ETIOLOGY extreme stress or trauma current situation that arouses intense emotional pain.

-reactivated or re-experienced unconscious defense mechanism that protects a person from the emotional pain of experiences or conflicts that have been repressed. SUDDEN TEMPORARY CHANGE OF CONSCIOUSNESS, IDENTITY OR MOTOR BEHAVIOR SO THAT SOME PART OF THE FUNCTIONS ARE LOST. IDENTIFICATION REPRESSION OF IDEAS THAT LEADS TO AMNESIA AND OTHER FORMS OF DISSOCIATION IS CONCEIVED AS A WAY OF PROTECTING THE INDIVIDUAL FROM EMOTIONAL PAIN ARISING FROM EITHER DISTURBING EXTERNAL CIRCUMSTANCES OR INTERNAL PSYCHOLOGIC CONFLICTS Dissociative states refer to the splitting off or removal from conscious awareness of some information, emotion, feeling, or mental function. PSYCHOGENIC AMNESIA amnesia is a sudden loss of memory or an inability to recall important personal information.. The precipitant - severe psychosocial stress, such as the threat of physical injury or death- intensely disturbing event. GLOBAL - TOTAL LOSS OF MEMORY FOR EVENTS THAT OCCURRED DURING A PERIOD RANGE FROM FEW HOURS TO A WHOLE LIFETIME ANTEROGRADE RECENT EVENTS RETROGRADE DISTANT EVENTS PSYCHOGENIC FUGUE The major feature of psychogenic fugue is sudden, unexpected travel away from home or locale with the assumption with a new identities (partial or complete) and a forgetting of ones previous identity. -travel and behavior appear normal to casual observers, -person is not wandering in a confused state. WANDERS FAR - FORGETS PAST LIFE AND ASSOCIATIONS, IS UNAWARE OF HAVING FORGOTTEN ANYTHING. WHEN HE RETURNS DOES NOT REMEMBER THE PERIOD OF FUGUE. DEPERSONALIZATION The sense of ones reality is changed but the patient is oriented as to time, place, and person. In depersonalization, the person feels detached from the parts of his body or mental processes. It involves an altered perception of self so that the person feels unreal or strange. It could also involved feeling like a robot or as if the person were in a dream. Depersonalization is often accompanied by symptoms of derealization in which the person feels that the outside world is changed or unreal. FEELING OF DETACHMENT

FROM THE SELF MULTIPLE-PERSONALITY DISORDER/ DISSOCIATIVE IDENTITY DISORDER The major feature is the existence within the person of two or more distinct personalities. TRANSITION FROM OE PERSONALITY TO ANOTHER IS SUDDEN AND DRAMATIC -The transition from one personality to another occurs suddenly at times of emotional stress. The original personality is unaware of the secondary personalities. However, the personalities are aware of each other in varying degrees and are aware of the original personality. TWO OR MORE DISTINCT PERSONALITIES. Each personality is quite different from the others and from the original personality. Each personality has its own name, behavior traits, memories, emotional characteristics, and social relations. Secondary personalities are of varying ages, races, and sex. The most common personality is a fearful, terrified child and the next is the persecutor personality modeled on the abuser(s).

PSYCHOTHERAPEUTIC MANAGEMENT OF DISSOCIATIVE DISORDERS Management : PSYCHOANALYSIS HYPNOSIS , DREAM ASSOC. , FREE ASSOCIATION a. The nurses relationship with the person experiencing amnesia and fugue includes interventions to establish trust and support b. The nurse will assist with gathering data regarding feelings, conflicts, or situations that the patient experienced prior to his amnesia or the fugue state. c. The nurse will slowly help/ assist the patient to deal with anxiety and conflicts in his life. d. With MPD the treatment goal is to ultimately integrate the personalities so that they can live together in the original personality.

CRISIS AND CRISIS INTERVENTION SITUATION THAT OCCURS WHEN AN INDIVIDUALS HABITUAL COPING ABILITY BECOMES INEFFECTIVE TO MEET THE DEMANDS OF THE SITUATION TYPES : SOCIAL MATURATIONAL / DEVELOPMENTAL SITUATIONAL / ACCIDENTAL CRISIS STATE LAST 4-6 WKS, SELF LIMITING INDIVIDUALIZED , AFFECTING SUPPORT SYSTEM ( BASED ON SELF

-PERCEPTION) CAN PROMOTE GROWTH AND NEW BEHAVIORS PERSONS BECOMES PASSIVE AND SUBMISSIVE STAGES OF CRISIS D ENIAL I NCREASED TENSION AND ANXIETY D ISORGANIZATION A TTEMPTS TO REORGANIZE ;ATTEMPTS TO ESCAPE;GENERAL REORGANIZATION CRISIS INTERVENTIONS GOAL DIRECTED, FOCUS ON HERE AND NOW; FOCUS ON CLIENTS IMMEDIATE PROBLEM ACTIVE AND DIRECTIVE TO IDENTIFY AND MOBILIZE RESOURCES EXPLORE UNDERSTANDING OF PROBLEM ; HELP CLIENT BECOME AWARE OF FEELINGS AND VALIDATE THEM; DEVELOP A PLAN ; FIND NEW COPING SKILLS AND MANAGE FEELINGS 3C C- catharsis C- coping C- contingency

Classification of Pregnancy Gravida number of time of pregnancy regardless of outcome including the present pregnancy Nulligravida a woman whos never been pregnant Primigravida a pregnant woman for the first time Multigravida pregnancy for the 2nd ,3rd, 4th and 5th time Grandmultigravida 6th pregnancy and above BQ Para the number of pregnancy that had reach the age of viability which is 20 weeks

AOG. Abortion is not included. Multifetal pregnancy, twins or triplets is counted as 1 in parity count. Nullipara a woman who has been given birth to a baby beyond 20 weeks AOG Primipara a woman who had given birth to one baby beyond 20 weeks AOG Multipara a woman who had given birth two or more babies beyond 20 weeks AOG Grandmultipara a woman who had given birth six or more babies beyond 20 weeks AOG

Diagnosis of Pregnancy Presumptive Signs and Symptoms Subjective: usually felt by the mother Least indicative of pregnancy Cannot be documented by examiner Breast changes Feeling a breast tenderness (Mastalgia) Fullness or tingling sensation Enlargement and darkening of areola Nausea and vomiting Frequent urination Fatigue/ Lassitude Uterine enlargement Quickening Linea Nigra Chloasma / Melasma Gravidarum Striae gravidarum

Probable Signs and Symptoms Objective: can be documented by examiner Not positive and not yet diagnostic Serum laboratory test: (+) pregnancy test brought by HCG Chadwicks sign Bluish discoloration of the vagina and cervix Goodells sign Softening of the cervix Hegars sign Softening of the lower uterine segment (isthmus) Ladins Sign At 6 weeks, the uterus softens in the anterior midline

along the utero-cervical junction McDonalds Sign The uterus becomes flexible at the uterocervical junction at 7-8 weeks Von Fernwald Sign An irregular softening of the Fundus over the site of implantation at 4 to 5 weeks AOG Piscakeks Sign Irregular softening of the cornual area, it may be confused with uterine myoma or abnormal uterine development. Sonographic evidence of gestational sac Ballotement Braxton Hicks contraction Fetal outline felt by the examiner

Positive Signs and Symptoms Absolute evidence Diagnostic of pregnancy Evidence of fetal outline by ultrasound and x-ray Fetal heart audible by Doppler (10-12 weeks) and fetoscope (16-20 weeks) Fetal movement felt by the examiner

Clients education Skill development for novice nurse prioritization ( which will given as the highest priority by the nurse) subjective vs objective data Nursing process characterictics e.g. dynamic, universal Which is the correct nursing diagnosis for each disease conditon Care of the dying DABDA, terminally il Medication administration: How to prepare the meds e.g. vial and ampule, telephone order critical thinking skills ( How to use ) Medication error requisites e.g. incident report process standard vs quality assurance program Standards of nursing practice DOCUMENTATION ( nasa notes ko ang bullets) SOMR POMR Bioethical principles ( Fideity, veracity, non malifiscence, benefiscence, justice) code of ethics for filipino nurses

RA 9173 - provisions Continuing education program asepsis and infection control --labs WBC, ESR, Neutrophil, basophil, medical vs surgical handwashing BURNS assessment and care acid base imbalance ( acidosis vs alkalosis) incorporated in different disorders therapeutic procedures ( NGT, suctioning, tracheostomy, chest tubes, chest physiotherapy) Diagnostic procedures ( endoscopic procedures, may mga centesis "thora para") - usually preparations Inc. ICP vs shock -- assessment and intervention CAST care includes assessment - plaster of paris vs fiberglass transferring client ( bed to wheelchair or bed to stretcher) Body mechanics and correct positioning ( positioning is incorporated in disease condition) caring for debilitated or unconscious clients safety - restraints, side rails, Radiation safety first aid measures ( poisoning, drowning) in various emergency situation medication administration and calculations ( site to use) advantages and disadvantages bowel and urinary elimination ( stress incontinence, diarrhea, constipation, UTI) Blood pressure correct procedures and contraindications of taking BP oxygenation ( oxygen, pulse oximeter, mechanical ventilator care IV solutions - care and assessment of complications management: PODC planning directing organizing controlling Delegation and authority qualitative vs quantitative research

Documentation written legal record of all pertinent interaction with the patient Clinical record/chart/client record legal document that provides evidence for clients care DOCUMENTATION GUIDELINES 1. Date and Time 2. Timing 3. legibility 4. Permanence 5. Accepted terminology 6. Correct spelling 7. Signature 8. Accuracy 9. sequence 10. appropriateness 11. Completeness 12. Conciseness

13. Legal prudence

PURPOSE OF CLIENTS RECORD Communication Diagnostic and therapeutic procedure Care planning Quality Review Research Decision analysis Education Legal documentation Reimbursement Historical Documentation

DOCUMENTATION SYSTEM 1. Source oriented Medical Record 2. Problem oriented Medical record 3. PIE documentation 4. Focus Charting 5. Charting by exceptiom 6. Computerized Documentation 7. Case Management 1. Source oriented medical record (SOMR) >traditional clients record >records are separated by each healthcare member >narrative charting written notes that include routine care, normal findings and clients problem > Convenient because provider from each discipline can easily locate the form on which to record data >expedient during emergency >DISADVANTAGE: info about clients problem is scattered and difficult to locate the chronological order COMPONENTS OF SOMR 1. Admission sheet demographic data of patient, date and time of admission, admitting diagnosis, attending physician, insurance information 2. Initial Nursing assessment findings from initial nursing history and PA 3. Graphic Record V/S, MIO and O2 Sat 4. Daily Record care activity, diet, bathing and elimination record 5. Special flow sheet fluid balance record and skin assessment

6. Medication record meds and name of person who administer with initials 7. Narrative Nurses Notes assessment, H. teaching and pt. response 8. Medical History and physical examination past and family medical history, present medical problem, current diagnosis, PE findings by MD 9. Physicians order sheet 10. Physician Progress notes 11. Consultation records report by medical and clinical specialist 12. Diagnostic reports 13. Consultation reports PT and RT 14. Client discharge plan and referral summarY 2. Problem Oriented Medical Record (POMR) >established by lawrence weed in 1960 >data are arranged according to clients problem >each member of HC team contribute to problem list Advantage encourage collaboration among HC team - easily alert caregiver with clients need - easier to track the status of client COMPONENTS OF SOMR 1. Database 2. Problem List 3. Plan of Care 4. Progress Notes

1. Database > demograhic data of pt. >physicians history > results of physical examination >baseline diagnostic test (*) Data are constantly updated as clients health status - CBQ 2. Problem List > derived from database kept in front of the chart >problems are listed in order and list is constantly updated as other problem are solved > all members of HC team contribute to problem list (physiologic, psychologic, social, culltural, spiritual and developmental 3. Plan of care > made reference upon the present active clients problem

4. Progress Notes > made by all member of HC team involve in pt care >SOAP , SOPIE, SOPIER - CBQ 3. PIE Documentation (problem, intervention, evaluation) Components 1. Client care assessment 2. Flow sheet 3. Progress notes Advantage : Eliminate traditional plan and incorporate an ongoing care plan to progress notes - nurses will not create and update separate plan Disadvantage > nurse must review all nurses notes before giving care to determine which problems are current and which intervention is effective

3. PIE Documentation (problem, intervention, evaluation) Components 1. Client care assessment 2. Flow sheet 3. Progress notes Advantage : Eliminate traditional plan and incorporate an ongoing care plan to progress notes - nurses will not create and update separate plan Disadvantage: > nurse must review all nurses notes before giving care to determine which problems are current and which intervention is effective 4. Focus Charting > strength the focus of care > use three columns 1. date and time 2. Focus 3. Progress notes DAR ( data, action, response) FOCUS: - maybe condition, Nsg. Dx, a behavior, S/sx, acute change in client condition, client strength

5. Charting by Exception (CBE) > a type of charting that only abnormal or significant findings or exception to norms are recorded

> 3 Elements 1. Flow Sheet 2. Standards of nursing Care 3. Bedside access to chart forms 6. Computerized Documentation > Needs individualized password > patients status can be easily updated 7. Case Management > Emphasize on quality, cost effective care care delivered within the established length of stay > multidisciplinary approach