The Integument

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         It consist the skin, nails and scalp.

         Provides the body’s external protection and regulates body temperature.
         It acts as a sensory organ for pain, temperature and touch.
 
  1. Skin
  •  Window to detect a variety of conditions affecting the client.
  •  It views the changes in oxygenation, circulation, nutrition, local tissue damage and hydration.
Health History:
         Ask the patient about any presence of lesions, rashes and bruises.
         Determine whether there has been a recent change in skin color or trauma in the skin.
         Assess for history of allergies, use of topical medications and a family history of serious skin disorder.
Color:
         Skin color should be uniform all over the body.
         Normal skin pigmentation ranges from ivory or light pink to ruddy pink in white skin and light to deep brown or olive in dark skin.
         Check for any signs of alterations in skin color.
Moisture:
         Hydration of skin and mucous membranes helps to reveal body fluid imbalances, changes in the skin’s environment and regulation of body temperature.
         Refers to the wellness and oiliness of the skin.
Temperature:
         Depends on the amount of blood circulating through the dermis.
         Increase or decrease in skin temperature reflects on increase or decrease in blood flow.
         More accurately assessed by palpating the skin with the dorsum of the hand.
Texture:
         It is the character of the skin’s surface and the feel of deeper sensation.
         Normally smooth, soft and flexible.
Turgor:
         It is the skin’s elasticity which can be diminished by edema or dehydration.
         Normally looses its elasticity with age.
         The hand or forearm is grasped with the fingertips and is released.
Vascularity:
         The nurse inspects edematous areas for location, color and shape.
         Edematous skin also appears stretched and shiny.
         Palpate area of edema to determine mobility, consistency and tenderness.

Edema is usually caused by direct trauma and or impairment of venous return. Failure of the skin to reassume its normal contour or shape after being pinched indicated dehydration which places the patient at risk for skin breakdown. Tenting is the term to describe skin that remains in a pinched position.

Procedure:  Palpate dependent areas (sacrum, feet, and ankles) for mobility by applying pressure with fingers noting degree of indentation. If indentation occurs, firmly apply pressure with your thumb for 5 seconds. Note the degree of edema based on the depth of indentation (pitting) in centimeters. Dependent edema gives the skin a stretched, shiny appearance. The degree of pitting edema reflects the depth if indentation (1+ to 5+).

Lesions:
         Skin is normally free of lesions.
         When a lesion is detected, inspect for color, location size, type and distribution.
         Palpation determines the lesion’s mobility, contour and consistency.
Types of skin lesions:
  1. Macules – freckles and petichiae
  2. Papules – small moles, acne
  3. Nodules – big mole
  4. Tumor – extends to the subcutaneous area
  5. Wheal – superficial, localized edema (e.g. mosquito bites)
  6. Vesicle – chicken pox
  7. Pustule – with pus (e.g. acne vulgaris)
  8. Ulcer – deep loss of skin
  9. Atrophy – thinning of skin (e.g. arterial insufficiency)
  1. Hair and Scalp
Types of hair:
  1. Terminal hair – long
  2. Vellus hair – tiny hair
Health history:
         Changes in growth or loss of hair.
         Types of hair care products used.
         Has the patient undergone chemotherapy?
Inspection:
         Inspect distribution, texture and lubrication of body hair.
         Observe characteristics of color and coarseness.
         Inspect the scalp for lesions and presence of lice.

Alopecia (hair loss) is one effect of chemotherapy and some patients may be having hirsutism (excessive hair growth). Dry flaking, scaling occurs in seborrhea (dandruff) and psoriasis (red patches covered by thick, silvery, adherent scales that result form excessive development of epithelial cells.

  1. Nails
Health history:
         Ask for history of any trauma.
         Ask the patient to describe nail care practices.
         Inquire whether the patient has risks for nail-foot problems.
Inspection and Palpation:
         Inspect the nail bed color, thickness and shape of the nail.
         Palpate the nail base to determine firmness and condition of circulation.
         Assess for capillary refill by using blanching test.
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GENERAL SURVEY

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         It begins upon contact with the patient and conducted while the nurse prepares the patient for the physical exam.
         It must be assessed in relationship to culture, educational level, socioeconomic status and current circumstances
         It involves observation of the patient’s general appearance and mental status, measurement of vital signs, height and weight.
         Vital signs are measured to establish baseline data against which to compare future measurements and to detect actual and potential health problems. Pain assessment is included in the taking of vital signs.
It includes:
  1. Gender, Age, Civil Status
  2. General appearance – e.g. disheveled/kempt/unkempt
  3. Facial expression
  4. Body Built, Height and Weight in relationship to patient’s age, lifestyle and health
  5. Posture and Gait
  6. Hygiene, Grooming and Body and Breath Odor
  7. Signs of Distress in posture or facial expression
  8. Obvious Signs of illness
  9. Level of consciousness
  10. Attitude
  11. Mood and Affect
  12. Speech
  13. IV set-up
  14. Cardio-pulmonary set-up
  15. Special devices attached to the patient – e.g. cast, foley catheter, etc.
  16. Special devices attached to bed – e.g. bed frames, pulleys, trapeze

Look Good, Feel Good

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Every woman wants to look good and attractive no matter where they are. It brightens their day whenever they are given nice compliments about the way they look. That’s why they put extra effort in pampering their selves. However, no matter how expensive and classy the clothes that you wear are, if your hair doesn’t look great, neither will you. That is why it is very important to take good care of your hair.

Choosing hair products is very essential. When looking for the right product, it’s important to choose which you think best suits you. Most of the popular shampoos and conditioners today have a minty smell. These may smell even great when used and makes you feel like your head is being massaged. For dry and damaged hair, choose products that can restore moisture, shine and glow. It would be nice to use products that can add volume, thickness and softness to dull hair. For women who color their hair, it’s best to choose shampoos with color protection to help color last longer.



There are a lot of hair products nowadays, but choosing what you think is right for you will make you look your best and feel great.

Damaged Hair and How To Fix It

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Sometimes, hair problems go beyond issues such as dryness or frizz. Most times hair is damaged beyond repair. No matter what you do, it doesn’t seem to work. You just end up with an empty wallet trying to figure out how you can fix your hair.

One major cause of damaged hair is chemical abuse. Products such as relaxers and hair color are easily accessible in the market; anyone can just buy them and use them readily. A lot of times, they aren’t used properly and that’s where damage comes in. Paying a professional to do the job is highly recommended.
Heat can also do a lot of damage to your hair. Whether your hair is chemically processed or natural, too much heat can damage it. This pertains to daily use of flat irons, curling irons, etc. Hair can and will burn if extremely hot tools are used on it.
There is a solution, though. When your hair is just dry, you can still get the moisture back in it. It may take a while but it can be done. On the other hand, damage is completely different. Once hair is fried past the point of no return, the only solution is to cut off it off. This is quite drastic; however, long hair that’s damaged won’t do anything good for your look. Instead, just get rid of the damaged ends and start over. But don’t do the same mistake again.

The Ignored Nurses’ Rights in the Philippines

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Nursing, nowadays, in the Philippines, is like a viral disease that infects many people. Every one wants to enroll in this profession so that after they graduate they would be able to work in a decent hospital, give nursing care to people and then go to abroad to earn big bucks. Hey, what can I say, I’m just presenting reality to every one especially the parents who has no complete background about the profession but only thinks of the $$$ and the sure bright future that they will have once they have a nurse in the family.
As you can experience, nursing is no longer a unique and in-demand profession in the country. It’s dignity as a vital profession that shapes up the nation’s health status has downgraded through the years. Now, people treat professional nurses in a different way. They treat them the same way as they treat servants and maids, ordering them around like they are mere helpers who follow their every command.
Doctors, on the other hand, are still treated with much respect because they have stabilized their profession’s dignity to be as such. People and patients would look up to families with doctors as intelligent breeds. But before nurses in the family was also looked up as such but now it’s like a normal occurrence.
It is a fact that patients in the hospital have rights, such as:
  1. Right to appropriate medical care and humane treatment.
  2. Right to informed consent.
  3. Right to privacy and confidentiality.
  4. Right to Information.
  5. Right to choose health care provider and facility.
  6. Right to self-determination.
  7. Right to religious belief.
  8. Right to medical records.
  9. Right to leave.
  10. Right to refuse participation in medical research.
  11. Right to correspondence and to receive visitors.
  12. Right to express grievances.
  13. Right to be informed of his rights and obligations as a patient.
With all these rights, nurses have their own rights too, such as:
1.      Nurses have the right to practice in a manner that fulfills their
obligations to society and to those who receive nursing care.
2.      Nurses have the right to practice in environments that allow them to act
in accordance with professional standards and legally authorized scopes of
practice.
3.      Nurses have the right to a work environment that supports and
facilitates ethical practice, in accordance with the Code of Ethics for
Nurses and its interpretive statements.
4.      Nurses have the right to freely and openly advocate for themselves and
their patients, without fear of retribution.
5.      Nurses have the right to fair compensation for their work, consistent
with their knowledge, experience, and professional responsibilities.
6.      Nurses have the right to a work environment that is safe for themselves
and their patients.
7.      Nurses have the right to negotiate the conditions of their employment,
either as individuals or collectively, in all practice settings.
8.      Nurses have the right not to be abused in any form by physicians, pharmacists, administrators or nursing directors. Any abuse that occurs should be dealt with in a professional and impartial manner by the nurse’s employer.
9.      Nurses have the right not to be exploited and abused by being floated to areas of practice that they are not familiar with.
10.  Nurses have the right to refuse any assignment that they feel is unsafe. Such as when a nurse is assigned a patient load he/she feels is unsafe. A nurse is assigned to work in an area of nursing in which he/she is not familiar. A nurse knows that equipment/supplies are inadequate or not available.
These solid rights are not much implemented in the country. It could either be that nurses themselves are ignorant of their own rights or that they are too afraid to strengthen their rights because they fear that they’ll be given a negative remark in their institution. Nurses in the Philippines are becoming a bunch of scary cats who only cower in their comfort zones ‘til one brave soul fights for it.
It’s not a matter of waiting for someone to die as heroes for those rights. Nurses must start with themselves and implement their rights in any workplace they are assigned to. Nurses must have pride in themselves because nursing is not just any four-year course but a crucial profession that will save lives of thousands and at the same time save much on national budgets. Act now, nurses!

Filipino Nurse Volunteers: The oppressed helping hands of the community

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Volunteers, described as someone who does charitable or helpful work without pay. In the past, the word “volunteer” was a title only given for those who would lend out a helping hand to aid in the manpower of a certain organization, company, industry, or event. With the presence of volunteers, results are very much evident whether via rapid increase in productivity or work development, only signifies that their contribution has a major impact in many ways.


What is a Volunteer Nurse(VN)? A volunteer nurse is a professional registered nurse of a certain country who renders free services for a company, organization, industry, or a event. Volunteer Nurses are mostly found in hospitals, mostly government-owned, and private clinics.


There is a question if being a so-called Volunteer Nurse would serve as work experience if ever they would plan to work abroad someday. The most probable answer is,”NO!,” and the most logical reason is going back to the essence and authentic definition of a volunteer.

When a registered nurse(RN) will work as a VN in a hospital, a clinic or any health care facility, it is then understood that he will offer his services for charity supposedly without any equal exchanges because it is an act of self-giving but a VN of the Philippines thinks otherwise, for them being a volunteer nurse is a position given for them if they render competent nursing work in exchange for a certification of work experience depending on the number of hours they have been in service and the kind of hospital areas they were assigned to.

What are the mindsets of being a Filipino VN?
  • Rendering my service will earn me a work experience to be used for abroad jobs in the future.

This is wrong because again “volunteerism” is not counted as work experience for the reasons that in abroad, as a volunteer, you will not get paid for your work. You will serve deprived and needy people. These individuals need your full support and concern, for they can’t pay for health services. Some nurses abroad find fulfillment in helping fellow citizens without expecting anything in return, and, a VN is not fully responsible for the patient. He is not responsible 100% for the care of the patient and in the majority of the facilities they also do not administer medications as well thus not counted as competent nursing service.

  • I need to be a VN for a certain amount of time in order to qualify as a staff nurse in the hospital.

This is somewhat true in certain hospitals. In some hospitals, rendering a minimum of 1year service entitles that VN to be issued a job order for them be able to work as a staff nurse of that institution thus be able to gain a salary and benefits.

  • I have to pay a certain amount of money as a requirement in applying as a VN.

This is one of the most insulting part for RNs who will apply as VNs in order to work in the hospital. Lawmakers of the Philippines described it as “illegal,” the imposition of fees on volunteer nurses, saying that such treatment makes trainees “worse than slaves.” Charging fees to trainees may constitute a violation of the Volunteer Act (Republic Act 9418), which states that volunteers should be given incentives and not be made to pay for rendering services. It is also stated in Section 12(d) of RA 9418 mandates that government agencies and non-government organizations implementing volunteer programs must “provide volunteers recognition and incentive package” which may include allowances and insurances.

Yet, what really is the benefit of being a VN? Actually, many nurses find volunteer work rewarding and in fact, most of them enjoy the relaxing feeling of being able to help others without expecting anything in return. They are able to provide others (who are weak and less fortunate) with comfort. With the additional training that they have to undergo, they are enhancing their aptitude and preparation in the medical field. In some places in abroad, volunteer nurses receive free access to fitness centers, meal passes, parking, learning seminars, tax deduction, yearly vaccinations, and attend recognition parties or dinners. This is their chance to meet various kinds of people. They will not only be working with patients but they will also be mingling with volunteer executives. They will learn how to deal with them individually and properly.


In conclusion, volunteer work is supposed to be a rewarding experience for a person in which his selflessness lead to a big change to all the people in the community that he has helped and offered his charitable services with. Hospitals has used that word wrongly, they know for a fact that RNs would come to them and work for free in exchange for the work experience where they can develop or enhance their knowledge, skills and attitude therefore making them more competent for future nursing/heath-related jobs, and, if they want to hire nurses who would offer their free services in order to increase their manpower with no expense, then they should use the word “trainee” rather than “volunteer.” A position as nurse trainee sounds better than volunteer nurse and somehow more acceptable abroad, where as a nurse trainee, it is well-understood that the hospital or any health care facility hired them to offer their professional services depending on the level of their competencies and it is the responsibility of the facility to expand and enhance more their knowledge and skills with added incentives such as allowances and/or benefits making them fit and proficient enough to meet the requirements needed for a staff nurse or specialized nurse in the future. If this is only implemented, then maybe somehow, the oppression and exploitation of Filipino RNs would stop and the delivery of heath care services to the community would improve.