Ab

10. Accept the fact that you can never know everything. Therefore, once you see an unfamiliar question that was never been taught, use your test taking strategies. [ From principle of contradiction up to magic words. Please refer to Dervid Jungco's lecture ] 9. If you are in Test I, II, III, and IV and you are being asked to prioritize, Use the principle of prioritization. [ Refer to Dervid Jungco's lecture ] 8. The use of your nursing process is heralded by the word: "The Nurse Would or The nurse's initial action" Remember to Assess first before intervening. If the situation and the question already assessed the patient, then proceed with the next step. 7. Encircle your modifiers. Some people make mistakes because of failure to see the word, "EXCEPT" or "NOT" or "INAPPROPRIATE" 6. Use your questionnaires as your scratch. You can write anything on that paper. If you will skip a number, place an asterisk or encircle the number. 5. DO NOT USE BLUNT PENCIL. Always use a sharp one and shade lightly. A sharpened pencil will give a very dark shade even if you will shade it lightly. Use the sides of the pencil not the tip. Use MONGOL NUMBER 2 ONLY. Some brands especially those made in china pencils are substandard. The machine will check the lead. If you are INCONSISTENT with your shading like an altering dark and light shades, you will FAIL the boards because of technicalities. NEVER USE SAME PENCIL THAT YOU USED IN ANNOTATING YOUR QUESTIONNAIRE AND ANSWERING THE ANSWER SHEET. Use separate pencils for the questionnaire and answer sheet. 4. In your NP I, Remember to master these topics : The levels of prevention, 3 way bottle system, Chest physiotherapy and Postural drainage,Nursing process, Managerial process, Managerial leadership style, Patterns of Nursing care, Knowing your Independent and Dependent variable, The exact arrangement of the research process as well as research design [qualitative and quantitative] , Sampling methods both the probability and non probability, RA 9173, The PRC and the BON Power and responsibilities as stipulated in RA 9173, The nurse's code of ethics, Nursing ethical principles like your benificence, non maleficence, prudence, justice, etc. Delegation and prioritization [Staff nurse will report to headnurse and then supervisor] Therapeutic communication, always answer "You seem afraid or upset"The complications of Immobility like your atelectasis, pneumonia and deep vein thrombosis and also your crimes related to nursing and the circumstances of the crimes, Blood transfusion and IV Fluids and your IV Therapy, which are isotonic, hypo and hypertonic, The complications associated with IV therapy like Phlebitis and Infiltration. For optimum studying, read MERGE diagnostic, comprehensive preboard

examination and critical examination for NP1. 3. In your NP II, Remember the following : Stages of labor, The causes of bleeding during pregnancy in the first, second and third trimester, Anesthesia during labor and interventions when the client is in PACU, IMCI Pneumonia, Diarrhea, Malaria and Measles especially the breathing cut off according to age [ Eg. 60 for under 2 months ], Acute/Chronic cutoff [Acute diarrhea and ear infection under 14 days] The interventions for CHILD A, B and C, The world health organization programs, Breastfeeding and Attachment, Heat loss of neonates, Characteristic of toddlers in communicating [ Negativistic, Give option, Asking too many questions] .Leukemia and other hematologic diseases of the child, Newborn screening and the different diagnostic examinations for the female client and neonate especially your Amniocentesis, Sonogram and Leopold's maneuver. Study Pregnancy induce hypertension. For optimum studying, Refer to the NP2 material that will be given last day of your final coaching [ For MERGE students only ] 2. In your III and IV, Master the following topics : Burns, Classification of Burns and Nursing Diagnosis for Burns, Drug use in burns [Silver Sulfadiazine], Electrolyte changes in burn [Hyperkalemia, Hyponatermia]. The WHO Pain ladder scale, Pain medications especially Demerol and Morphine, Pancreatitis, Cholecystitis, Hepatitis, Diabetes Milletus, Hyperkalemia, Hypokalemia, Hypo and Hypercalcemia ECG Changes in your fluid and electrolye imbalances as well as in your Myocardial Infarction, Pharmacologic and Non pharmacologic pain medications, HIV/AIDS Psychosocial managements, Pneumonia, Tuberculosis and Leprosy especially knowing which are the late and early signs of leprosy. Study Blood transfusion, Breast cancer and Colon cancer and the management and care of client's with colostomy. Study perioperative nursing and the complications following anesthesia, PACU Monitoring, Activities in the operating room, The aseptic technique, the functions of a srub and circulating nurse. Diabetes Milletus type 1, Insulin administration and monitoring for hypoglycemia, S/S of hypoglycemia, Hyperthyroidism and Hypothyroidism, PTU, Lugol's,Tapazole/Methimazole, Acute and chronic renal failure, Dialysis, AGN, Rheumathoid and Ostearthritis, Bell's Palsy and Trigeminal neuralgia, Leukemia and Hematologic disorders especially Anemia. Blood transfusion reaction and the nursing actions during blood transfusion reaction. Anticancer drugs especially Oncovin, Prednisone, Adriamycin and Cytoxan. Study radiation and chemotherapy and their usual side effects [Skin burn, redness, do not wet radiation mark]. Mammography, BSE, TSE, DRE, Prostate and Colon cancer, Changes that occurs during elderly, Bladder, Colon and Cervical cancer Diagnostic examination/CEA,Proctosigmoidoscopy,Biopsy,Pap smear. For optimum studying, Refer to NP3 AND NP4 of MERGE preboard, diagnostic and comprehensive exam. Study the FINAL COACHING material given during Mr, Dervid Jungco's lecture. [ The 250 item bullets ]

1. In your Test V study the following : Anxiety and anxiety disorders, The level of anxiety and your anxiolytics, Schizophrenia : Paranoid type and Catatonic type and your nursing interventions for these clients as well as your priority nursing diagnosis. Depression and your antidepressants, Mania, Personality disorders especially your Antisocial, Borderline and Paranoid. The defense mechanism use for different types of disorders and the priority NURSING DIAGNOSIS for each psychiatric disorders, Antipsychotic drugs its side effects and nursing intervention for each side effects. Electroconvulsive therapy, Thought process disturbance manifestation such as Clang Association, Pressured speech, Thought blocking, Word salad, perseveration etc. etc. Alteration in perception and thought like hallucination and delusion. Types of delusions eg. religious and persecutory. Activities and diet as well as nursing diagnosis for a client with Mania, Depressed and Alzhemiers/Dementia patient, Eating disorders and the treatments of choice [Cognitive Behavior therapy for Anorexia, Psychotheapy for the PDs, Cognitive for depression ] Always answer "STAY WITH THE CLIENT" especially if the question is about anxiety disorders and panic attacks. Always choose an option that will encourage verbalization of feelings, never answer an option with the word WHY. Study your counter transference and your transference, Glaucoma, Cataract and crutch/cane walking. The principles of body mechanics, cranial nerve functioning and how to assess them as well as their disturbances especially Bells and Trigemnal Neuralgia. Meniere's disease, Delirum, Dementia, CVA/Stroke pathophysiology and Factors. For optimum studying, Read NPV of MERGE Preboard, comprehensive and diagnostic examination. Also study the 250 item bullets given by Mr. Dervid Jungco. ADDENDUM For OPERATING ROOM NURSING in NP3, answer them with breeze using your OR questions seen in diagnostic, comprehensive and preboard examination in NP3. For non merge students, study the following:1. Functions and roles of the Circulating nurse, scrub nurse, anesthesiologist and surgeon.2. Counting process of instruments, needles, and equipments.3. Sterilization, Disinfection [High level to low level] and decontamination.4. AORN guidelines in sterilization5. Restricted, semi restricted and unrestricted areas and their appropriate attire6. PERSONAL PROTECTIVE EQUIPMENTS7. Critical, Non critical and Semi critical instruments. [ Critical is sterilized, Non critical is decontaminated and Semi critical is disinfected ]8. Event related sterility9. ANESTHESIA : Types and side effects. Routes of Spinal and epidural anesthesia. Caring for clients in the PACU.10. The functions of different hospital departments: Blood bank, Dietary, Chaplaincy, Social service, pathology and crematory. You are all set!

What Michelle Means to Us We've never had a First Lady quite like Michelle Obama. How she'll change the world's image of African-American women—and the way we see ourselves. Allison Samuels NEWSWEEK From the magazine issue dated Dec 1, 2008 At a recent Sunday brunch after church, my "sista friends" and I sat on the patio of a Los Angeles restaurant gabbing about the election of Barack Obama. Sure, we were caught up in the history of the moment. Most of us never thought we'd see an African-American president. But as a group of six black women in our 30s and 40s, we were equally excited by who is coming along with Obama to the White House—his wife, Michelle, and their two young daughters. We all praised—OK, maybe even envied—Michelle's double Ivy League pedigree, her style, her cool but friendly demeanor. And yet we're all aware of how much we have riding on her. At 44, Michelle Obama will be the youngest First Lady since Jacqueline Kennedy. And many are expecting her to usher in a similarly glamorous era in Washington. ("Bamelot," as some are already calling it.) But Michelle's influence could go far beyond the superficial. When her husband raises his hand to take the oath of office, Michelle will become the world's most visible African-American woman. The new First Lady will have the chance to knock down ugly stereotypes about black women and educate the world about American black culture more generally. But perhaps more important—even apart from what her husband can do—Michelle has the power to change the way African-Americans see ourselves, our lives and our possibilities. It's an amazing opportunity—and a huge responsibility. "I think she's always going to be classy, because she knows she's not just representing herself,'' said my friend Gertrude Justin, 40, a nurse from Houston. "She knows she's fighting stereotypes of black people that have been around for decades and that her every move will be watched. I'm sure she's been just as insulted by the lack of true depictions of African-American women as any other black woman.'' Michelle will be a daily reminder that we're not all hotheaded, foaming-at-the-mouth drug addicts, always ready with a quick one-liner and a roll of the eyes. Like many African-American women I know, Michelle has had a lot of practice at the delicate tap dance of getting along in the mainstream white world. During all those years in boardrooms and a topnotch law firm—not to mention the exclusive clubs of Princeton and Harvard Law School—she's had to learn to blend in. Now she'll have to go even further in convincing two very different constituencies—African-Americans and everyone else—that they can trust her as their First Lady. And she'll have to do it all while remaining true to her authentic self. Michelle has already shown she understands how universal her appeal must be. Early on in the primaries, after she was labeled too forward and too loud, Michelle demonstrated self-restraint and discipline by dialing back. She stopped making harmless jokes about Obama's morning breath and other breaches of hygiene. Her remark about being "proud of my country" for the first time was another rare misstep. But she quickly learned to play the adoring and uncontroversial wife, talking up her husband on shows like "The View." She showed she could calibrate her remarks for predominantly black audiences too, opening up a bit more about what Obama's election would mean for them—and what it would also mean for her, referring to herself as "the little black girl from the South Side of Chicago." Yet when The New Yorker caricatured the Obamas in July doing a "terrorist fist bump" in the Oval Office, the image stung. It was Michelle who came across as the domineering one—the angry black woman. She toned it down and took to wearing pearls and reassuring J.Crew cardigans. Will that softer side win out now that she's headed to the East Wing? When I met Michelle earlier this year for an interview in Atlanta, I was taken by her warmth and eagerness to chat about everything—fashion designers she'd like to wear, her girls' taste in clothes, even dogs. (On a follow-up phone call, she greeted me with "Hey, girlfriend," like she was a long-lost sorority sister.) There was no pretense—no second-guessing her next word or move the way she seemed to do after the campaign became a mudfest. I personally hope that she will let more of that true, colorful personality seep through. There are some good hints she might. Her daring election-night red-speckled dress, designed by Narciso Rodriguez, was hardly a cautious choice. It wasn't altogether flattering, but it showed that Michelle is searching for her own style. Other clues come from her winning, if still demure, performance during the recent "60 Minutes" interview. Looking chic and relaxed—and genuinely affectionate with her husband—she poked fun at the president-elect's professed affinity for doing the dishes and told him she wouldn't accompany him on a walk on a cold Chicago day. That easy warmth between the Obamas as a couple was another thing that my girlfriends and I fixated on at our brunch. Nearly 50 percent of all African-American women are single. And, "The Cosby Show" aside, there are still woefully few public examples of solid, stable black marriages. What can this handsome first couple do for the future of the black family, we wondered? "I want my son to see first-hand what two people can do when they work together and respect each other,'' said Janese Sinclair, an executive assistant and 34-year-old single mother of a 12-year-old son. "His father

and I divorced when he was 2—so he never had the chance to see the way a relationship works. Many of his friends have single moms too, so the Obamas are going to teach us that love and happiness is not just for others but us too. It's easy to forget when you look at TV or movies." Making her young daughters, Malia and Sasha, her top priority is heartfelt, but it could also help Michelle broaden her appeal. Taking lessons from the Carters and the Clintons—Amy was 9 and Chelsea was 12 when their fathers took office—Michelle is creating a protective cordon around the girls. What parent can't relate to wanting to shield young children from the glare of the national spotlight? But Michelle's declaration that she plans to be the "Mom in Chief" has already ignited a minor flare-up in the ongoing white mommy wars between stay-at-home mothers and working women. (Don't all moms put their kids first, even if they're working? Is such an accomplished woman going to be content with Mom in Chief?) Still, most AfricanAmerican women I know are thrilled she's in a position to make that choice. The average African-American family can't survive without two incomes—the poverty level among black families hovers above 30 percent, according to 2006 U.S. Census figures. And for single moms, that can mean working two jobs, leaving precious little time with the children. Michelle has already survived the working-mom juggling act, getting her law degree and working in government and administration before leaving during Obama's campaign. I'm hoping the whole Mom in Chief role will leave plenty of room for Michelle to tackle significant, meaty issues even if she's not clamoring for a West Wing office. That's a tricky balancing act for any First Lady—think Hillary Clinton and health-care reform. Most follow the path of Laura Bush in choosing non controversial interests like literacy. So far, Michelle has listed popular causes—military families and the struggles of working parents—that are hard to find fault with. But she'll have another dimension to worry about: if she focuses on the black community—helping urban schools, say—will her interests be viewed as too parochial? And while every First Lady—and plenty of professional women— walk the line between being confident and seeming like a bitch, African-American women are especially wary that being called "strong" is just another word for "angry." Appearance could be another minefield for Michelle. First Ladies are always scrutinized—how else did Hillary end up in those black pant-suits? Though Michelle has shown a penchant for sleek hair and form-fitting dresses, her style is still evolving and wide-ranging. She's gone from $148 off-the-rack outfits to Dolce & Gabbana. When she showed up for her first tour of the White House wearing a striking red dress, she indicated she's willing to be daring. But will she retreat if critics slam her for bad hair days or talk too intimately about her shape? She has one advantage over many of her predecessors—she's got the lean, tall build of an athlete. That could have serious implications far beyond the style pages. A self-proclaimed fitness junkie who works out every morning, Michelle could actually encourage women of color to take better care of themselves. African-American women face alarmingly high rates of high blood pressure and obesity. And like everyone else, we have plenty of excuses for being sedentary, including the always-present fear of messing up our carefully done hair. "I look at her and think, I have two kids and she has two kids,'' said my friend Tamara Rhodes, a 37-year-old public-safety officer in Long Beach, Calif. "If she can find time in the day to do her thing to look good—why can't I? She looks good and in a way that I can see myself looking—not a size zero—but really healthy.'' As my brunch friends and I continued talking about Michelle, our conversation wandered into one area we seldom discuss, even among our families and closest confidantes. Michelle is not only African-American, but brown. Real brown. In an era when beauty is often defined on television, in magazines and in movies as fair or white skin, long straight hair and keen features, Michelle looks nothing like the supermodels who rule the catwalks or the porcelainfaced actresses who hawk must-have cosmetics. Yet now she's going to grace the March cover of Vogue magazine—the ultimate affirmation of beauty. Who and what is beautiful has long been a source of pain, anger and frustration in the African-American community. In too many cases, beauty for black women (and even black men) has meant fair skin, "good hair" and dainty facial features. Over the years, African-American icons like Lena Horne, Dorothy Dandridge, Halle Berry and Beyoncé— while beautiful and talented—haven't exactly represented the diversity of complexions and features of most black women in this country. That limited scope has had a profound effect on the self-esteem of many African-American women, including me. "When I see Michelle Obama on the cover of magazines and on TV shows, I think, Wow, look at her and her brown skin,'' said Charisse Hollands, a 30-year-old mail carrier from Inglewood, Calif., with flawless ebony skin. "And I don't mean any disrespect to my sisters who aren't dark brown, but gee, it's nice to see a brown girl get some attention and be called beautiful by the world. That just doesn't happen a lot, and our little girls need to see that—my little girl needs to see it.''

In Africa, skin-lightening creams are all the rage even though the chemical they contain, hydroquinone, has been shown to cause harm in high doses. Visit any beauty-supply shop in an American inner city and you'll find an entire aisle dedicated to less-potent forms of these products. "It's a truth that's long been with us,'' says comic and television host Whoopi Goldberg, who came to fame with a one-woman stage show featuring her longing for straight blond hair and blue eyes. "In society and in the black community, the lighter you are and the more European your features, the more you are desired. Now many of us want to deny that's true or say it's changed, but it hasn't. The darker you are makes you less than ideal. Plain and simple. And that messes with your mind something awful." If you're an actress, it can also keep you from appearing in a hip-hop video or getting the juiciest movie role. But it affects regular girls and women too. On a recent episode of the nationally syndicated "Tom Joyner Morning Show," the host asked listeners if the president-elect's choice of a wife and her look had in any way influenced their vote. The answer was a resounding yes, followed by comments like "She's a regular sister,'' and "I love the fact that she looks like the woman next door or like my cousin or niece.'' Michelle has accomplished so much even before moving into the White House. Imagine what she can do if she decides to tackle substantive problems—perhaps even just a single one she's mused about, like helping the local Washington, D.C., community. Now that's the kind of influence that could reach far beyond my friends at the brunch table. URL: http://www.newsweek.com/id/170383

HYPERNATREMIA "You Are Fried" F - Fever (low), flushed skin R - Restless (irritable) I - Increased fluid retention & increased BP E - Edema (peripheral and pitting) D - Decreased urinary output, dry mouth Can also use this one:

SALT S = Skin flushed A = Agitation L = Low-grade fever T = Thirst

HYPOCALCEMIA “CATS”

Hyperkalemia Signs & Symptoms Increased Serum K+ MURDER

of

Increased Serum K+

“Machine" M - Medications - ACE inhibitors, NSAIDS

M - Muscle weakness U - Urine, oliguria, anuria RRespiratory distress D - Decreased cardiac contractility E - ECG changes R - Reflexes, hyperreflexia, or areflexia (flaccid)

A - Acidosis - Metabolic and respiratory C - Cellular destruction - Burns,

Sx’s minor bleeding: BEEP

. "HOOK" for serum sickness: each letter stands for a key sign or symptom of serum sickness.

C - Convulsions A- Arrhythmias T - Tetany S - Spasms and stridor

B: Bleeding gums E: Ecchymoses (bruises) E: Epistaxis (nosebleed) P: Petechiae (tiny purplish spots)

Cancer Assessment CAUTION

ABG's:

C: Change in bowel/ bladder habits A: A sore that doesn’t heal U: Unusual bleeding or discharge T: Thickening or lump I: Indigestion or difficulty swallowing O: Obvious changes in a wart or mole N: Nagging cough or hoarseness.

HYPERKALEMIA Causes

ROME Respiratory Opposite Metabolic Equal

traumatic injury

H – Hypoaldosteronism/ hemolysis I - Intake - Excessive N - Nephrons, renal failure E - Excretion - Impaired

F: Fever A: Arthralgias R: Rash M: Malaise Respiratory depression inducing drugs "STOP breathing": Sedatives and hypnotics Trimethoprim Opiates Polymyxins

COPD: blue bloater vs. pink puffer diseases

emPhysema has letter P (and not B) so Pink Puffer. chronic Bronchitis has letter B (and not P) so Blue Bloater.

Croup: symptoms 3 S's: Stridor Subglottic swelling Seal-bark cough

Asthma acute attack: Pneumonia: risk factors 5 life threatening signs SHOCK: INSPIRATION: Immunosuppression Silent chest Neoplasia Hypotension Secretion retention One third of best/predicted PFR Pulmonary oedema Cyanosis Impaired alveolar Konfusion macrophages RTI (prior) Antibiotics & cytotoxics Tracheal instrumentation IV dug abuse Other (general debility, immobility) Neurologic impairment of cough reflex, (eg NMJ disorders) RDS -Respiratory distress syndrome in Lung cancer: main sites for distant infants: major risk factors PCD metastases BLAB: (Primary Ciliary Dyskinesia, a Bone cause of Respiratory distress Liver syndrome): Adrenals Prematurity Brain Cesarean section Diabetic mother

Neonatal resuscitation: successive steps "Do What Pediatricians Say To, Or Be Inviting Costly Malpractice"

Drying Warming Positioning Suctioning Tactile stimulation Oxygen Bagging Intubate endotracheally Chest compressions Medications Asthma: management of acute severe “O-SHIT” O- oxygen (high dose: >60%) S- salbutamol (5mg via oxygen-driven nebuliser)

H- Hydrocortisone (or prednisolone) I - Ipratropium bromide (if life threatening)

T- theophylline (or preferably aminophylline-if life threatening

Pneumothorax: sx P-THORAX: Pleuretic pain Trachea deviation Hyperresonance Onset sudden Reduced breath sounds (& dypsnea) Absent fremitus X-ray shows collapse

Bronchi: which one is more vertical "Inhale a bite, goes down the right" Inhaled objects more likely to lodge in right bronchus, since it is the one that is more vertical.

Beta-1 vs Beta-2 receptor location "You have 1 heart and 2 lungs": Beta-1 are therefore primarily on heart. Beta-2 primarily on lungs.

Wheezing: causes ASTHMA: Asthma Small airways disease Tracheal obstruction Heart failure Mastocytosis or carcinoid Anaphylaxis or allergy

Shortness of breath: short differential AAAA PPPP: Airway obstruction Angina Anxiety Asthma Pneumonia Pneumothorax Pulmonary Edema Pulmonary Embolus TB: antibiotics used STRIPE:

Respiratory co anaesthesia: patients at risk COUPLES: COPD Obese Upper abdominal surgery Prolonged bed rest Long surgery Elderly Smokers

Dyspnea: differential 3A's: Three Airways: Airway obstruction, Anaphylaxis, Asthma 3P's: Three Pulmonary's: Pneumothorax, PE, Pulmonary edema 3C's: Three Cardiacs: Cardiogenic pulmonary edema, Cardiac ischemia, Cardiac tamponade 3M's: Three Metabolics: (DOC) DKA, Organophosphates, Carbon monoxide poisoning

Ascultation: crackles (rales) "PEBbles":

drugs to

STreptomycin Rifampicin Isoniazid Pyrizinamide Ethambutol

Pneumonia Edema of lung Bronchiti

Pulmonary edema: tx MAD DOG

Kubler-Ross dying process: stages "Death Always Brings Great

Morphine Aminophylline Digitalis Diuretics Oxygen GGases in blood (ABG's)

Acceptance":

Denial Anger Bargaining Grieving Acceptance

http://d.pdfcoke.com/docs/14j5j21qrfudwy4r7tud.pdf

treat viral respiratory infections "You'd get a respiratory infection if you shoot an ARO (arrow) laced with viruses into the lungs":

ARO: Amantadine Rimantadine Oseltamivir