese

SX:
Change in bowel movement
A sore doesnt heal
Unusual bleeding/discharge
Thickening lump
Indigestion
Ovicus change in nagging of /hoarseness
Sudden lost wt.
Anemia

Right sided lesion

Dull abd. Pain

Melena

Left sided lesion

Abd. Distention
Abd. Cramping
Constipation
 Melenal hematochizia

Rectal lesion
Hematochizia
Rectal pain
Constipation
Feeling oof incomplete exsacerbarion after bowel movement

DX/LAB

CEA- mauken for colorectal

-carcino embrayonic antigen
50 above / yearly
-Normal- smoking
Non- smoking
0-5 ng/dl
0-2 ng/dl
FOBT (Guiac test)- 50 above / yearly
Barium enema- 50 above (every 3-5 yrs)
-no need to ask for allergy
Colonoscopy/protosigmoidoscopy- 50 above (every 5-10 yrs)

Preparation
3 days low fiber
1day clear liquid
Night before laxative NPO
AM cleansing enema

Chemo/Radiation/Surgery

Medical surgical Nsg.

CVS function:
- Tissue perfusion
 Blood volume 5-6 L
Heart
Blood vessel
- Artery- resistnace vessel
- Vein capacitance vessel
Shock: inadequate tissue perfection due to collapse cardio

Smooth muscle- vascular tone

-contract vascular vessel constrict
-relax vascular vessel dilate

Distributive- circulatory shock

Cause of loss vascular tone

Inflammation-response of vascularize tissue
Vaso dilation
Infection
Allergy
Spinal cord injury

Osteoarthritis- not an inflammation

Blood vessel peripheral vasalar disorder

Thromboangitis obliterans (burgers ase)

Anteriosclerosis obliterans
Raynaulds dse.
Deep vein thrombosis
Various vein

Thromboangitis obliterans

-irreversible
Obliteration remove plaque> affecting medium vein/arteries
-permanent

Anteriosclerosis obliterans hardening

-lower extremities
Irreversible- dependent legs
Ppermanent- affecting lower ex.

Raynaulds dse upper extremities

Hemels,vectoplasm

DVI phlebothrombosis
-sudden pain
Thromboplebilis cause
-inflammation
Asymptomatic maneuver to fast

Varicous vein

Superficial vein
Deep vein

Valves helpthe blood to go up back to heart

against the rull of gravity

Prolong standing

Destroyed blood

-stasis of blood

-hyper coagulabilty Virchons trial

Thrombus formation

Distended venous insufficiency

Injury to B.V
Position the leg elevated
Management:
-surgical
Vein striping- remove thrombus
-scluos therapy

Diagnostic test
Doppler ultrasound
Angiography-deflimitive
-arteography
-venography

Mgt.
Immobilize
Analgesic IV
Heparin IV

Surgical mgt:
Insution of scent
Medical mgt:
Elastic stocking
-as ordered
 Sleeping-remove
Molning- balik
Trombolytic
-urokinase
-streptokinase
Shepiase

Buergers Disease
Idiopatnic
R factor
- Smoking
- Men/women(20-40 y/o)
- Stress is risk factor
- HPN
- DM
Nicotine vasoconstriction
addiction
Read
Cyanide NeuroToxic

Methane- gas
TAR- canus
Arsenic rat poison
Formative- preserve

Smoking injury to blood vessel

Small and medium size arteries & vein

Inflammation to the wall of BV

Trombus blood flow

Ischema

Lower extremities
PAIN

Risk For injury infection

Clandication

Pain on walking

INDEPENDENT
 Stop smoking
Avoid trauma/infection
Contol BP
Control sugar
Avoid Stress

DEPENDENT
Analgesic NSAID
Vaso dilator rarely given
-dont dilate dilate ds. Vessel, It dilate normal vessel
Ampulation/Blue white red dse.

Reyneulds dse.
Idiophatic
Exposure to cold temp.
Women than men
Young adult
Smoking,HPN,DM,stress

Reyneulds phenomenon
Connective tissue dse.
-phematoid
Scherodema
Exposure to cold temp.

Vasospasm of arterioles

Blood vessel of upper extremities

Hand/finger(ischema)

BLUE
Severe spam

WHITE

Peperfusion

RED

Numbness and tingling sensation

Risk for injury/infection

Nsg intervention

Avoid enposure to cold temp.

Always wear gloves
Avoid smoking/ stress/ trauma
Control BP, sugar, avoid injection
Vasodilators as ordered
- Peferfusion
- Diltiazem Ca. chammel Blocker

ARTERIAL ULCER

-skin surrounding ulcer is pale

Lesion: well circumscribe
-no edema
- decrease or absent pulse

VENUS ULCER
-cyanotic
-irregular border
-edema (+) pulses difficult to palpate

ANATOMY/PHYSIOLOGY

Heart- hollow muscular organ

-middle mediastineum
- fest

Systemic pressure- 120/80

Pulmonary pressure 25/90

Left CA
- Left anterior descending branch
- Circumference branch
Right CA
- Posterior interventicular
- Marginal branch

Conducting System
SA node
AV node
Bundle of chis
Right and left
Fiber

Impulses
Conducting to transmit impulse

Conduction:
- Nerve cell
- Mucle cell
Action potential- a rapid change in membrane potential

Cell has electrical change

-60 to 90 milli voltz
Restling membrane potential

Depolarization- more (+) Na

Repolarization- more(-)

Nerve-sodium in potassium out

Lidocaine- close sodium channel. No impulse

Decrease stimuli No pain

No P- premature ventricular contraction/complex

1 heart beat = 1 carddiac cycle
-events taking penses in the heart inn one heart beat 0.8 sec

Arial systole
Isovolumetric ventricular increase P due to close all value contraction
Maximum injection
Isovolumetric ventricular relaxation
Rapid ventricular filling
Diastasis time

S3
S4 gallop normal inandible

Stroke volume 70 ml
-volume affected/beat
Factor affecting SV
Preload-volume of blood is already in the heart before it contract
(remons return)
Factors affecting preload
Positioning
Breathing pattern
Deep inspiration increase SV
Straining/intathoraxic decrease SV

After load pressure that must be considered

By the heart before in contract

Increase after load

Increase BP
Athero sclerosis of aorta
Contiactility
-inotropism decrease mat. OF sv

# of the heart beat (60-150)/min

Factors:
SNS
PNS
Thyroid hormone
Temp
Enelcise

SV x HR
Vol/beat (70) beat/min (70)
-cardiac output
4900vol/min

MAP= CO x TPR (vascular resistance)

-viscosity
-diameter of blood vessel

Dependent when the client become at risk to cardio vascular disease

Increase BP

Primary: idiopatnic
Secondary: causes tumorpheocromocytoma
Increase nerepinephrine increase
BP SNS
Anti hypertensive drug

1. Alpha, antagonist
Block a receptor (vasodilator)
Prazosin.terazosin.doxazosin
2. Alpha2 agonist
-found in CNS decrease flowof nor epi
Symphatetic response
-clonidine(catapres)
-methyldopa)dl domet)
3. Beta antagonist/blocker
B1- decrease HR decrease BP
B2- lungs bronchoconstriction
B1 blocker,metoprolel.atinolse

(RAAS)

Rennin angiotensin 1
Angiotensin2
V.
Constriction
increase BP
aldosteron Na retension
4. ACE inhibitor (vasodilation)
s/e: cough production

Captropil
Enalapril
Quinapril

5. A II receptor blocker
Tumisutan
Valsautan
Losautan

6. Druretii
Thiazide D.
Hydrochloeothyzine- distal tubeles
Best in morning
Urine output
7. Vaso dilator (smooth muscle of blood cell)
-Direct acting
Relax smooth muscle of blood vessel
*hydralazin (apresolin)
*Nitrates (sensitive to ligh/heat)
-Indirect acting
Vaso dilator
*decrease the release of Ca in the smooth muscle
 Ex:Crannel blocker
-nifedipine
-amlodipine
Felocipine
Diltiazon
Verapamil

Coronary artery dse.

-artherosclerosis

Rfactor: modifiable

Non modifiable:
Rall. Men
Testosterone Cyclooxydenase enzymeV.constrictionestrogen
(+) V.dilation
Decrease Lumen og B.V- ischemia
CAD- ischemic heart dse.

Angina peetoris
-imbalance og O2 in the heart work load
Gral- reverse the ischemia

Prevocation-position/location
Pain scale
(+) facial gramace
(+)lewne sign
Quality
-stabbing
-Crusting
-heaviness
constant and not affects by breathing & movement og chest

Mayocardial infection
Nectrosis irreversible damage
Realiving factor
Rest
NTG
None
Symptoms associated
Diaphoresis
Puler
N/V
Bowel dysfunction
Time
-3-5 mins (<15 min) (>30min)

Angina rectoris
-decrease O2 increase work load
In affective perfusion

Types og angina:
Stable heart work load RESA
Unstable angina
-sevre atherosclerosis decrease O2
> dependent (first)
NTG.O2
Pulmonary metal
Coronary rasopasm decrease O2
NTG On

DX test:
ECG T. Wave inversion difimitive
Blood test increase homocystein level
C reactive protein
Coronary angiography

Mgt.

NTG (sublingnal)
-fast action
-coronary V. dilation increase O2
-peripheral V. dilation --? Decrease heart work load

Mononitrate
-slow onset of action
Coronary V. dilation increase O2peripheral V dilation --? Decrease heart work load
Beta Blocker
-beta blocker
Decrease HR decrease heart contraction- decrease heart work load
Ca channel blocker
> peripheral V. dilation
>diltianeum
>verapamb

Surgery PTCA reculation

Coronary angion plusty

MI acute pain pain control

>dependent (1st)
>morplane.neperidu as ordered

ECG during pain

>30 min.
>defirmitive

1. Twave inversion (myocardial ischema)

2. ST depression (myocardial injury)
3. ST segment elevation
4. Pathologi Q/inverted Q
>late sign of acute MI

Acute coronary syndrome

Cardia enzyme elevation

-CK MB isoenzyme (4-6) most specific
-CPK
-LON Non specific
-AST
No IM infection to ml
-myoglobin
-tropomin protein not enzyme *sensitive/reliable
*persist for 3wks elevated
* coronary angiography

Medical mgt:
Pain relief-morphine
Relieve anxiety
Thrombo entie therapy
ACE inhibitor
Surgery
-CABG
-PTCA

Most Common Complicaton Of MI

>dysrhythmia
>premature ventricular contaction

Preventing of impulses
6 or more per min

Normal ECG
Heart Failure
Inability to pump effectively
CARDIAC decompesation
Syndrome

Etiology
>cardiac dse.

-IM
-disrhytmia
-congenital heart dse.

>Non cardiac dse.

-COPD
-renal decrease

2 types:
1 left sided- LV fails
Right sided- RV fails
P, Edema
Cough, orthopere, dysprea decrease GIT, weakness (+) chackle
Decrease Kidney
Ineffective airway clearance
Ineffective breathing pattern
Impared gas exchange
Decrease CO
Ineefective tissue perfusion
Activity intolerance
Fluid volume excess

DX Test
-chest X ray
-cardiomegaly pulmonary congestion
Mgt:
>high fowlers
O2 therapy
Diaretics loop og heale
-edema
-cardiac Work Load

Flid volume excess

Restrict fluid/ Na
Monitor v/s
Weigh pt daily
Continue diaretics & pot spairy
Heart failure
-Low cardiac contractility

Increase heart contractility

Cardiotonic Agent
>symphatommetic
>increase cardiac heart rate
Increase cardiac contractility
Ex: dopamine

Cardiac Glucoside
Diagoxin (0.5-2mg/ml)
(+) intropic increase heart contractility cell
Increase the release of Ca in the heart rate
(-)chronotropic decrease HK
By prolong cardiac pepolargation by slowing K out In all.

Nsg care:
Insert HR with hold <60
Monitor K level- hypo K
Hypokalemma increase diatalis toxiaty
Monitor ECG
Avoid Ca channel vlocker while taking cardiac glycoside
Dont give while taking mal that decrease HR
Minitor level
Monitor digitudistoxicity
-N.V
-lack of appetite
-Gi toxicity
Visual disturbance

Refer dos. digimind

Tiology
 Infection
Trauma
Connective dse. (SLE)
Malignance

Pain-concern with deep inspiration

Lyria donn O2 turning & revealed by sitting
O2 lenning forward
(+) Friction rub- asacultate at 4th intersioctal space left sterna border
Priority
Position
NSAND/steroid

Complication
Pericardial ceffusion-accumulatae fluid
Cardiac tanponade
>distant/mupple heart sound
>Becks TRIAD
-decrease BP
-Increase venus pressure
-muple sound

Heart is normal obstructive shock

semi fowlers- rericardialcentesis

NURSING MANAGEMENT (TECHNICAL SKILL)

-planning
-organizing
-directing
-establish formal authority
LEADERSHIP use personal trait to influence change of behavior of
other
**PRODUCTIVITY
(5) LEVELS OF LEADERSHIP
ACCORDING TO INFLUENCE
-position/right
-permission/relationship
-production/result
-people development/reproduction
-person hood/respect
COLINS- leadership levels (TYPES OF LEADERSHIP)
1.Highly capable individual
-skill,knowledgable
2.Countibuting team member
-assest
3.Competent manager
-efficient performance PODC
4.Effective leader
-result of efficiency
5.Great leader
-whole rest of 1-4
LEADERSHIP GREATNESS
(WHOLENESS)
*conscience spirit
*vision mind
*discipline body
*passion heart
(3) area of nsg maturation
1. education
2. practice
3. regulation
PROFESSIONAL MATURATION
>DR. Maria Linda Buhat. RN,MAN INTERNATIONAL
>Patristia benner
(5) PROFESSIONAL MATURATION LEVAL
1. NOVICE skill focus development
2. ADVANCE BIGINER leadership
3. COMPETENCY confidence
4. PROFICIENT Innovativeness/creativeness
5. EXPERT analysis
NOVICE staff nurse
Activities: 1.Basic nursing procedures
2.Utilize nursing procedures
3.Introduction to career/directing
ADVANCE BEGINNER:
(AFTER 2 YEARS)
Position: head nurse, senior nurse, nurse clinician
Educ: MAN/MSN 9 units
MAN administration supervision clinical teaching
MSN clinical specialization
Activities:
>advance skills enhancement
>management and leadership activities
>formulate comprehensive nsg care
-patient contened
ROLE OF SUPERIOR
-coaching/supportive
COMPETENT 5 yrs. Supervision, nurse clinically
Nurse Researchers, clinical instructors
EDUCATIONAL Requirement 30 units
 MAN/MSN
ACTIVITIES:
1.Relate and confer w/ health team MP
-RN
-ANCIALLY
-SOCIAL WORKER
2.Propose polices/researcher
4.PROFICIENT
-8-10 YRS
-Position: chief nurse
NSCE Nsg, specialty certification council
-expersite specialization
Clinical nurse specialize
ACTIVITIES:
1.Involvement in new approaches
2.Implementation of research output
5.Expert
12 yrs onward
Position consultant nsg administration
-nsg educ
-nsg research
-nsg practice
- licencing analysis
*president of prof. org.
PNA ADPCN nsg education
-ANSAP nsg practice
-PRE-BON nsg regulation
>ROLE OF SUPERIOR
-EDUC-DOCTORABLE
>ROLE OF SUPERIOR
1. Novice teaching/directing
2. Advance beginner coaching/supporting
3. Competent
4-5. Proficient/expert supporting relegating
Ooooooooooo] TRANSITION
(NOVICE TO EXPERT)
1.NSG EDUCATION
-acquisition of basic
2.NSG REGULATION
-safety regulation
3.NSG PRACTICE
-recruitment > selection
4.INSERVICE TRAINING
-exclusive to recognize employers
*continuing prof. Educ
-complianced of PRE
5.IMPACT Professionalism
- Quality NSG CARE
SIGNIFICANCE OF CORE COMPETENCY
-key areas of responsibility
1. Tool basis for performance evaluation of nurses.
2. Basis for advancement and specialization.
3. Formulation of test syllabus for entrants in the profession.
4. Yardstick for unethical and unprofessional practice.
5. Formulation of communication in nsg.
(11) KEY AREAS OF RESPONSIBILITY
1. Safe and quality nsg care
2. Management of resources and environment
3. Health education
4. Ethico moral responsibility
5. Legal responsibility
6. Personal/professional responsibility
7. Record management
8. Quality improvement
9. Research
10. Communication
11. Collaboration and Teamwork
NURSING ACTIVITIES EMPHAGING SAFETY
1] POST operative patient
- side rails
- post op, complication
- v/s monitoring
2] INTERVIEW/CRITICAL CARE PATIENT
- intake/output
- signs of complication
3] ELDERLY
- high risk far injury
- maximum assistance ADL
- neuro sensory defect.
4] PEDIATRIC
- fall/aspiration
 - always instruct/moiginitor/supervise parent / guardians
(10) RIGHTS OF MED.
1. Right patient
2. Right drug
3. Right route
4. Right dose
5. Right documentation
6. Right time
7. Right education
8. Right assessment
9. Right evaluation
10. Right effect
2. (7) MS
1. Money finance
2. Man tumor
3. Material supplies
4. Moment time
5. Machine equipment
6. Manager aduri
7. Method strategy
(3) AREAS OF LEARNER
1. COGNITIVE knowledge nsg measure: health teaching
2. AFFECTIVE behavior therapeutic communication skills
3. PSYCHOMOTOR skills RETURN DEMO
*collaboration
*evaluate
*independence
>BIOETINES
(4) REFFERENCES FOR ETHICO MORAL DECISION
1. Code of ethics for professionals.
1. nurse and co worker
2. nurse and profession
3. nurse and practice
4. nurse people
5. nurse institution
2. Bio ethical principle
1.Beneficience good
2.Non malificience no harm
3.Varicosity truth
4.Authonomy determination
5.Role fidelity respect
6.Confidentiality right
3. PATIENTS BILL OF RIGHT
1.right to refuse
2.right to dignified death
3.right to accessibility w/ finances
4.right to quality care
4. NURSING JUDGEMENT
- analysis
-critical thinking
LEGAL RESPONSIBILITY
-RA 2164 9173 (2002)
-REASONS FOR AMMENDEMENTS
1. Expansion of nurses roles
2. Explore new opportunities for affective acquisition of SKA
3. Emphasis on nurses employment. (abroad)
BASIS FOR PROFESSIONAL DEVELOPMENT
1.Be a member of prof. org.
2.Participate in sociocivic activities
(voluntarism)
3.Propation of professional image of amerces.
(proper deubrum)
7.RECORD MANAGEMENT
> narrative medico legal
> par existing health problem
>soapie prioritize health problem
TYPES OF INSTITUTIONAL RECORD
1.ANECDOTAL RECORDS records of performance appearance
Evaluation of nurses
2.INCIDENT REPORT
- Narration of what happened
- Record of untoward occurrence/ situation
3.END OF SHIFT
- Endorsement
4.Chenting
- Nurse patient activities
QUALITY IMPROVEMENT
-QUALITY ACCURANCE
(Standard) evaluation of performance within standard.
NURSING AUDIT evaluation of nurses performance of procedures
PERFORMANCE APPEARANCE evaluation of nurses for purpose: promotion
retention, future employment
SELF APPRAISAL
-evaluation of individual performance.
***REEL REVIEW
-evaluation of nurses with common profession
-nsg to nsg
CHARACTERISTICS OF EVALUATION TOOL
1.OBJECTIVITY w/ bias
2.RELIABILITY accuracy
3.VALIADIDY relevance
(2) TYPES OF NSG AUDIT RECORDS
1. ACCUENT - During hospitalization
2. RETROSPECTIVE after discharge
>ERRORS OF EVALUATION
1. HALOS EFFECT strength
2. HORNES EFFECT weakness
3. LINENCY ERROR average
(3) REASONS OF EMPHASIS OF RESEARCH IN NSG.
1. Evidence based practice
2. Enhancement of clinical skills
3. Explore new 1 deas and techniques
COMMUNICATION
*UPWARD SUPERIOR (TOP LEVEL)
*DOWNWARD subordinate
*HORIZONTAL rear/college
*OUTWARD patient relative, significant other
*LINE direct
*BROLEN indirect
 *SQUARE position
*RECTANGLE department
>COLLABORATION
(MANAGEMENT THEORY)
1.Scientific mgt theory (Tailor)
2.Bureaucratic organization (Weber)
3.Mngt fxn (Fayol)
4.Participative mngt (Follet)
5.Hawthorne effect (Mayo)
6.Activities of mgt (Gullick)

>FRUSTRATAL / ESS. AMOUNT OF WORK DECREASE PRODUCTIVITY

1). BEUROCRATIC ORGANIZATION
- System/penalty
1. Formal authority
2. Formulation of polices
3. Rules/Regulation
2). MANAGEMENT FUNCTION (FAYOL 14 BASIC PRINCIPLE)
>Plan
>Organizing
>Command
>Control
>Coordinate
(14) BASIC PRINCIPLE
1. DIVISION OF WORK task assignment, delegation
2. AUTHORITY AND RESPONSIBILITY right to act
3. DICIPLINE compliance w/ rules / regulation
4. UNITY OF COMMAND only one superior
5. UNITY OF DIRECTION one plan, goal, objective fortune morality
6. SUBORDINATION channels of communication
(PATRICIA BENNER)
*NOVICE limited, needs supervision/inflexion
*ADV. BEGINNER demonstrate acceptable performance
*COMPETENT consciously plan nursing plan
*PROFICIENT general to specific
*EXPERT flexible
7. RENUMERATION incentives/benefits conversation
8. CENTRALIZATION
LEVELS OF MANAGER
1.Front line 1st level head nurse
2.Middle level supervisor
3.Top level executive nsg direction chief nurse
9.SCHOLAR CLAIM tolerance of work load of nurses patient (ratio)
*Nurse to nurse scapular method
10.INITIATIVE willing to serve
11.EQUITY fairness and just / treatment employment
12.ESPRITD CORP teamwork
13.HIRARCHY flow of org.
14.DEPARTMENTATION division of group task
PARTICIPATION MGT COLLECTIVE DECISION MAKING
-ACTIVITIES OF MGT.
*Planning
*Organization
*Staffing
*Directing
*Coordination
*Reporting
*Budgeting
6. HAWTHORNE AFFECT
- attends to needs of employees productive
7. Theory x lazy
Theory y motivated
Theory z factors lead long term committed
Theory m effect of environment to work performance
8. EMPLOYEE PARTICIPATION
-discouragement (passive response)
TYPES OF LEADER
*NATURAL LEADER self totality
*CHARESMATIC LEADER characteristic charisman power
*RATIONAL LEADER thinks right always authentic
*CONCENSUS LEADER majority
TYPES:
1.OVERT consultation
2.COVERT w/ consultation
3.DEVELOPMENT physiology
4.PLANNED projected
PHASES OF TRANSITION
1.ENDING 2.NEUTRAL ZONE 3.NEW BEGINNING
A.POSSING -ANALYSIS -ACCEPTING
B.LETTING GO -CONFLICT
-DECISION -CONSCIENCE
>PHASES OF CHANGE
Denial primary response
Resistance majority
Exploration analysis
Commitment offering self
>STAGES OF CHANGE
1. UN FREEZING awareness of the problem
2. CHANGING - possible solution
3. REFRECING specific solution
>MANEGERIAL GRID
-people
-production
(4) SYSTEM APPROACH
1. BENEVOLENT AUTHORITATIVE reward
2. EXPLOITIVE AUTHORITATIVE threats, force punishment
3. CONSULTATIVE offers reward
4. PARTICIPATIVE encouragement
- no expectation
(3) MAJOR ROLES OF MANAGER
ACCORDING TO (Mintzberg)
1.Interpersonal - leader laiason ,
2.Informational monitoring role spokes person, disseminating
3.Decissional problem discover untrepreneur
(2) MAJOR ROLES OF MANAGER
1. Accountability answer own action has obligation to act
- admit mistake rather blaming other
- assume responsibility that is w/ in score of practice
2. Leadership interpersonal relationship
LEADERSHIP STYLE DIRECTING
1-2. AUTRICRATIC/LAUYZER FAINE
-no monitoring for progression
-abdicates responsibility
3. DEMOCRATIC manager acts as faithlitator but majory decides
4. PARTICIPATIVE/BEUROCRATIC it promotes feedback but manager
decides.
TYPES OF CONFLICT
1.INTRAPERSONAL self conflict
2.INTERPERSONAL self and other
3.INTRAGROUP w/ in group
4.INTERGROUP one group to other

PLANNING
1.Strategy plan Long term/broad
2.Operational plan daily/short term
3.Contigency urgency
4.Projectal plan expected
ELEMENTS OF PLANNING
1.Forecasting
2.Establish mission/vision and polices
3.Bun getting
HOSPITAL population serve-carative-rehabilitation
HOSPITAL LICENSURE
1.diagnose
2.treat tend
3.care sundered
HOSPITAL categories (Phil health)
1.Primary 49