KAREN KATRIN MAGSILANG TABUNAN
819 Barangay Baloc, Sto. Domingo Nueva Ecija
tkarenkatrin@yahoo.com
09268344124
PERSONAL DATA
City Address: Sto. Domingo
Provincial Address: Nueva Ecija
Date of Birth: January 26, 1989
Place of Birth: Brgy. Baloc, Sto. Domingo Nueva Ecija
Age: 20 years old
Civil Status: Single
Citizenship: Filipino
Gender: Female
Height: 5’2”
Weight: 45 kilograms/99 lbs
Religion: Roman Catholic
Father’s Name: Rolando L. Tabunan
Mother’s Name: Josefina M. Tabunan
Address: Baloc, Sto. Domingo Nueva Ecija
Languages or dialects you can speak or write: English, Filipino
Special Skills: Operating Computer, Cooking, Singing, Lettering
EDUCATIONAL BACKGROUND
June 2009 Nurse Licensure Examination Passer
With an average rating of 75%.
College Level: Nueva Ecija University of Science and Technology
General Tinio Street, Cabanatuan City,
Bachelor of Science in Nursing
Date Graduated: April 2, 2009
Secondary Level: Sto. Domingo National Trade School
Baloc, Sto. Domingo Nueva Ecija
Date Graduated: April 15, 2005
Elementary Level: Baloc Elementary School
Baloc, Sto. Domingo Nueva Ecija
Date Graduated: March 30, 2001
SEMINAR, WORKSHOP AND TRAININGS ATTENDED
Personality Enhancement and Human Relation
Doña Asuncion G. Romulo Memorial Hall
Nueva Ecija University of Science and Technology
College of Health Sciences, Cabanatuan City, August 25-26, 2005
Nursing and Allied Health Symposium:
Risk Management in Hospital
Nueva Ecija Convention Center
Palayan City, Nueva Ecija, October 5, 2007
Nursing and Allied Health Symposium:
Different Age Groups: Skin Disorders and Prevention
Nueva Ecija Convention Center
Palayan City, Nueva Ecija, October 5, 2007
Nursing and Allied Health Symposium:
Quality Improvement in Health Care
Nueva Ecija Convention Center
Palayan City, Nueva Ecija, October 5, 2007
Organizational Capacity Assessment Workshop
Federation of Central Luzon Youth at Work Incorporated
Shahani Conference Room, PCC Hostel
Philippine Carabao Center, Central Luzon State University
Science City of Munoz, Nueva Ecija, January 13-14, 2006
Leadership Training Seminar
Christian Children’s Fund, Saranay Project
The Farm, Barangay Cabu, Cabanatuan City,
September 16-17, 2006
CHARACTER REFERENCES
Name Occupation Address
1. Eppie DC. Bugarin Dean, College of Nursing, NEUST Cabanatuan City,NE
2. Jennifer M. Lopez Clinical Instructor, NEUST Cabanatuan City,NE
3. Diacono A. Lee, Jr. Barangay Captain Baloc, Sto. Domingo,NE
I hereby certify that the above information is true and correct.
Karen Katrin M. Tabunan
Monday, January 18, 2010
Sunday, July 26, 2009
watawat
WATAWAT NG PILIPINAS
Ang pambansang watawat ng Pilipinas ay may araw na walo ang sinag, at tatlong bituin, parehong kulay ginto, at nakapatong sa puting tatsulok na equilateral. Sa gawing taas ng natitirang bahagi ay ang kulay asul at sa ibaba nito ang kulay pula. Ang pagkakabagay-bagay ng watawat ay 1:2.Ang watawat ay unang naisip gawin ni Emilio Aguinaldo. Si Marcela Agoncillo, ang kanyang anak na si Lorenza, at ang pamangkin ni Jose Rizal na si Josefina Herbosa de Natividad ang nagtahi ng unang bandila sa Hong Kong. (Sa ibang aklat, ang pangalan ng pamangkin ay Delfina Herbosa de Natividad.)Ito ang paglalarawan sa orihinal na watawat ng Pilipinas na na-konsepto ni Hen. Emilio Aguinaldo. Mas marahan ang kulay asul nito kaysa sa kasalukuyang pinag-uutos na kulay royal blue, mas marami itong sinag noon pero walo rin ang naging mga dulo, at may mahiwagang mukha.Ayon sa Pamamahayag ng Kalayaan ng Pilipinas ng Hunyo 12, 1898, ang puting tatsulok ang natatanging sagisag ng Katipunan na sa pamamagitan ng pagsasanib ng dugo ay nakapanghikayat sa mga Pilipino na sumama sa rebolusyon. Ang tatlo nitong bituin ay kumakatawan sa tatlong heograpikal na grupo ng mga isla sa bansa: Luzon, Visayas, at Mindanao, bagama't sa Deklarasyon ng Kalayaan ng Pilipinas, ang isa sa tatlong bituin nito ay orihinal na kumatawan sa isla ng Panay, imbes na Visayas. Gayunpaman, kapwa silang nagpapahiwatig ng mismong ideya: ang pagkakaisa ng mga magkakahiwalay na tao at kultura sa iisang Nasyon. Ang walong sinag ng araw ay sumasagisag sa walong probinsyang unang nag-alsa sa Kastila: Maynila, Cavite, Bulacan, Pampanga, Nueva Ecija, Bataan, Laguna, at Batangas.Bagaman tinuturing na isang lungsod ang Maynila, ang pagkakadagdag nito sa lupon ay wasto sapagka't noong 1898, ang Maynila at ang kanyang mga suburbyo ay pinangasiwaan bilang isang hiwalay at nagsasariling probinsya. Ang lalawigang ito ay kilala ngayon bilang Pambansang Kabiserang Rehiyon.Ang kabuluhan ng mga kulay na pula, puti at asul ay ang mga sumusunod: Ang puting tatsulok ay sumasagisag sa pagkakapantay-pantay at kapatiran; asul para sa kalayaan, katotohanan, at katarungan; at pula para sa kabayanihan at kagitingan. Sinasabing hinalintulad ang bandila sa bandila ng Cuba na, tulad ng Pilipinas, ay nakikibaka para sa kalayaan mula sa Espanya noong panahong din yon. Ito ang unang opisyal na watawat na naglayong irepresenta ang bansa. Ginawa ng Katipunan sa Naic, Cavite noong 1897.Ang lilim na bughaw na ginamit sa itong watawat ay naging paksa ng kontrobersiya ng halos siyamnapung taon na ang tanda. Mula 1920 hanggang 1985, ang lilim ay navy blue hanggang sa inutos ni Pangulong Ferdinand Marcos na baguhin ito sa lilim na sky blue, mula sa abiso ng mga sirkulong kasaysayan, sa mismong lilim na ginamit sa bandila ng Cuba, na ka-alyado ng bansa noon laban sa Espanya. Dahil sa kakulangan sa materyal at istandardisasyon noong Digmaang Pilipino-Amerikano, ang mga taga-suporta ng lilim "navy blue" at "sky blue" ay nagpasa ng kanikanilang katibayan na kapwang sumasalungat sa bawat argumento. Silipin Mga Watawat ng Himagsikang PilipinoHabang klarong nilalahad ng mga opisyal na dokumentong rebolusyonaryo na ang orihinal na lilim ng asul na ginamit sa unang bandila ay azul oscura, na kung isasalin sa Filipino ay "malabong bughaw" o madilim, at kung ano ang eksaktong lilim na tinutukoy nito ang siya pa ring magiging paksa ng debate sa mga susunod na taon. Sumasang-ayon ngayon ang mga historiador na ang azul oscura na tinutukoy ay isang mas malalim na lilim kaysa sa sky blue, ngunit mas marahan naman sa navy blue.Para pagpahingahin na ang kontrobersiya, ang kasalukuyang inuutos na lilim ay royal blue, ayon sa Aktong Pangrepublika Blg. 8491. Sa kasamaang palad, ang kilos na ito ay naglikha ng panibagong kontrobersiya sa pagitan ng mga historiador at pulitiko ukol sa kung maaaring gawin ito ng gobyerno na baguhin ang mga sagisag ng kasaysayan at orihinal na kahulugan ng mga ito para lang sa kaginhawaan ng lahat.Ang watawat ng Pilipinas ay walang-kapares, sapagka't maaari nitong ipakita ang isang kalagayan ng digmaan. Kapag ang bandila ay naka-baligtad at nasa ibabaw ang pula (o nasa kaliwa kung ito ay nakatanghal na patayo), ang ibig sabihin nito ay ang Pilipinas ay nasa nakasabak sa digmaan. Ito ay unang itinaas noong Ika-4 ng Pebrero, 1899, sa simula ng labanan ng Digmaang Pilipino-Amerikano sa mga taong 1899-1913
fil.wikipilipinas.org/index.php?title=Watawat_ng_Pilipinas
www.blogcatalog.com/topic/watawat+ng+pilipinas/
Ang pambansang watawat ng Pilipinas ay may araw na walo ang sinag, at tatlong bituin, parehong kulay ginto, at nakapatong sa puting tatsulok na equilateral. Sa gawing taas ng natitirang bahagi ay ang kulay asul at sa ibaba nito ang kulay pula. Ang pagkakabagay-bagay ng watawat ay 1:2.Ang watawat ay unang naisip gawin ni Emilio Aguinaldo. Si Marcela Agoncillo, ang kanyang anak na si Lorenza, at ang pamangkin ni Jose Rizal na si Josefina Herbosa de Natividad ang nagtahi ng unang bandila sa Hong Kong. (Sa ibang aklat, ang pangalan ng pamangkin ay Delfina Herbosa de Natividad.)Ito ang paglalarawan sa orihinal na watawat ng Pilipinas na na-konsepto ni Hen. Emilio Aguinaldo. Mas marahan ang kulay asul nito kaysa sa kasalukuyang pinag-uutos na kulay royal blue, mas marami itong sinag noon pero walo rin ang naging mga dulo, at may mahiwagang mukha.Ayon sa Pamamahayag ng Kalayaan ng Pilipinas ng Hunyo 12, 1898, ang puting tatsulok ang natatanging sagisag ng Katipunan na sa pamamagitan ng pagsasanib ng dugo ay nakapanghikayat sa mga Pilipino na sumama sa rebolusyon. Ang tatlo nitong bituin ay kumakatawan sa tatlong heograpikal na grupo ng mga isla sa bansa: Luzon, Visayas, at Mindanao, bagama't sa Deklarasyon ng Kalayaan ng Pilipinas, ang isa sa tatlong bituin nito ay orihinal na kumatawan sa isla ng Panay, imbes na Visayas. Gayunpaman, kapwa silang nagpapahiwatig ng mismong ideya: ang pagkakaisa ng mga magkakahiwalay na tao at kultura sa iisang Nasyon. Ang walong sinag ng araw ay sumasagisag sa walong probinsyang unang nag-alsa sa Kastila: Maynila, Cavite, Bulacan, Pampanga, Nueva Ecija, Bataan, Laguna, at Batangas.Bagaman tinuturing na isang lungsod ang Maynila, ang pagkakadagdag nito sa lupon ay wasto sapagka't noong 1898, ang Maynila at ang kanyang mga suburbyo ay pinangasiwaan bilang isang hiwalay at nagsasariling probinsya. Ang lalawigang ito ay kilala ngayon bilang Pambansang Kabiserang Rehiyon.Ang kabuluhan ng mga kulay na pula, puti at asul ay ang mga sumusunod: Ang puting tatsulok ay sumasagisag sa pagkakapantay-pantay at kapatiran; asul para sa kalayaan, katotohanan, at katarungan; at pula para sa kabayanihan at kagitingan. Sinasabing hinalintulad ang bandila sa bandila ng Cuba na, tulad ng Pilipinas, ay nakikibaka para sa kalayaan mula sa Espanya noong panahong din yon. Ito ang unang opisyal na watawat na naglayong irepresenta ang bansa. Ginawa ng Katipunan sa Naic, Cavite noong 1897.Ang lilim na bughaw na ginamit sa itong watawat ay naging paksa ng kontrobersiya ng halos siyamnapung taon na ang tanda. Mula 1920 hanggang 1985, ang lilim ay navy blue hanggang sa inutos ni Pangulong Ferdinand Marcos na baguhin ito sa lilim na sky blue, mula sa abiso ng mga sirkulong kasaysayan, sa mismong lilim na ginamit sa bandila ng Cuba, na ka-alyado ng bansa noon laban sa Espanya. Dahil sa kakulangan sa materyal at istandardisasyon noong Digmaang Pilipino-Amerikano, ang mga taga-suporta ng lilim "navy blue" at "sky blue" ay nagpasa ng kanikanilang katibayan na kapwang sumasalungat sa bawat argumento. Silipin Mga Watawat ng Himagsikang PilipinoHabang klarong nilalahad ng mga opisyal na dokumentong rebolusyonaryo na ang orihinal na lilim ng asul na ginamit sa unang bandila ay azul oscura, na kung isasalin sa Filipino ay "malabong bughaw" o madilim, at kung ano ang eksaktong lilim na tinutukoy nito ang siya pa ring magiging paksa ng debate sa mga susunod na taon. Sumasang-ayon ngayon ang mga historiador na ang azul oscura na tinutukoy ay isang mas malalim na lilim kaysa sa sky blue, ngunit mas marahan naman sa navy blue.Para pagpahingahin na ang kontrobersiya, ang kasalukuyang inuutos na lilim ay royal blue, ayon sa Aktong Pangrepublika Blg. 8491. Sa kasamaang palad, ang kilos na ito ay naglikha ng panibagong kontrobersiya sa pagitan ng mga historiador at pulitiko ukol sa kung maaaring gawin ito ng gobyerno na baguhin ang mga sagisag ng kasaysayan at orihinal na kahulugan ng mga ito para lang sa kaginhawaan ng lahat.Ang watawat ng Pilipinas ay walang-kapares, sapagka't maaari nitong ipakita ang isang kalagayan ng digmaan. Kapag ang bandila ay naka-baligtad at nasa ibabaw ang pula (o nasa kaliwa kung ito ay nakatanghal na patayo), ang ibig sabihin nito ay ang Pilipinas ay nasa nakasabak sa digmaan. Ito ay unang itinaas noong Ika-4 ng Pebrero, 1899, sa simula ng labanan ng Digmaang Pilipino-Amerikano sa mga taong 1899-1913
fil.wikipilipinas.org/index.php?title=Watawat_ng_Pilipinas
www.blogcatalog.com/topic/watawat+ng+pilipinas/
Thursday, February 26, 2009
burns
BURN INJURY
Burns are caused by a transfer of energy from a heat source to the body. It is a cell destruction of the layers of the skin and the resultant depletion of fluid and electrolytes. The depth of the injury depends on the temperature of the burning agent and the duration of contact with it. It disrupts the skin which leads to increased fluid loss, infection, hypothermia, scarring, and changes in function, appearance and body image.
A. Young children and elderly people are at higher risk for burn injury.
B. Those younger than 5 and older than 40 years old are at high risk for death after burn trauma.
CAUSES OF BURN INJURY
• Scalds (steam, hot bath water, tipped over coffee cups, cooking fluids, etc.)
• Contact with flames or hot objects (from stove, fireplace, curling irons, etc.)
• Chemical burns (from swallowing things like drain cleaner or watch batteries or spilling chemicals such as bleach on to skin.)
• Electrical burns (from biting on electrical cords or sticking fingers or objects in electrical outlets )
• Overexposure to sun.
ASSESSMENT OF BURN INJURY
First-degree burns (Superficial partial-thickness burns)
The epidermis and possibly a portion of the dermis are injured. (E.g. sunburn)
S/Sx:
a. Pink to red with slight edema which subsides quickly
b. Pain may last up to 48 hours
c. Relieved by cooling
Reparative process:
a. In about 5 days, epidermis peels.
b. Itching and pink skin persist for about a week.
c. No scarring.
d. Heals spontaneously if it does not become infected within 10 days-2 weeks.
Second-degree burns (Deep partial-thickness burns)
The epidermis and the upper to deeper portions of the dermis are injured. (E.g. Scald)
S/Sx:
a. Superficial layers of the skin are destroyed.
b. Pink or red
c. Blister form ( vesicles);weeping
d. Edematous, elastic
e. Wound moist and painful
f. Deep dermal
g. Edematous reddened areas blanch on pressure.
Reparative process:
a. Takes several weeks to heal.
b. Scarring may occur
Third-degree burns (Full-thickness burns)
The epidermis, entire dermis and sometimes the underlying tissue are injured. (E.g. Burns from a flame or electrical current.)
S/Sx:
a. Destruction of epithelial cells-epidermis and dermis destroyed.
b. Reddened areas do not blanch with pressure.
c. Not painful; coloration varies from white to brown leathery devitalized tissue- eschar.
Reparative process
a. Eschar must be removed.
b. For areas larger than 3-5 cm, grafting is required.
c. Expect scarring and losses of skin function.
d. Areas require debridement, formation of granulation tissue and grafting.
TYPES OF BURNS
a. Thermal burns: Caused by exposure to flames, hot liquids, steam or hot objects.
b. Chemical burns: caused by tissue contact with strong alkali or organic compounds, systemic toxicity from cutaneous absorption occurs.
c. Electrical burns: caused by heat generated by electrical energy as it passes through the body.
d. Radiation burns: caused by exposure to radioactive source, UV light and x-rays.
WHEN TO SEEK IMMEDIATE MEDICAL HELP?
a. You think the patient has a second or third-degree burn.
b. The burned area is large, even if it seems like a minor burn. For any burns that appears to cover more than 10% of the body. Do not use wet compresses because it can cause body temperature to drop. Instead cover the area with a clean, soft cloth or towel.
c. Burn comes from fire, an electrical wire or socket or chemicals.
d. The burn is on face, scalp, hands, joint surfaces or genitals.
e. The burn looks infected (with swelling, pus, and increasing redness).
METHODS IN ESTIMATING THE EXTENT OF THE INJURY
a. Lund and Browder Method- Modifies percentage s for body segment according to age. It provides more accurate estimate of the burn size. It uses a diagram of the body divided into sections with the representative % of the TBSA for ages throughout the lifespan.
b. Palm Method- It is used to estimate percentage of scattered burns using the size of the patient’s palm (1% of BSA) to assess the extent of burn injury.
c. Rule of nine Method- an estimation of the TBSA burned by dividing the body into multiples of nine
ASSESSMENT FOR THE PATIENT WITH BURNS
a. Review the initial assessment data obtained.
b. Focus on the major priorities of any trauma patient: Airway, Breathing, and Circulation.
c. Assess respiratory status as first priority (airway patency and breathing adequacy).
d. Note any increased hoarseness, stridor, and abnormal respiratory rate and depth or mental changes from hypoxia.
e. Evaluate circulation (apical, carotid and femoral pulses).
f. Check vital signs frequently.
g. Arrange for patient with facial burn to be assessed for corneal damage.
h. Assess depth of wound and identify areas of full and partial thickness injury.
i. Assess neurologic status: consciousness, psychological status, pain and anxiety and behavior.
PHASES OF MANAGEMENT OF THE BURN INJURY
Emergent phase
Begins at the time of injury and ends with the restoration of capillary permeability usually at 48-72 hours after the injury. The primary goal is to prevent hypovolemic shock and preserve vital organ functioning. This includes prehospital care and emergency room care.
Resuscitative phase
Begins with the initiation of fluids and ends when capillary integrity returns to near normal levels and the large fluid shifts have decreased. The amount of fluid administered is based on the client’s weight and extent of injury. Most fluid replacement formulas are calculated from the time of injury and not from the arrival at the hospital. The goal is to prevent shock by maintaining adequate circulating blood volume and maintaining the vital organ perfusion.
Acute phase
Begins when the patient is hemodynamically stable, capillary permeability is restored and diuresis has begun. This usually begins 48-72 hours after the time of injury. The goal of this is infection control, wound care, wound closure, nutritional support, pain management and physical therapy.
Rehabilitative phase
This is the final phase of burn care. It overlaps the acute care phase and goes well beyond hospitalization. The goal of this phase is designed so that the client can gain independence and achieve maximal function.
MANAGEMENT OF BURN INJURY
Fluid Resuscitation
a. Indications:
a. Adults with burns involving more than 15%-20% TBSA
b. Children with burns involving more than 10%-15% TBSA.
c. Patient with electrical injury, the elderly, or those with cardiac or pulmonary disease and compromised response to burn injury.
b. The amount of fluid administered depends on how much intravenous fluid per hour is required to maintain a urinary output of 30-50ml/hr.
c. Successful fluid resuscitation is evidenced by stable v/s, adequate urine output, palpable peripheral pulses and clear sensorium.
Pain management
a. Administer Morphine SO4 or Demerol as prescribed by the IV route; avoid IM or SC routes because the absorption through the soft tissue is unreliable when hypovolemia and large fluid shifting are occurring.
b. Avoid administering oral medication because of the possibility of GI dysfunction.
c. Medicate the patient prior to painful procedures.
Nutrition
a. Maintain NPO status until the bowel sounds are heard; then advanced to clear liquids as prescribed.
b. Nutrition maybe provided via enteral tube feeding.
c. Provide a diet high in protein, carbohydrates, vitamins and minerals
Topical antimicrobial agents
Silver sulfadiazine
a. Most widely used agent and least common incidence of side effects.
b. May cause Transient leucopenia that disappears 2-3 days of treatment.
c. Used with open treatment, light or occlusive dressing.
d. Applied once or twice daily after thorough wound cleansing.
Mafenide acetate 10% cream or 5% solution (Sulfamylon)
a. Painful during and for a while after application.
b. May cause metabolic acidosis, not used if >20% TBSA
c. Cream must be reapplied 12 hours to maintain therapeutic effectiveness.
d. Solution concentration is maintained with bulky wet dressings, rewet every2-4 hours.
Other topical dressings:
a. Silver nitrate
b. Cerium nitrate
c. Povidone iodine
d. Gentamycin
e. Polymixin B-Bacitracin ointment
Auto grafting
It is a surgical removal of a thin layer of a patient’s own unburned skin, which is then applied to the excised burn wound.
Temporary wound coverings
Amnion
It comes from amniotic membrane from human placenta, dressing is changed q48hours.
Allograft (Homograft)
It is donated from human cadaver; skin is harvested within 24 hours after death. Monitor for wound exudates and infection. Rejection can occur within 24 hours.
Xenograft (Heterograft)
It is a porcine skin which is harvested after slaughter and preserved. Rejection can occur within 24-72 hours. It is replaced q2-5days until the wound heals naturally or until closure with autugraft is complete.
Biosynthetic and synthetic
A Visual inspection of the wound is possible; s dressings are transparent or translucent.
TYPES OF SKIN GRAFTING
Split thickness
Graft half of the epidermis, applied in sheets or postage stamp-like pieces.
Full thickness
Graft consisting of epidermis and dermis; it is commonly used for reconstructive surgery months or years after the initial injury.
Pedicle flap
Commonly used for reconstructive surgery months or years after the initial injury.
Cultured Epithelium
Used of the client’s unburned skin. Keratinocytes are isolated and epithelial cells are cultured in a laboratory; these cells then attached to the burned wound.
NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
COLLEGE OF NURSING
General Tinio St. Cabanatuan City
Submitted by:
Karen Katrin M. Tabunan
BSN IV-J
Submitted to:
Ms. May-flor Lazatin
Ms. Marian Legaspi
Head nursing
Ms. Jean Christian Mangoba
Clinical instructor
Burns are caused by a transfer of energy from a heat source to the body. It is a cell destruction of the layers of the skin and the resultant depletion of fluid and electrolytes. The depth of the injury depends on the temperature of the burning agent and the duration of contact with it. It disrupts the skin which leads to increased fluid loss, infection, hypothermia, scarring, and changes in function, appearance and body image.
A. Young children and elderly people are at higher risk for burn injury.
B. Those younger than 5 and older than 40 years old are at high risk for death after burn trauma.
CAUSES OF BURN INJURY
• Scalds (steam, hot bath water, tipped over coffee cups, cooking fluids, etc.)
• Contact with flames or hot objects (from stove, fireplace, curling irons, etc.)
• Chemical burns (from swallowing things like drain cleaner or watch batteries or spilling chemicals such as bleach on to skin.)
• Electrical burns (from biting on electrical cords or sticking fingers or objects in electrical outlets )
• Overexposure to sun.
ASSESSMENT OF BURN INJURY
First-degree burns (Superficial partial-thickness burns)
The epidermis and possibly a portion of the dermis are injured. (E.g. sunburn)
S/Sx:
a. Pink to red with slight edema which subsides quickly
b. Pain may last up to 48 hours
c. Relieved by cooling
Reparative process:
a. In about 5 days, epidermis peels.
b. Itching and pink skin persist for about a week.
c. No scarring.
d. Heals spontaneously if it does not become infected within 10 days-2 weeks.
Second-degree burns (Deep partial-thickness burns)
The epidermis and the upper to deeper portions of the dermis are injured. (E.g. Scald)
S/Sx:
a. Superficial layers of the skin are destroyed.
b. Pink or red
c. Blister form ( vesicles);weeping
d. Edematous, elastic
e. Wound moist and painful
f. Deep dermal
g. Edematous reddened areas blanch on pressure.
Reparative process:
a. Takes several weeks to heal.
b. Scarring may occur
Third-degree burns (Full-thickness burns)
The epidermis, entire dermis and sometimes the underlying tissue are injured. (E.g. Burns from a flame or electrical current.)
S/Sx:
a. Destruction of epithelial cells-epidermis and dermis destroyed.
b. Reddened areas do not blanch with pressure.
c. Not painful; coloration varies from white to brown leathery devitalized tissue- eschar.
Reparative process
a. Eschar must be removed.
b. For areas larger than 3-5 cm, grafting is required.
c. Expect scarring and losses of skin function.
d. Areas require debridement, formation of granulation tissue and grafting.
TYPES OF BURNS
a. Thermal burns: Caused by exposure to flames, hot liquids, steam or hot objects.
b. Chemical burns: caused by tissue contact with strong alkali or organic compounds, systemic toxicity from cutaneous absorption occurs.
c. Electrical burns: caused by heat generated by electrical energy as it passes through the body.
d. Radiation burns: caused by exposure to radioactive source, UV light and x-rays.
WHEN TO SEEK IMMEDIATE MEDICAL HELP?
a. You think the patient has a second or third-degree burn.
b. The burned area is large, even if it seems like a minor burn. For any burns that appears to cover more than 10% of the body. Do not use wet compresses because it can cause body temperature to drop. Instead cover the area with a clean, soft cloth or towel.
c. Burn comes from fire, an electrical wire or socket or chemicals.
d. The burn is on face, scalp, hands, joint surfaces or genitals.
e. The burn looks infected (with swelling, pus, and increasing redness).
METHODS IN ESTIMATING THE EXTENT OF THE INJURY
a. Lund and Browder Method- Modifies percentage s for body segment according to age. It provides more accurate estimate of the burn size. It uses a diagram of the body divided into sections with the representative % of the TBSA for ages throughout the lifespan.
b. Palm Method- It is used to estimate percentage of scattered burns using the size of the patient’s palm (1% of BSA) to assess the extent of burn injury.
c. Rule of nine Method- an estimation of the TBSA burned by dividing the body into multiples of nine
ASSESSMENT FOR THE PATIENT WITH BURNS
a. Review the initial assessment data obtained.
b. Focus on the major priorities of any trauma patient: Airway, Breathing, and Circulation.
c. Assess respiratory status as first priority (airway patency and breathing adequacy).
d. Note any increased hoarseness, stridor, and abnormal respiratory rate and depth or mental changes from hypoxia.
e. Evaluate circulation (apical, carotid and femoral pulses).
f. Check vital signs frequently.
g. Arrange for patient with facial burn to be assessed for corneal damage.
h. Assess depth of wound and identify areas of full and partial thickness injury.
i. Assess neurologic status: consciousness, psychological status, pain and anxiety and behavior.
PHASES OF MANAGEMENT OF THE BURN INJURY
Emergent phase
Begins at the time of injury and ends with the restoration of capillary permeability usually at 48-72 hours after the injury. The primary goal is to prevent hypovolemic shock and preserve vital organ functioning. This includes prehospital care and emergency room care.
Resuscitative phase
Begins with the initiation of fluids and ends when capillary integrity returns to near normal levels and the large fluid shifts have decreased. The amount of fluid administered is based on the client’s weight and extent of injury. Most fluid replacement formulas are calculated from the time of injury and not from the arrival at the hospital. The goal is to prevent shock by maintaining adequate circulating blood volume and maintaining the vital organ perfusion.
Acute phase
Begins when the patient is hemodynamically stable, capillary permeability is restored and diuresis has begun. This usually begins 48-72 hours after the time of injury. The goal of this is infection control, wound care, wound closure, nutritional support, pain management and physical therapy.
Rehabilitative phase
This is the final phase of burn care. It overlaps the acute care phase and goes well beyond hospitalization. The goal of this phase is designed so that the client can gain independence and achieve maximal function.
MANAGEMENT OF BURN INJURY
Fluid Resuscitation
a. Indications:
a. Adults with burns involving more than 15%-20% TBSA
b. Children with burns involving more than 10%-15% TBSA.
c. Patient with electrical injury, the elderly, or those with cardiac or pulmonary disease and compromised response to burn injury.
b. The amount of fluid administered depends on how much intravenous fluid per hour is required to maintain a urinary output of 30-50ml/hr.
c. Successful fluid resuscitation is evidenced by stable v/s, adequate urine output, palpable peripheral pulses and clear sensorium.
Pain management
a. Administer Morphine SO4 or Demerol as prescribed by the IV route; avoid IM or SC routes because the absorption through the soft tissue is unreliable when hypovolemia and large fluid shifting are occurring.
b. Avoid administering oral medication because of the possibility of GI dysfunction.
c. Medicate the patient prior to painful procedures.
Nutrition
a. Maintain NPO status until the bowel sounds are heard; then advanced to clear liquids as prescribed.
b. Nutrition maybe provided via enteral tube feeding.
c. Provide a diet high in protein, carbohydrates, vitamins and minerals
Topical antimicrobial agents
Silver sulfadiazine
a. Most widely used agent and least common incidence of side effects.
b. May cause Transient leucopenia that disappears 2-3 days of treatment.
c. Used with open treatment, light or occlusive dressing.
d. Applied once or twice daily after thorough wound cleansing.
Mafenide acetate 10% cream or 5% solution (Sulfamylon)
a. Painful during and for a while after application.
b. May cause metabolic acidosis, not used if >20% TBSA
c. Cream must be reapplied 12 hours to maintain therapeutic effectiveness.
d. Solution concentration is maintained with bulky wet dressings, rewet every2-4 hours.
Other topical dressings:
a. Silver nitrate
b. Cerium nitrate
c. Povidone iodine
d. Gentamycin
e. Polymixin B-Bacitracin ointment
Auto grafting
It is a surgical removal of a thin layer of a patient’s own unburned skin, which is then applied to the excised burn wound.
Temporary wound coverings
Amnion
It comes from amniotic membrane from human placenta, dressing is changed q48hours.
Allograft (Homograft)
It is donated from human cadaver; skin is harvested within 24 hours after death. Monitor for wound exudates and infection. Rejection can occur within 24 hours.
Xenograft (Heterograft)
It is a porcine skin which is harvested after slaughter and preserved. Rejection can occur within 24-72 hours. It is replaced q2-5days until the wound heals naturally or until closure with autugraft is complete.
Biosynthetic and synthetic
A Visual inspection of the wound is possible; s dressings are transparent or translucent.
TYPES OF SKIN GRAFTING
Split thickness
Graft half of the epidermis, applied in sheets or postage stamp-like pieces.
Full thickness
Graft consisting of epidermis and dermis; it is commonly used for reconstructive surgery months or years after the initial injury.
Pedicle flap
Commonly used for reconstructive surgery months or years after the initial injury.
Cultured Epithelium
Used of the client’s unburned skin. Keratinocytes are isolated and epithelial cells are cultured in a laboratory; these cells then attached to the burned wound.
NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
COLLEGE OF NURSING
General Tinio St. Cabanatuan City
Submitted by:
Karen Katrin M. Tabunan
BSN IV-J
Submitted to:
Ms. May-flor Lazatin
Ms. Marian Legaspi
Head nursing
Ms. Jean Christian Mangoba
Clinical instructor
Tuesday, February 10, 2009
eto pa
POTT’S DISEASE
Definition
Pott’s disease is a presentation of extra pulmonary tuberculosis that affects the spine. It is also called tuberculous spondylitis. The original name was formed after Percival Pott, a London Surgeon. It is most commonly localized in the thoracic region (T9, T10) of the spine.
Causative agent
Mycobacterium tuberculosis
Predisposing factors
• Family history of pulmonary tuberculosis
• Poor environment
• Poor nutrition
• Occupation
• Lack of immunization
Signs and Symptoms
• Back pain
• Fever
• Night sweat
• Anorexia
• Weight loss
• Spinal mass
Diagnostic test
• Increase Erythrocyte Sedimentation Rate- markedly elevated due to inflammation
• Tuberculin skin test (Mantoux test/purified protein derivatives) - this determine whether an individual has been infected with the mycobacterium tuberculosis organism. The test usually consists of an intracutaneous injection of tuberculin, a purified protein derivative of the bacillus.
• Bone biopsy- surgical removal of living body tissue for the study and diagnosis. This is performed to analyze the cause and nature of the disease and on tumors or abnormal tissue growths.
• Radiograph of the spine- to determine the severity or extent of the spinal cord damage.
Medical Management
Chemotherapy
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Streptomycin
Vitamin C, D and B complex
Surgical Management
• Anterior Decompression Spinal Fusion (ADSF)- Best surgical intervention for Pott’s disease.
• Traction and Cast- to immobilize the affected extremities.
• Laminectomy- removal of the ruptured disks in the spine
Nursing Management
• Immobilize the spine
• Provide comfort measures.
• Reposition the patient every 2 hours by the help of other personnel.
• Inspect skin for presence of abscess.
• Increase oral fluid intake
• Encourage the patient to verbalize feelings and concerns.
• Observe for signs of respiratory distress.
• Administer medication as prescribed.
Definition
Pott’s disease is a presentation of extra pulmonary tuberculosis that affects the spine. It is also called tuberculous spondylitis. The original name was formed after Percival Pott, a London Surgeon. It is most commonly localized in the thoracic region (T9, T10) of the spine.
Causative agent
Mycobacterium tuberculosis
Predisposing factors
• Family history of pulmonary tuberculosis
• Poor environment
• Poor nutrition
• Occupation
• Lack of immunization
Signs and Symptoms
• Back pain
• Fever
• Night sweat
• Anorexia
• Weight loss
• Spinal mass
Diagnostic test
• Increase Erythrocyte Sedimentation Rate- markedly elevated due to inflammation
• Tuberculin skin test (Mantoux test/purified protein derivatives) - this determine whether an individual has been infected with the mycobacterium tuberculosis organism. The test usually consists of an intracutaneous injection of tuberculin, a purified protein derivative of the bacillus.
• Bone biopsy- surgical removal of living body tissue for the study and diagnosis. This is performed to analyze the cause and nature of the disease and on tumors or abnormal tissue growths.
• Radiograph of the spine- to determine the severity or extent of the spinal cord damage.
Medical Management
Chemotherapy
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Streptomycin
Vitamin C, D and B complex
Surgical Management
• Anterior Decompression Spinal Fusion (ADSF)- Best surgical intervention for Pott’s disease.
• Traction and Cast- to immobilize the affected extremities.
• Laminectomy- removal of the ruptured disks in the spine
Nursing Management
• Immobilize the spine
• Provide comfort measures.
• Reposition the patient every 2 hours by the help of other personnel.
• Inspect skin for presence of abscess.
• Increase oral fluid intake
• Encourage the patient to verbalize feelings and concerns.
• Observe for signs of respiratory distress.
• Administer medication as prescribed.
headnursing
PEPTIC ULCER DISEASE
Definition
A peptic ulcer is an excavation formed in the mucosal wall of the stomach, pylorus, duodenum or esophagus. It is frequently referred to as gastric, duodenal or esophageal ulcer depending on its location. Peptic ulcer is most likely to be in the duodenum than in the stomach. They tend to occur singly, but there maybe several present at one time. Chronic ulcer usually occurs in the lesser curvature of the stomach, near the pylorus.
Predisposing Factors
• Helicobacter pylori
• Chronic use of ASA, NSAID’s (Non steroidal anti-inflammatory drugs), Steroids
• Severe physiologic stress
• Hypersecretory states.
• Cigarette smoking and alcohol intake
• Caffeine, Fatty, spicy, highly acidic foods
• Type O blood
• Genetics
Signs and Symptoms
• Epigastric pain
• Nausea and vomiting
• Dyspepsia (bloating, belching, distention)
• Heart burn
• Chest discomfort
• Anorexia
• Weight loss
• Hematemesis or melena
Medical Management
Medications such as:
Antacids
• Neutralizes HCl
• Taken 1 to 2 hours p. c.
• Examples of drugs are: Amphogel, Basaljel., Milk of magnesia. Maalox (Magnesium based- diarrhea, Aluminum based- constipation)
Histamine (H2) receptor antagonists
• Reduces HCl secretion
• Taken with meals
• Examples are: Zantac (Ranitidine), Pepcid (Famotidine), Axid (Nizatidine), Tagamet (Cimetidine).
Side effects:
• Diarrhea
• Abdominal cramps
• Confusion
• Dizziness
• Weakness
• Cimetidine- antiandrogenic effect (gynecomastia, decrease libido, impotence)
Cytoprotective
• Coats ulcer and increases prostaglandin synthesis
• Taken on an empty stomach (30-60 minutes before meals)
• Example: Carafate (Sucralfate)
Prostaglandin analogue
• Replaces gastric prostaglandin
• Example: Cytotec (Misoprostol)
Proton Pump inhibitor
• Gastric acid secretion inhibitor
• Example : Losec (Omeprazole)
Helicobacter pylori Drug treatment
• Amoxicillin/ tetracycline-Drug of choice
• Flagyl(Metronidazole)
Surgery
Vagotomy
• Resection of vagus nerve
• Decrease cholinergic stimulation
Pyloroplasty
• Surgical dilatation of the pyloric sphincter
• Improves gastric emptying of acidic chime
Antrectomy
• Removal of 50% of the lower part of the stomach
Types:
• Billroth I (Gastroduodenostomy)
• Billroth II (Gastrojejunostomy)
Nursing Management
• Take prescribed medications as ordered
• Diet:
Liberal bland diet during exacerbation
Eat slowly and chew food properly
Small frequent feedings during exacerbation
Avoid fatty foods, coffee, tea, cola drinks, chocolate, spices, red/black pepper, alcohol.
• Quit smoking
• Stress therapy
• Regular pattern of exercise
Differentiation between Gastric and Duodenal Ulcer
Gasric Ulcer
• Poor Man’s ulcer/laborer’s ulcer
• 20% incidence
• 50 years old and above
• Malnourished
• Normal gastric secretions and normal emptying rate
• Radiates to left
• Pain appears ½ to 2 hours p. c.
• Do not relieved by food
• Nausea and vomiting, hematemesis are common
• Complications are:
Hemorrhage
Perforation
Peritonitis
Duodenal Ulcer
• Executive’s ulcer
• 80% incidence
• 25-50 years old
• Well-nourished
• Over secretions of Hydrochloric acid
• Radiates to right
• Pain appears 3 to 4 hours p. c.
• Relieved by food
• Melena is more common
• Complications are:
Obstruction
Hemorrhage
Perforation
Peritonitis
Definition
A peptic ulcer is an excavation formed in the mucosal wall of the stomach, pylorus, duodenum or esophagus. It is frequently referred to as gastric, duodenal or esophageal ulcer depending on its location. Peptic ulcer is most likely to be in the duodenum than in the stomach. They tend to occur singly, but there maybe several present at one time. Chronic ulcer usually occurs in the lesser curvature of the stomach, near the pylorus.
Predisposing Factors
• Helicobacter pylori
• Chronic use of ASA, NSAID’s (Non steroidal anti-inflammatory drugs), Steroids
• Severe physiologic stress
• Hypersecretory states.
• Cigarette smoking and alcohol intake
• Caffeine, Fatty, spicy, highly acidic foods
• Type O blood
• Genetics
Signs and Symptoms
• Epigastric pain
• Nausea and vomiting
• Dyspepsia (bloating, belching, distention)
• Heart burn
• Chest discomfort
• Anorexia
• Weight loss
• Hematemesis or melena
Medical Management
Medications such as:
Antacids
• Neutralizes HCl
• Taken 1 to 2 hours p. c.
• Examples of drugs are: Amphogel, Basaljel., Milk of magnesia. Maalox (Magnesium based- diarrhea, Aluminum based- constipation)
Histamine (H2) receptor antagonists
• Reduces HCl secretion
• Taken with meals
• Examples are: Zantac (Ranitidine), Pepcid (Famotidine), Axid (Nizatidine), Tagamet (Cimetidine).
Side effects:
• Diarrhea
• Abdominal cramps
• Confusion
• Dizziness
• Weakness
• Cimetidine- antiandrogenic effect (gynecomastia, decrease libido, impotence)
Cytoprotective
• Coats ulcer and increases prostaglandin synthesis
• Taken on an empty stomach (30-60 minutes before meals)
• Example: Carafate (Sucralfate)
Prostaglandin analogue
• Replaces gastric prostaglandin
• Example: Cytotec (Misoprostol)
Proton Pump inhibitor
• Gastric acid secretion inhibitor
• Example : Losec (Omeprazole)
Helicobacter pylori Drug treatment
• Amoxicillin/ tetracycline-Drug of choice
• Flagyl(Metronidazole)
Surgery
Vagotomy
• Resection of vagus nerve
• Decrease cholinergic stimulation
Pyloroplasty
• Surgical dilatation of the pyloric sphincter
• Improves gastric emptying of acidic chime
Antrectomy
• Removal of 50% of the lower part of the stomach
Types:
• Billroth I (Gastroduodenostomy)
• Billroth II (Gastrojejunostomy)
Nursing Management
• Take prescribed medications as ordered
• Diet:
Liberal bland diet during exacerbation
Eat slowly and chew food properly
Small frequent feedings during exacerbation
Avoid fatty foods, coffee, tea, cola drinks, chocolate, spices, red/black pepper, alcohol.
• Quit smoking
• Stress therapy
• Regular pattern of exercise
Differentiation between Gastric and Duodenal Ulcer
Gasric Ulcer
• Poor Man’s ulcer/laborer’s ulcer
• 20% incidence
• 50 years old and above
• Malnourished
• Normal gastric secretions and normal emptying rate
• Radiates to left
• Pain appears ½ to 2 hours p. c.
• Do not relieved by food
• Nausea and vomiting, hematemesis are common
• Complications are:
Hemorrhage
Perforation
Peritonitis
Duodenal Ulcer
• Executive’s ulcer
• 80% incidence
• 25-50 years old
• Well-nourished
• Over secretions of Hydrochloric acid
• Radiates to right
• Pain appears 3 to 4 hours p. c.
• Relieved by food
• Melena is more common
• Complications are:
Obstruction
Hemorrhage
Perforation
Peritonitis
Saturday, February 7, 2009
sunshine M.
BRIEF HISTORY OF “THE SUNSHINE”
“ANG SINAG”
The campus paper Sinag was a product of perseverance and willingness to give information to every student.
Due to this willingness, Miss Rosario Bernardo, Miss Teresita Torio, Miss Annaliza Torres, and Miss Florence Datuin created the “Sinag” or “The Sunshine” in the year 1995.
It was the campus paper of Eduardo L. Joson Memorial High school.
It was a magazine size campus paper with 8 pages, having an article written in English and Filipino language. In every school year, they produce 500 copies given for every student.
The process of production was assisted by the printing press a dummy was sent to them. It cost 50 pesos per campus paper. Until now, the “Sunshine” publication still shines.
BASIC INFORMATION
The size of the paper being use was 12 x 18 for contest entry but in regular issue, they produce a magazine size. In every, production they always make sure that the magazine is composed of 8 pages. 1,000 copies were produce in every production. It was produced two times in a school year in order to inform the students what was happening in the school. They are using a glossy type of paper with an ADOBE page maker for every printing. Now the “THE SUNSHINE” causes 90 pesos per copy.
MAN POWER/HUMAN RESOURCES
From the two advisers, Mrs. Crispina S. Bravo and Mrs. Mylene R. Alviar down to the Editor-in-chief, Associate editor, Feature editor, News editor and sports editor, the division of labor was distributed.
The editor and staff wrote the articles, and then the advisers will be the one to suggest if there is something to change or something to be added, and then approve it.
The advisers also supervise the staff and serve as a coach in the press conferences. They also serve as manager for releasing funds for the paper.
The school administrator serves as a consultant of the publication. The Parents-Teachers Association (PTA) serves as one of the great supporter of the publication.
WORK PROCESS
Work process was distributed to the top position up to the last.
For gathering information, all of the staff uses their seeking power to gather different information. The News editor, Feature writer and the Editor-in-chief were the one responsible for writing an article about the said information they have gathered.
In editing the articles, the copy reader is the one who’s responsible for it. In laying out pages, the editor-in-chief was assigned to do this.
The printing press has the role in the printing process of the materials. The distributions of copies were the responsibility of the staff and teachers.
OTHER ACTIVITIES
The staffs of “The Sunshine” attended different press conferences and seminars. Last September, 2006, they have attended the Regional Training for School paper advisers and journalist held at Talavera Central School. Last August, 2007, they have attended the same workshop seminar at Subic, Zambales.
Last October 14, 2008, they did attend the School District Level Press Conference held at Zaragosa National High School. On November, 2006, they attended the District Level Press Conference held at Talavera Central School. Last November, 2007, they have attended again the same Division Level Press Conference (DSPC) at same place.
“ANG SINAG”
The campus paper Sinag was a product of perseverance and willingness to give information to every student.
Due to this willingness, Miss Rosario Bernardo, Miss Teresita Torio, Miss Annaliza Torres, and Miss Florence Datuin created the “Sinag” or “The Sunshine” in the year 1995.
It was the campus paper of Eduardo L. Joson Memorial High school.
It was a magazine size campus paper with 8 pages, having an article written in English and Filipino language. In every school year, they produce 500 copies given for every student.
The process of production was assisted by the printing press a dummy was sent to them. It cost 50 pesos per campus paper. Until now, the “Sunshine” publication still shines.
BASIC INFORMATION
The size of the paper being use was 12 x 18 for contest entry but in regular issue, they produce a magazine size. In every, production they always make sure that the magazine is composed of 8 pages. 1,000 copies were produce in every production. It was produced two times in a school year in order to inform the students what was happening in the school. They are using a glossy type of paper with an ADOBE page maker for every printing. Now the “THE SUNSHINE” causes 90 pesos per copy.
MAN POWER/HUMAN RESOURCES
From the two advisers, Mrs. Crispina S. Bravo and Mrs. Mylene R. Alviar down to the Editor-in-chief, Associate editor, Feature editor, News editor and sports editor, the division of labor was distributed.
The editor and staff wrote the articles, and then the advisers will be the one to suggest if there is something to change or something to be added, and then approve it.
The advisers also supervise the staff and serve as a coach in the press conferences. They also serve as manager for releasing funds for the paper.
The school administrator serves as a consultant of the publication. The Parents-Teachers Association (PTA) serves as one of the great supporter of the publication.
WORK PROCESS
Work process was distributed to the top position up to the last.
For gathering information, all of the staff uses their seeking power to gather different information. The News editor, Feature writer and the Editor-in-chief were the one responsible for writing an article about the said information they have gathered.
In editing the articles, the copy reader is the one who’s responsible for it. In laying out pages, the editor-in-chief was assigned to do this.
The printing press has the role in the printing process of the materials. The distributions of copies were the responsibility of the staff and teachers.
OTHER ACTIVITIES
The staffs of “The Sunshine” attended different press conferences and seminars. Last September, 2006, they have attended the Regional Training for School paper advisers and journalist held at Talavera Central School. Last August, 2007, they have attended the same workshop seminar at Subic, Zambales.
Last October 14, 2008, they did attend the School District Level Press Conference held at Zaragosa National High School. On November, 2006, they attended the District Level Press Conference held at Talavera Central School. Last November, 2007, they have attended again the same Division Level Press Conference (DSPC) at same place.
Tuesday, February 3, 2009
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