Wednesday, August 26, 2009

Nurse's Notes

||||| still working on this |||||

Here are the links or you could try browsing my archive instead.


Note: There's no guarantee.




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NCM 101
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*RLE

1) SCRUBBING, GOWNING, GLOVING AND ARRANGING SURGICAL EQUIPMENT:


http://suikoden18.blogspot.com/2009/08/scrubbing-gowning-gloving-and-arranging.html




2)Hot Sitz Bath and Perilite Exposure:


http://suikoden18.blogspot.com/2009/08/hot-sitz-bath-and-perilite-exposure.html




3)HOT & COLD APPLICATION:


http://suikoden18.blogspot.com/2009/07/hot-cold-application.html




4) Admission, Labor Watch, Enema:


http://suikoden18.blogspot.com/2009/06/admission-labor-watch-enema.html





*THEORY

1) Responsible Parenthood:


http://suikoden18.blogspot.com/2009/06/responsible-parenthood-theory.html



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CHN/ Community Health Nursing
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*RLE

1) FIRST AID:


http://suikoden18.blogspot.com/2009/08/first-aid.html



2) CARDIOPULMONARY RESUSCITATION:


http://suikoden18.blogspot.com/2009/08/cardiopulmonary-resuscitation.html



3)BAG TECHNIQUE:


http://suikoden18.blogspot.com/2009/07/bag-technique.html




4)URINE TESTING:

http://suikoden18.blogspot.com/2009/07/urine-testing.html





*THEORY

1)N/A

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Saturday, August 22, 2009

The Great Raid

The Great Raid

In World War II, American forces led a successful mission into a remote corner of the Philippines, where more than 500 prisoners of war had been held near a village called Cabanatuan for three years. The movie is quite an informative account of one of modern histories boldest and inspiring rescue missions. This is a movie for people more interested in the subject matter than its dramatic presentation. It shows the hard work and courage of troops whose reality is danger and death.

The film is unique in giving full credit to the Filipino fighters who joined the Rangers and made the local logistics possible by enlisting the secret help of local farmers and villagers (their ox carts were employed to carry prisoners too weak to walk). Moreover, The Great Raid is one of the finer war movies out there that no one has seen. A gripping depiction of human resilience, the film vividly brings to life the personal courage and audacious heroism that allowed a small but stoic band of World War II soldiers to attempt the impossible in the hopes of freeing their captured brothers. It also rendered the appalling conditions within the Japanese death camps and the horrendous mass executions of U.S. soldiers with gruesome accuracy; in one of the most harrowing scenes, a Japanese camp commandant barricades a group of American soldiers in a foxhole, douses them with gasoline and burns them alive. In addition, the mentality of the Japanese back then was to fight to the death, civilian or not. Surrender was weak. Nevertheless, I admire Margaret Utinsky, an astonishingly courageous American war widow who posed as a Lithuanian nurse and helped in the spearheading of the covert quinine delivery, supplies and information from Manila. Though the climax of the film -- the actual raid -- is exciting, the rest of it is bogged down in too many subplots and runs on for too long. The story is one of the greatest examples of this type of operation and the movie is balanced with emotional dilemas, action, and drama

The most moving part of the entire film occurs in the epilogue when we see footage of the real participants after the rescue. In a matter of minutes, this small section touches you in ways the movie just can't do.

SECRET WINDOW: Isang Masinsinang Panunuring Pampelikula

SECRET WINDOW
Isang Masinsinang Panunuring Pampelikula


I. PANIMULA

Ang pelikulang ito ay hindi maaring makita ng mga may edad na mas mababa sa labintatlo. Ito ay sa kadahilanang binigyan ang pelikula ng rating na “PG-13” ng Motion Picture Association of America. Kaya inaasahan ang lubos na pag-iingat na mga magulang dahil may mga bahagi na hindi nababagay sa mga bata dahil na din sa mayroon itong masidhi at marubdob na dahas at namuong dugo.

A) Pamagat ng Pelikula

SECRET WINDOW

B) May- Akda ng Novela/Kuwento

Stephen King (nobela)
David Koepp (dulang pansine)

C) Direktor

David Koepp

II. BUOD

Mistersyosong bantog na manunulat, si Mort Rainey ay kinumpronta ng isang taong-di-kilala sa labas ng kanyang bahay. Ang taong ito ay nagngangalan na John Shooter at pinagbintangan na nagnakaw si Mort ng ideya ng isang kuwento sa kanya na karaniwang tinatawag na “plagiarism” sa Ingles. Pagkatapos, ibinigay ni Shooter ang manuskrito na inaangkin niya na siya mismo ang nagsulat.

Sa unang bahagi ng pelikula, inaakala ni Mort na si Shooter ay may sakit sa pag-iisip at inihagis ang aklat. Subalit ang kanyang mutsatsa ay kinuha ito sa basurahan dahil naniniwala siya na ang kanyang amo ang nagmamay-ari nito. Sa halip na itapon niya ito uli, hindi niya kayang mawala ito sa isipan at sa banding huli ay binasa ito. Halos magkakambal ang dalawa. Kasunod na ipinakita ay ang pagpupunyagi ni Mort para mapatunayan niya kay Shooter at sa kanyang sarili na hindi niya nangungopya ng kuwento. Si Shooter naman ay patuloy ang pandiwari na paggahasa kay Mort at mangyayari rin ay pinatay ang aso na nagngangalang Chico. Sa pagdaloy ng kuwento, umupa si Mort ng isang pribadong imbestigador at humingi ng tulong sa lokal na serip, na hindi naman naniwala sa kanya. Nagtanong ang imbestigador kung may mga saksi o testigo, at bumalik sa kanyang ala-ala na mayroon siyang tao na nakakita. Ngunit agad pinaslang ni Shooter ang imbestigador pati na din ang lalaki at inilagay ang mga patay na katawan sa loob ng sasakyan.

Hinanap ni Mort ang magasin na magpapatunay na siya ang tunay na may-akda. Pero noong lumabas siya sa kanyang kotse, lumapit ang serip sa kanya nadala ang isang tawang-asosa mukha at nagtanong kung pwede bang magtanong. Umalis si Mort pagkatapos. Noong nakuha na ni Mort ang magasin, sinunod niya ang kanyang saloobin na hindi maaaring nagalaw ang magasin dahil natanggap niya ito na nakatakip at hindi bukas. Nahinuha ni Mort na si Shooter ay hindi totoong tao, isa lamang kathang-diwa ng kanyang imahinasyon na naisatao dahil mayroon pala siyang “dissociative identity disorder” na nagpersonify sa maitim na anyo ng kanyang personalidad at ang mismong gumagawa ng mga masasamang bagay na hindi kaya gawin ni Mort kagaya ng pagpatay ng tao.

Noong panahon ng pagsisiwalat, ang kanyang dating asawa ay pumunta sa kanyang kabanya at sa mga oras na iyon ay biglang nagbago ang kanyang katauhan na naman. Pumasok an kanyang dating asawa at sinubukan na hanapin si Mort. Nakita niya ang isang bote ng “Jack Daniels”, ang tunay na sanhi ng paglabas ng masamang si Shooter sa loob ni Mort. Sa ikalawang palapag ng bahay ay nakita ng dating asawa ni Mort ang salitang shooter. Napag-alaman ng babae ng an totoong kahalagahan ng salitang shooter ay “shoot her” pala. Pagkatapos nito ay nagsidalian siyang umalis pero mas maliksing gumalaw si Mort kaysa sa kanya. Pinaslang ni Mort ang kanyang dating asawa at ang kalaguyo nitong si Ted gamit isang pala at sinaktan ang mga ito at inilibing sa kanyang hardin na tinamnan niya ng mais.

Kasunod ay nagbago na si Mort. Naging matino na siya. Sa pagtatapos pelikula, ito ay nagtapos ng isang lisya na paalaala. Ang lokal na serip ay pinagsabihan si Mort na alam niya ang kasalanan ni Mort at pagkatapos na matagpuan ang mga patay na katawan, mabubulok si Mort sa bilanguan. Sumagot si Mort sa serip at sabi niya na ang katapusan ang pinakamahalaga na bahagi ng kuwento.

III. PAGSUSURI

A) Uri ng Pelikula

Sikolohikal na Pagpukaw ng Damdamin(Psychological Thriller)

B) Kaanyuan ng Pelikula

• Ang TEMA ng pelikulang SECRET WINDOW ay natutungkol sa taong may sakit sa pag-iisip. Dapat tulungan natin ibalik sa katinuan ang nangangailangan ng tulong natin lalung-lalo na iyong mga may problemang hindi madaling matapus-tapos.
• Ang PAKSA ito ay ang pagtingin natin sa mga taong may dissociative identity disorder.
• Ang PINAKASUKDULAN ng pelikula ay nagsimula sa bahagi na flashback, ang oras na pinagtangkaan patayin ni Mort ang kanyang dating asawa at ang kalaguyo nito.
• Ang mga PANGUNAHING TAUHANG nagsiganap ay: Johnny Depp, bilang Mort Rainey, ang taong may dissociative identity disorder; John Turturo, bilang John Shooter, ang alter ego ni Mort na gumagawa ng karumaldumal na mga agay na hindi kayang gawin ni Mort; Maria Bello, bilang Amy Rainey, ang dating asawa ni Mort.

Ito ay sa panulat ni Stephen King at sa dirkesyon ni David Koepp.

C) Uri ng Pananalig na Ginamit

Mayroong kaibahan ang uri ng pananalig na ginagamit sa pelikulang ito, and tinatawag na Humanismo, na kung saan ito ay nagbibigay ng pagpapahalaga sa buhay ng isang tao kung saan ang sentro ng akda ay ang tao. Ang tao ang siyang pinahahalagahan dito, siya lamang ang makagagawa ng paraan upang siya ay umunlad at ikatatagumpay niya, siya rin ang nakagagawa ng ikababagsak at ikalalagapak ng kanyang buhay.

Sa naging kalagayan ni Mort, nasa sa kanyang kamay talaga ang solusyon ng kanyang problema ngunit and nakakalungkot isipin lang ay sa huli na niyan napag-alaman na mayroon pala siyang problema sa pag-iisip.

D) Istilo ng Paglalahad

Hindi pangkaraniwan ang istilo ng paglalahad dahil nagsimula ang pelikula ng isang parang flashback. Pinupukaw talaga nito ang kakayahan sa pag-iisip. May kahirapan din na unawain ang balangkas.

E) Matayutay o Matalinhagang Pananalita

May ilang matayutay o matalinghagang pananalitang ginamit sa pelikulang ito, gaya ng:

a) “The ending is the most important part of the story. This one is very good. This one is perfect.” Ito ang sagot ni Mort sa lokal na serip na nangangahulugan na sa bawat kuwento lagin ang katapusan ang parang kinasukdulan nito dahil na rin nga sa “hanging” na katapusan ng kuwento.

b) “If you want to talk to somebody about some grievance you feel you may have, you can call my literary agent.” Ito ay nagsasaad na parang walang paki-alam si Mort sa mga taong kinakahalubilo biya.

c) “This is not my beautiful house. This is not my beautiful wife anymore.” Ito ang binanggit ni Mort noong pinuntahan niya ang kanyang dating asawa at ito ay nag-udlot sa paglabas ng sakit ni Mort.

F) Sariling Reaksyon

Mga Pansin at Puna sa:

a) Mga Tauhan
Si Johnny Depp ay isang napakamahusay sa larangan ng pagsasadula. Nang dahil sa kanyang kakayahan, ako tuloy ay parang natatakot kapag nakikita ko an mukha niya lalo na hitsura niya sa pelikula, nakakatitindig balahibo! Bagay na bagay si John Turturro sa kanyang ginampanang papel bilang si Shooter. Hindi rin pwedeng kalimutan si Maria Bello na magaling din ngunit para sa akin, palaging may kulang.

b) Galaw ng pangyayari

Hindi ako lubos na nasisiyahan sa galaw ng pangyayari lalung-lalo na sa hulihan kung saan napaka-iba nito kung ilulumpara sa nobela na katapusan.

IV. PANANAW: SOSYOLOHIKAL, SIKOLOHIKAL AT ARKETYPAL

Sosyolohikal:

Hindi pangkaraniwang nagyayari sa buhay ngunit mayroong mga kaganapan na gaya nito na nagaganap. Sa kaganapan na may dissociative identity disorder si Mort, at dahil doon ay kaya niyang gumawa ng kasamaan, mapupulot ang mga ugali na mayroon ang tao gaya ng karahasan, kasamaan, pag-aapi.

Sikolohikal:

Sa kaloob-looban ni Mort, matagal na niyang gustong patayin ang kanyang dating asawa kaya nga ang pangalan ng kanyang alter ego ay “Shooter” na ibig sabihin ay “ shoot her”. Napaptunayan ito sa huling bahagi ng pelikula. Sa kalaunan ay naging matiwasay na ang buhay niya dahl tapos a ang problema niya ngunithindi pa rin tayo nakakasiguro sa pwedeng mangyari. Kung sana ay natulungan siya noong simula pa sa kanyang problema, wala na sanang kailangan mabawian ng buhay.

Arktipal:

Kung titiyakin natin ang dahilan sa kng bakit Secret Window ang pamagat ng pelikula ay siguradong mahirap itong mabatid. Sa katayuan ni Mort, tunay nga na sobrang mahirap kalabanin ang sarili. Subalit natapos naman ang lahat dahil nga sa pagkamit ng kanyang layunin na paslangin si Amy.

V. BISANG PAMPANITIKAN

a) Bisa sa Isip

Pagkatapos ko na makita ang pelikula, naramdaman ko na nagbago na ako. Ito ay dahil napag-alaman ko na hindi lahat ng taong mukhang walang sakit ay walang karamdaman. Dahil sa pelikulang iyon, nagbago na ang aking pananaw sa mga taosa akin kapaligiran. Hindi natin tayo dapat masyadong pabaya at magtiwala. Lubhang napakalaki ng bisa ng kuwento sa akin. Nabuksan talaga ang aking isipan sa lalong malawak na pang-unawa ng mga bagay-bagay.

b) Bisa sa Damdamin

Hindi lang isa ngunit maraming beses akong natinag sa pagpanood ng pelikula. Habang ako ay nanonood,ako ay natakot dahil parang nawalan na ako ng pagtitiwala sa mga tao sa aking paligid. Takot ako na baka biglang may huhugot ng kutsilyo ay saksakin ako na wala naman akong ginagawang masama. Ang nakasama pa doon sa pelikula ay parang katulad din ako ni Mort, parang may alter ego! Ngunit hindi ko lang namamalayan.

c) Bisa sa Kaasalan

Nag-iwan ang pelikuang Secret Window ng pamalagiang pamantayang pang-moral na nagiging batayan na pagsusuri ng sarili kong pagkatao. At naibahagi ko na iyon sa itaas. Ang pagiging “time-aware” at “time conscious” ang maaaring ihambing sa tunay na buhay ko. Sa katunayan, ang pagiging listo palagi ang aral na aking napulot at palagi ko na itong gagamitin sa bawat oras dahil lalung-lao na sa panahon ngayon, hindi na tiyak an gating kaligtasan sapagkat may mga kasamaan na nagaganap na sa mundo gaya ng pagkalulong sa droga at marami pang iba.
VI. PAGLALAPAT NG MGA SALAWIKAIN

a) “Kahit paliguanman ng pabango ang aso, lalabas at lalabas pa rin ang mabahong amoy nito”.

Si Mort ay may karamdaman. Isang malubhang sakit sa pag-iisip kaya nga kahit siguro anong gawin niya, lalabas at lalabas talaga iyong ibang sarili niya na si Shooter dahil may layunin si Shooter na dapat gampanan. Makikita sa pelikula na lumabas talaga si Shooter sa sarili at ang dahilan ng pagkasawi ng dating asawa n Mort at ang kalaguyo nitong si Ted.

b) “Madali ang maging tao, subalit mahirap magpakatao”.

Sa buhay ni Mort, ang hirap magpakatao dahl na nga sa kanyang karamdaman na “writer’s block”. Ito ang sanhi ng kanyang pagbabago at saka nagbunga nang masasamang epekto sa buhay ng iba. Kaya niyang magbago ngunit huli na ang lahat. Kahit malaman pa iya siguro na may sakit siya, kahit anog pilit ay hindi talaga maiiwasan na ang nakatakda.


VII. EVALWASYON

Kung ako ay isa sa mga tauhan ng pelikula, ang papel na gusto kong gampanan ay ang papel ni Amy. Bakit? Ito ay sa kadahilanang gusto kong tulungan si Mort sa kanyang problema. Hindi ako magiging pabigat sa kanya. Gagawinko ang lahat upang mawala an masamang alter ego niya.

Secret Window an pamagat ng pelikula dahil may bintana o durungan sa bahay ni Mort. Doon ay ang lugar kung saan niya inilibing ang mga patay na katawan nina Amy at Ted. Dapat manatili itong lihim dahil mabubulok siyasa bilangguan kapag nagkagayon na malaman ng serip ang katotohanan.

Sang-ayon ako na ipalabas ang ganitong uri ng pelikula dahil nakakamulat ito ng pananaw sa buhay. Nagtuturo di ito ng mga aral na dapat tularan.

American Rule in the Philippines

American Rule in the Philippines

During the American regime, there was much progress in our country. The Filipinos enjoyed a better life under America than as a colony of Spain. The standard of living was raised. Agriculture and industry were developed. Transportation and communication were improved. Domestic and foreign trade expanded. Health and sanitation were promoted. Education and religion marched with the times. What Spain could not do in over 300 years, the United States did in less than 50 years.

Let us now talk about the positive results brought about by the American influence to our motherland.

America’s plans for the Philippines were truly a blessing! After the ratification of the Treaty of Paris, President William McKinley issued his Benevolent Assimilation policy towards our country. The policy stated that, “The Philippines is ours not to exploit but to develop, to civilize, to educate and to train in the science of self-government.” This was in preparation for eventual independence. Another was the laws passed by the Taft Commission which contained about 400 laws and one of which was the appropriation of 2,000,000 pesos for the construction and maintenance of roads and bridges. Next is the Philippine Bill of 1902 which permitted more Filipinos opportunity to occupy many government positions. And lastly the Jones Law of 1916 which was passed by the US Congress, the first organic law which provided for the granting of Philippine Independence and a bicameral assembly – the Senate and House of Representatives.

The agricultural sector showed remarkable development! In 1902, the Bureau of Agriculture was established. Our people were taught scientific methods of land cultivation. Modern tractors and other farm machinery were introduced. Pretty soon, the Filipinos had more food and farm animals. The agricultural increase during the American era was fantastic. Next is currency reform. At the end of Spanish rule, the silver currency was the medium of exchange in our country. The money of other nations, such as Spanish gold coins, Mexican silver pesos, and coins of the neighboring Oriental countries, circulated freely in our country. In 1903, Congress passed a currency law placing our money on gold standard. This law stabilized our currency and helped financial transactions.

Another positive result is free trade with America. To promote our trade with the United States, Congress passed a law in 1902 granting a discount of 25% from the American regular tariff rates in favor of Philippine exports. In 1909, Congress passed the Payne-Aldrich Act providing for partial free trade between the Philippines and the United States. In 1913, the Underwood-Simmons Act was passed, establishing full free trade. This was the most important economic change in the American era. This then caused foreign commerce expansion. The immediate effect of our free trade relations with America was the great expansion of our foreign commerce including domestic trade.

Then there was also growth of industries. Under America, greater attention was given to our industries, such as the manufacture of cigars and cigarettes, copra, hemp, sugar and embroideries; mining of gold, silver, asbestos, iron manganese, and other minerals, fishing and lumbering. Our household industries were promoted such as the cloth-weaving industry in the Ilocos and Capiz; the pottery and brick industries in Laguna and Rizal; the cutlery industry in Pampanga and Batangas; the shoe and slipper industry in Manila, Rizal and Laguna; and the furniture-making industry in Bulacan, Manila, Rizal and Pangasinan. Retail trade inside the Philippines doubled. He Philippines entered the Industrial Age. Moreover, during the later part of the American period, our people became imbued with the spirit of economic nationalism. They realized that to be worthy of political independence, which they were desiring, they should have economic stability.

America introduced in our country the modern telephones, radios, radiophone service, and wireless telegraph. Our communications facilities were improved. In 1935, Manila had more telephones and radio receiving sets than any other city in the Far East. Our mail service was improved by America. The Bureau of Posts was established. Post-offices were opened in municipalities. Through the mail service, the remotest barrio in our country came in contact with the outside world. Notable development was made in our transportation during American regime. In 1898, there were 990 miles of roads and 2,000 bridges in the Philippines. For the first time, the Filipinos enjoyed the automobile, electric street car (tranvia), and many others. Water transportation was also developed. Port facilities, like piers and breakwaters were built, and inter-island hoping was promoted. The native boats and sailing vessels remained but better water crafts were introduced such as steamboats, motor launches, and ocean going streamers. Manila became a busy shipping center of the orient. Of recent development was air transportation. The first airplane reached Manila in 1911. Our commercial aviation began in 1930 when the PATCO (Philippine Aerial Taxi Company) was organized.

Another great achievement of America in the Philippines was the improvement of public health and sanitation. The epidemics of cholera, smallpox and plague were wiped out. The Bureau of Health and Quarantine Service were established. Modern methods of medicine were introduced. Health clinics and puericulture centers were opened in cities and towns. Our people were taught good hygiene and sanitation. The death rate fell and the population grew.

The good work of Spain in social service was continued by the United States. The government extended relief to typhoon and fire victims. Delinquent children were housed and trained in Welfarville. The Bureau of Welfare was established to help the poor and the needy families. Our people imbibed the American way of life. To a large extent, they became Americanized in their tastes and habits. They learned the English language and began to read American books and see American movies. They came to play American games, to sing American songs, and to dance American dances. They patronized American products. They also adopted American customs and the American way of life.

One of America’s great achievements in the Philippines was the establishment of the popular system of public education. English was made the medium of instruction. The American soldiers were the first teachers in English of our people. For the first time in Philippine history, education was no longer the privilege of just a few rich families. There was free education which helped the country because it enabled bright but poor students to become professionals and leaders.

On the other hand, the negative results brought about the American regime are discussed below.

From the Americans we learned good habits but we also got some bad habits like materialism, ruthlessness, drunkenness and selfishness. Colonial mentality, a lack of patriotism, became worse. Moreover, we sold our raw materials cheap and bought expensive manufactured goods from America. American capitalists and businessmen controlled the new companies. Domestic trade was controlled by foreigners. In 1935, Chinese controlled 50% of our domestic trade, the Filipinos 25%, the Japanese 20%, and other foreigners 5%. There was also population explosion because of improved sanitary and health services. Some American officials gave better treatment to Americans doing business in the Philippines. We could not break loose and make our own policies. And lastly, some provisions of the Tydings-McDuffie Law specifically limitation of Filipino immigrants to the US to 50 a year, gradual abolition of free trade with the Americans and right of the US president to suspend the operation of any law in the Philippines were some negative results that occurred during the American occupation in the Philippines.

Kasalukuyang balita/ Spot news na Editoryal

Kasalukuyang balita/ Spot news na Editoryal



Manny Pacquiao, Pandaigdigang Kamao!


Walang tiyaga, walang nilaga. Ipinakita muli ni Pacman ang kanyang gilas sa larangan ng boxing sa pamamagitan ng pagkapanalo niya laban kay Oscar Dela Hoya sa isang boxing match sa Mandalay Bay, Las Vegas, Estados Unidos, noong nakaraang ika-anim na araw ng buwan ng Disyembre.


Sa bakbakan nila, palaging si Oscar ang habol nang habol kay Manny at si Manny naman ay ang laging nagbibigay ng mga suntok. Mutik na nga manalo si Manny bago pa man nagsimula ang ika-pitong round dahil na nga sa bilis ng kanyang mga suntok na natulak si Oscar sa isang corner. Si Dela Hoya, na ang isang mata ay nakapikit na, ay tinuluy pa rin ang sagupaan ngunit sa kasamaang palad ay natalo bago pa man nagsimula ang ika-siyam na round. Nagpapasalamat nga si Manny sa Poong Maykapal na binigyan siya ng maliliksi’t malalakas na kamao. Dahil na rin sa pagkapanalo niya, nabigyan na naman ng dahilan ang mga Pilipino na itaas ang noo dahil na nga sa pagkapanalo niya sa Dream Match. Nakasaad nga sa Yahoo website na si Manny daw ang kasalukuyang “world’s finest fighter”. Para sa amin, tunay na kamangha-mangha si Manny Pacquaio dahil sa kanyang kagitingan at lakas ng loob at pananalig sa Diyos. Ito ang mga tanging dahilan sa kayang pagwagi maliban sa mahirap na training na isinagawa niya para sa laban.


Ang karukhaan ay hindi hadlang sa pagtatagumpay. Gaya nga ni Manny, sana’y maging katulad kay Manny ang lahat ng Pilipino. Ang tao ka ay dapat marunong lumaban sa pamamagitan ng paggamit ng kanyang mga kakayahan para sa ika-uunlad ng sarili at maging sa sangkatauhan. Ang tanging kulang sa karamihan ay ang kasipagan. Dapat lang na maiwasto ito. Hindi ba?

The Man Who Discovered LSD

The Man Who Discovered LSD

The article attached features the experience of Albert Hofmann, a Swiss scientist best known for having been the first to synthesize, ingest and learn of the psychedelic effects of lysergic acid diethylamide (LSD). LSD is the most common hallucinogen and is one of the most potent mood-changing chemicals. It is manufactured from lysergic acid, which is found in ergot, a fungus that grows on rye and other grains.

Based on Albert’s story, the effects of LSD were quite one of a kind! They depended on the amount taken. Out of curiosity, he tested his theory and intentionally ingested 250 µg of LSD. His sensations and feelings changed much more dramatically than the physical signs like his extremely dilated pupils. His vision was altered on the way home during the bicycle ride. The drug produced delusions and visual hallucinations. In addition, Albert felt several different emotions at once and swung rapidly from one emotion to another like when he felt very dizzy and had inclination to faint. His sense of time and thinking changed. Sensations seemed to “cross over”, giving him the feeling of hearing colors and seeing sounds.

The experience of Albert did not have much impact on his relation with his family because the effects of the drug faded away the day after his intake of it. However, his relationship to the society and to the world became like Alfred Nobel’s. Many despise both of them for discovering and creating a chemical product that has a high possibility of dooming almost everybody in the worlds’ lives.

In line with the article, we are now completely convinced not to take illegal drugs. Why? Honestly, it’s because there are times when we feel curious and we think about taking these types of drugs. But since we learned that illegal drugs just bring harm to us, we are already too scared to even think about it. Perish the thought!

Sources:

http://www.drugfree.org/Portal/Drug_Guide/LSD

http://en.wikipedia.org/wiki/Albert_Hofmann

http://answers.yahoo.com

Self–Awareness and Values Clarification Seminar

Self–Awareness and Values Clarification Seminar

The whole day seminar really was awesome! It made a great impact on me. How? It is because of the fact that everything I personally experienced and learned can, in a way, enable me to know more about myself. For example, we had this personality test wherein we were asked to draw a pig. Out of the drawing which we drew, the guidance councilor gave us the interpretations. After interpreting, the guidance councilor told us that the characteristics of the pig are a reflection of what we are! I then realized that the interpretation was precisely correct! According to the guidance councilor, my pig was realistic or practical, direct or innovative, and emotional or naïve and feels secure but stubborn at times because the pig sticks to its ideals. That pig is me.

I learned so many things throughout the seminar. For the self-awareness part, I knew that there are three steps in the creation process which are self-awareness, self-acceptance and taking ownership. Based on what I learned, self-awareness is the first step in the creation process. Moreover, we ourselves are the so-called “experts” of ourselves. Second step is self-acceptance. For this step to be developed, one must have the characteristics of being honest, courageous and being realistic which are necessary pre-requisites. Finally, in the step of taking ownership, it connotes that one should realize that he/she has the power to make his/her life happy.

In addition to the self-creation process, I also learned about the Johari window where the “self” is divided into four parts or windows which are: public self, private self, blind spot and potential self. Public self states that the person him/herself and others know that the characteristic is in him/her. The private self is where one has traits but others can not see it. Thus, people who belong to this window tend to be very secretive. For those who belong to the blind spot, these are the people who portray a good, responsible person however back at home, the person is the exact opposite. Finally, for those who belong to the potential self, these are people who are not aware that they can have these traits.

Values can be defined as principles, ideas, beliefs, and ideals that we cherish. It can be either instrumental, which are values in adjective form and refers to our personal characteristics, or terminal, which are values that we need to work for so that it can be developed. During the part two of the seminar which is the values clarification part, I learned that there are four things I ought to keep in mind. They are as follows: 1) I have to believe that I am capable of changing now; 2) I believe that my life is my responsibility; 3) I believe that my values determine my attitude and behavior and; 4) I believe that if I set my sights in a new direction, I will arrive near the place I wanted to be.

So based from what I learned throughout the seminar, I intend to apply my realizations. I ought to balance the four windows of myself to become a better person. I should not be secretive, boastful, plastic, and I should never be such an introvert! In addition, I must inculcate in my mind and heart the four important things regarding life which was tackled during the values clarification part of the seminar.

I am really thankful to the people behind the implementation of this seminar. It is because I learned new things that can aid me to become a more wholesome person emotionally/mentally and socially. The only recommendation I can give is that the seminar should be an overnight activity. That is all. Good day!

FIRST AID

FIRST AID

After 3 hours of varied learning discussion, the Level 2 students will be able to:

1. Define the following terms:
- accidents - injury
- bandaging - joints
- bites - shocking
- burns - seizure
- dislocation - shock
- emergency care - splinting
- fainting - sprain
- fracture - strain
- first aid - tourniquet
- hematoma - trauma
- hemorrhage - wound care
- infractions

2. State the importance of First Aid

3. Identify the aims of First Aid

4. Cite the rules and characteristics of a First Aider

5. Explain the different principles involved in First Aid

6. Enumerate the guidelines in preparation for First Aid

7. Discuss the First Aid Interventions for the following:

- epistaxis - dislocation
- bites - strain
- wounds - sprain
- burns - fractures
- poisoning - shock
- choking

8. show materials needed for a First Aider

9. demonstrate beginning skills in performing First Aid




DEFINITION OF TERMS

Accidents - a sudden, unforeseen event that produces unintended injury, death, or property damage.

Bandaging - an act of wrapping or applying bandage over an injured part of the body.
- Help to immobilize, support or protect the part.

Bites - puncture, laceration or penetration of the skin by human teeth or by an animal or insect.

Burns - A lesion of tissue due to chemicals, dry heat, electricity, flame, friction, or radiation.

Dislocation - A displacement of organs or particular surfaces, more especially of a bone at a joint; accompanied by pain and deformity .

Emergency care - Is an immediate health care procedure done to protect an emergency incident victim and keeping him safe from further injury, shock or other incident.

Fainting – loss of consciousness due or lack of adequate blood to the brain.

Fracture – a break in the continuity of bone, epiphyseal plate, or joint surface.

First aid – is the immediate and temporary care given t the victim of an accident or sudden illness, before the doctor arrives or medical treatment can obtained.
The “First Aid” was adopted officially in England for he first time in 1870 by the St. John Ambulance Association. The expression ‘First Aid’ had not come till 1894 and intended to designate any person who has received a certificate from an authorized association that he (o she) is qualified to render first aid.

Hematoma – a collection of blood beneath the skin.

Hemorrhage – escape of blood from the ruptured vessel.
External – obvious escape of blood from a wound or external orifice
Internal – in which the extraverted blood remains bleeding from within the body.

Infarction – formation of an infarct.
-death of a section of tissue because the blood supply has been shut off.
Infarct – the area tissue, or organ, or part that dies when the end artery supplying it, o the vein that carries blood from it, is occluded.

Injury – a wound or damage to a person, specifically any disruption to the continuity of body tissue that
may or may not involve in the skin.

Joints – the articulation or connection of two or more bones for mobility and stability.

Shocking – highly disturbing emotionally.

Seizure – a sudden attack or sudden occurrence of symptoms. Ex. Convulsion

Shock – is a circulatory deficiency within the body associated with the depression of essential organ
function. This results from lowered cardiac output, not from lowered arterial pressure.

Splinting – the application of splint to provide fixation of a fracture or dislocation.

Sprain – injury to the soft tissues surrounding joint, caused by forcible wrenching, or hyperextension of
the joint,; sometimes ligaments or tendons are ruptured but the bone is not fractured or dislocated. Classified as first, second, and third degree, according to severity and extent of the extent.

Strain – weakening or stretching of a muscle at the tendon area, resulting from over exercise, overuse
Improper use.

Tourniquet – an apparatus for the temporary compression of the blood vessels of a limb.

Trauma – a wound or injury caused by external force or violence.

Wound care – prevention of entrance of other bacteria o the wound.





IMPORTANCE OF FIRST AID
- To be prepared in any emergency that might occur
- To prevent or minimize further damages and infections of wounds when immediate medical care is not available
- To have control or not to panic in any emergency or accidents that might happen




AIM OF FIRST AID
- preserve life
- assist recovery
- prevent aggravation of the condition until the service of a doctor can be obtained
- recognized life-threatening situations
- supply artificial ventilation and circulation when needed
- It controls bleeding
- Minimize further injury and complications
- Prevent infection
- Make the victim as comfortable as possible
- Arrange for medical assistance and transportation





ROLES OF A FIRST AIDER
 Respond quickly to calls for assistance; the saving of a life depends on promptness of action.
 Adopt calm and the methodical approach to the casualty, quick and confident examination and treatment will relieve pain and distress, lessen the effect of the injury and may save life. Time spent on long and elaborate examination of a casualty may be time lost in his ultimate recovery.
 Treat obvious injuries and conditions endangering life such as failure of breathing severe shock, before making a complete diagnosis.
 Take first aid materials if this is immediately available. If standard equipment is not available the first aid must depend on material to hand which will have to be provided as required.
 Need to know his/her limitations.





CHARACTERISTICS OF A FIRST AIDER
• Resourceful – using available resources in the community
• Calm – one who is tranquil, quite or windless and one who is not agitated
• Tactful- does not embarrass but criticize in constructive manner
• Gentle- a person who is kind and has patience
• Efficient- should have necessary skills and knowledge, plans with people and let them participate in the plan.
• A keen observer – knows how to identify what problem to prioritized
• Empathetic – tries to put yourself in the patient’s shoes but not to the extent that you’ll be affected.
• Knowledgeable- a person who is well informed and who is intelligent
• Communicator – bridge between the victim






PRINCIPLES INVOLVED IN FIRST AID MANAGEMENT

Anatomy and Physiology
- Knowledge on the surface of the body many help in doing first aid.
Microbiology
- Aseptic procedure must be well observed in order to prevent infection.Pharmacology
- The use of ointments and medicines are need to facilitate healing or relieve pain.
Chemistry
- An understanding on the nature and composition of substances help the first aider to detect the effect of harmful substances that caused the injury and what to apply on injured areas.

Safety and security
- First aid training is of value in both preventing and treating sudden illness or accidental injury in caring for large numbers of persons caught in the a natural disaster.
Body mechanics
- The first aider must contain the good alignment and balance throughout the procedure so that they may not fell body strain.
Physics
- Applying pressure to prevent loss of the blood from the body without intervening with normal blood circulation







GUIDELINES FOR GIVING FISRT AID
-do “first things first quickly”, and without fuss or panic.
-Remember the primary survey of the victim – the ABC (airway, breathing, and circulation)
-“Give artificial respiration” if breathing is stopped – every second counts.
- assess client’s pain tolerance levels. Remember that pain is an important indicator.
- stop any bleeding
- “guard against or treat for shock” by moving the casualty as little as possible and handling him gently.
- “do not attempt too much” do the minimum that is essential to save life – and prevent the condition from worsening .
- “reassure the casualty” those around and so help to lessen anxiety.
- do not allow people to crowd round as fresh air as essential.
- do not remove clothes unnecessarily.
- arrange for the removal of the casualty to the care of a doctor (or) hospital as soon as possible.





DISCUSS THE FIRST AID INTERVENTION

1. EPISTAXIS (NOSEBLEED)
- Bleeding from the nose may be the result of blowing too hard, sneezing, picking air pressure changes or high blood pressure: occasionally blood disorders may be the cause :
- Infection
- Trauma
- Allergic and non allergic rhinitis

• Interventions:
- For a normal nosebleed, have the victim sit in a chair with his head slightly forward and pinch the nostrils together for at least 15 minutes
- Loosen any tight clothing around the neck
- Apply ice to nose and checks
- If bleeding persists consult a doctor. Let the victim see a doctor if he has lost so much blood that it makes him feel dizzy and pale.

2. BITES
- is a wound received from the mouth (and in particular, the teeth) of an animal, including humans. Animals may bite in self-defense, in an attempt to predate food, as well as part of normal interactions. Other bite attacks may be apparently unprovoked.
Animal Bites
1. Dog Bites – vary in extent from sunlight contusions, superficial abrasions and fang puncture wound to deep teaching lacerations if the animal or the victim attempts to pull away.






2. Cat bites and scratches - even if minute, may cause benign low-grade infection-cat stretch fever




3. Rat bites- infants living in squad surroundings may be injured severely by rat bites.

4. Bat bites – certain varieties of carnivorous and insectivorous bat may be rabid. They may carry other infectious viruses in their salivary glands.

5. Snake bites – bites of venomous snakes.









General First Aid Care for BITES:
*if the client is still present, remove it by gently scraping against it with edge of a credit card, the edge of a knife, or your fingernail.
*wash the area around the bite or sting gently with a soap solution.
*remove any jewelry or other constricting objects as soon as possible
*lower the site of the bite or sting slightly below the level of the victim’s heart.
* apply a cold compress to the site of an insect bite or scorpion sting to relieve pain and swelling.
*apply a paste of baking soda and water to relieve pain of bee sting
* observe the victim carefully for the least 30 minutes to determine whether he or she is developing the signs and symptoms of an allergic reaction.

SNAKE BITES SIGNS:
-the patient will tell you that he has been bitten by a snake.
-the punctured wounds produced by the snake’s fangs are clearly visible.
- the patient may show signs of poisoning. e.g: bleeding or paralysis.
- signs of shock

Symptoms:
-casualty may experience disturbed vision
-may fell nauseated or already be vomiting
- one or two small puncture wounds with sharp pain and local swelling
- breathing may become difficult or fail together
-symptoms and signs of shock
- salivation and sweating may appear in advanced stages of venom reaction.



AIM:
-Reassure the casualty
-prevent absorption of venom and
-arrange urgent removal of hospital

FIRST AID TREATMENT FOR SNAKE BITES:
-tie a piece of cloth (AT least within 1 hr) or a tourniquet, tightly above the bite to prevent the venous bleed return
-loosen the tourniquet for one minute in every 20 minutes
-keep the bitten limb hanging down
- treat for shock reassure, and keep the patient at rest and warm
-examine the wound

3. WOUNDS
-is a break in the continuity of a tissue of the body either internal or external.
-usually result from external physical forces such as motor vehicle accident, falls, mishandling of sharp objects and wounds.

Kinds of WOUNDS
1. Open Wounds – is a break in the skin or in the mucous membrane.

a. Abrasions – caused by scraping or rubbing away of an outer layer of skin.


b. Incisions – is a smooth cut; which are commonly caused by knives , metal edges, broken glass or other sharp objects.















c. Lacerations – are jagged, irregular cut or tear in the skin and soft tissues. Bleeding may be severe, especially if large vessel is torn.















d. Punctures – are penetrating open wounds caused by pointed objects such as bullets, nail, needle/knife.








e. Contusion – are open wounds in which the tissue is torn completely.
- caused by animal bites and accidents like motor vehicle, heavy machinery guns and
explosives


















2. Close Wound – involves underlying tissues without a break in the skin or a mucous membrane.








First Aid for Open Wounds:
-As a general rule, the first aider handles open wounds with three primary considerations
1. the bleeding must be stopped
2. additional contamination must be prevented
3. the injured are should be immobilized.


Techniques for CONTROL OF BLEEDING:
a. Pressure – the is to prevent loss of blood from the body without interfering with the normal blood circulation and shows down the blood flow to the extent that clotting an occur.
b. Elevation –is raising the injured area above the heart level, because his uses the force of gravity to help reduce the blood pressure in the injured area and aids in slowing down the loss of blood through open wound However, direct pressure on wounds must be continued.
c. Pressure points - are the sites where pressure can be applied. This should be used to control bleeding only when necessary, because the circulation within the active body part is affected.
-this are several points in the body, but the most practical and effective pressure points are the brachial artery in the upper arm and femoral artery in the groin.
d. Tourniquet – is a wide band of cloth placed just above a wound to stop flow of blood.
- should be used to control bleeding only as a last resort, when all other methods are failed.
4. BURNS
- Is an injury that results from heat, chemical agents or radiation. It may vary in depth, size and severely and may damage cells in the affected area.

SOURCES OF BURNS

1. CHEMICAL BURNS
- Occurs when skin becomes into direct contact with strong corrosive substances such as acid or alkali.
TREATMENT:
- Chemical burns should be flushed with a large amount of water to dilute chemical and overt the possibly of additional injury
- Remove the clothing from the areas involved because this will contaminate the skin from microorganism that will cause further injury.

2. SUNBURNS
- Is caused by long period of direct exposure to the uv rays
- This may be serve as 2nd degree burn or 1st degree burn.


TREATMENT:
- Application of cold wet compress or fresh water, ice pack to the burned area to prevent 1st degree burn from developing to a 2nd degree burn.

3. RADIATION
- Exposure to unsafe levels of radiations
- The amount of radiation absorb by the tissue determines the injury or danger.
- The higher the radiation absorbed dose ( ROD) , the greater the amount of damage
TREATMENT:
- Call the nearest hospital or emergency care center
- Direct the victim to flush the skin with amount of water

TYPES OF BURNS

1. First degree burn

o Is a superficial injury characterized by reddening of epidermis. This maybe painful, but usually heals without difficulty unless infection occurs.











TREATMENT:
o Apply cold water to relieve the pain and promote healing
o If possible use ice pack because once applied immediately this may prevent the first degree from developing second degree.

2. Second degree burn

o Are painful to touch and are characterized by blisters, deep reddening sensitivity to cold air and loss of body fluid and electrolytes.
o Result from extension of the injury into the deep layers of skin.








TREATMENT:
o Immerse in cold water but not ice water because this can reduce the burning effect of heat in the deep layers of skin.
o Loosen or remove clothing.

3. Third degree burn
o Involves deep damage to skin and unclearing tissues. This characterized by great destruction of fat tissues and some bone tissues












TREATMENT:
o Cover the burned area with sterile dressing
o Give sips of the fluid to alert victim
o Keep the victim warm and the feet slightly raise to improve circulation
o Do not apply ointment because this may interfere with the treatment of the physician.
o Take victim to the hospital as quickly as possible



5. POISONING
- is any substance that if taken into the body in sufficient quantity, can cause temporary or permanent damage.
- are solid, liquid or gas substances that harm the human body or disturb the functioning of its substances though chemical reaction.
-it is condition produced by a poison or toxin in contact or enters the human body.

• How poison enters the body ( ingestion, inhalation, injection, absorption)
-Either accidentally or intentionally
-Through the mouth by eating or drinking poisoning substance
- by injection into the skin as a result of bites from animals, insects.
- By absorption through the skin through the contact with the poisonous sprays such as
pesticides and insecticides.

WAYS OF POISONING

1. Poisoning by Ingestion – any substance solid or liquid has he potential to produced toxic
effect when ingested.
e.g. corrosive substances
>Alkali: dishwasher detergent
>Acids: Toilet bowl cleaners sulfuric or hydrochloric acid

Signs and Symptoms:
-burns around the mouth and throat; pain when swallowing

Treatment:
First aid for corrosive substances is limited, but if victim is conscious, the best and safest thing to do is to drink milk. Milk dilutes the poison as well as coat and GI.

2. Poisoning by Inhalation – inhalation of toxic gases ad vapors is responsible for a lot of
deaths per year
-example is Carbon Monoxide, an odorless, colorless and
tasteless gas that result from the incomplete contusion.

Signs and Symptoms:
-headache
-dizziness
-shortness of breath
-chest pain
-victim’s skin changes to color
-tending toward a cherry red especially lips and mucous membrane.


Treatment:
-while holding the breath, quickly open the windows to allow fresh air to enter
-check the heartbeat and breathing
-give oxygen, if available, oxygen hastens the elimination of carbon monoxide in the body.
-keep the victim lying down and comfortable.

3. Poisoning by Ingestion – results from the bite of stings f insects (bees), forms of marine
Life (jellyfish), reptiles (snakes),

Signs and Symptoms of stings of:
a. Insects (bees) - manifest severe systematic reaction characterized by respiratory
distress and vascular collapse, vomiting and abdominal cramps.
b. Marine Life (jellyfish) – mild rash, weakness, intense burning pain to shock, nausea,
vomiting or respiratory distress
c. Reptile (snake) – two puncture wounds seen at the site, swelling occurs at the site of
the bite, and painful feeling of weakness, sweating, pulse is rapid
and weak.
Treatment:
a. Insect (bites) – remove the stinger with care because the stinger have venom sac,
Once squeezed, this will inject toxin to victim.
-wash the affected area and supply cold water or ice wrapped in a towel
To reduce swelling and venom absorption.
b. Marine Life (jellyfish) – remove the tentacles, because they tend to cling where
contact was initially made
–remove by gently rubbing with towel/dry the area with soap sand an powder.
c. Reptiles (snakes) -have victim lie down and relax
-immobilize the bitten part
- apply constricting band just above the site but not on joint, neck
or head.

Poisoning by PLANT contact:
-plant such as ivy and poison oak are plants to which large number of people is hypertensive. The hypersensitivity is manifest itself as an allergic reaction of the skin.

Signs and Symptoms:
-usually appears within few hours after contact
-redness of the skin, swelling and itching
-blisters form with itching

Treatment:
-affected part must be kept dry and clean
FIRST AID IN POISONING
- maintain the airway and monitor the victim’s airway, breathing, circulation and disabilities. (ABCD’s)
- get medical aid as soon as possible
- keep carefully any bottle, glass, etc. which might have contained the poison and any vomit
- treat for shock keep the patient warm and loosen tight clothing

COMMON SIGNS AND SYMTOMS OF:
INGESTION:
-Nausea, vomiting and diarrhea
-Excessive salivation
-Abdominal pain, tenderness, bloating and or cramps
INHALATION
-Difficulty in breathing
-Chest pain
-Muscle weakness
-Dizziness
-Headache
-Altered mental status or confusion

INJECTION
-WEAKNESS
-DIZZINESS
-CHILLS AND FEVER
-NAUSEA AND OR VOMITING
ABSORPTION
-Exposure to poisonous substances
-Traces of liquid or powder on the skin
-Redness
-Itching or irritation

Types of Poison:
1. Irritants – which irritate and inflame the tissues. Examples of these are food certain fungi and barriers, kerosene oil, arsenic fluid lead and mercury.
2. Corrosive poisons – are strong acids, strong alkalis and disinfectants. These poisons burn the lips, mouth, esophagus and stomach. They cause severe pain and shock. The burned tissues may swell and cause breathing difficulty an there may be blood stained vomit.
3. Nerve poisons – affect the nervous system, can cause unconsciousness. (opium morphia, etc.)

First Aid Treatment for Irritant:
1. Make the patient vomit by tickling the back of the throat, or by giving emetics.
ex. Strong salt water (a tablespoon to a glass or 200 ml of water)
2. Give plenty of fluids, e.g. rice water, milk or plain water. This will dilute the poison and make up the fluids lost through vomiting and diarrhea.

First aid treatment for corrosive poisons:
1. Do not cause vomiting it might result in perforation of the stomach wall
2. Give two glasses of milk or water
3. Give an antidote if known, e.g.
- If acid has been swallowed give an alkali such as sodium bicarbonate or white wash, two tablespoon to a pint of water
- If alkali such as ammonia has been swallowed, give a weak acid such as lime juice or vinegar, two tablespoons to pint of water
- If a disinfectant has been swallowed, give magnesium sulphates two tablespoons in a pint of water or cupful liquid paraffin
4. Give soothing drinks e.g milk, white of egg, rice water of oil
5. Treat for shock
6. If the throat is swollen, give only cool fluids, and apply hot fomentation to the neck

First aid for nerve poisons:
1. Make the patient vomit, immediately before the drug is absorbed
2. Give strong black coffee or tea, unless there are spasms
3. If an antidote is known, give it e.g. for morphia give potassium permanganate solution
4. If there are spasms or delirium, keep the patient quite in a dark room
5. In the case of poisons like morphia, artificial respiration may be needed

6. CHOKING
- Also known as AIRWAY Obstruction, occurs when the airway becomes du to solid object fluids/ back of the tongue.
Common CAUSES:
-trying to swallow large pieces of food
-wearing dentures
-drinking alcohol before or during eating
- talking/laughing while eating
-walking, playing or running objects in the mouth

Types of Obstruction:
1. Partial Airway Obstruction
a. With Good Airway Exchange
-can cough forcely
-he may also wheeze between breaths
-stay with person and encourage him to continue coughing
-if coughing persists, secure medication attention
b. With Poor Airway Exchange
-have a weak, ineffective cough and make a high-pitched noise while breathing.
c. Complete Airway Obstruction
- when there is a complete obstruction of the airway, the person will not be able to speak, breathe or cough.
- the person may clutch at his throat with on both hands. This is universal distress signal of choking. You must act right away to clear the airway.

TREATMENT FOR AIRWAY OBSTRUCTION:
TREATMENT DEFINITION
Back slaps designed to use percussion to create pressure behind the blockage, assisting the patient in dislodging the article. In some cases the physical vibration of the action may also be enough to cause movement of the article sufficient to allow clearance of the airway.
Abdominal thrusts also known as the Heimlich Maneuver
involves a rescuer standing behind a patient and using their hands to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it. This amounts to an artificial cough.
Modified chest thrusts sometimes taught for use with pregnant women and obese casualties. The rescuer places their hand in the center of the chest to compress, rather than in the abdomen
Finger sweeping Some protocols advocate the use of the rescuer's finger to 'sweep' foreign objects away once they have reached the mouth. However, many modern protocols recommend against the use of the finger sweep as if the patient is conscious, they will be able to remove the foreign object themselves, or if they are unconscious the rescuer should simply place them in the recovery position (where the object should fall out due to gravity). There is also a risk of causing further damage (for instance inducing vomiting) by using a finger sweep technique

FIRST AID:
*Conscious victim
-determine if the victim is choking
-return abdominal thrust
*Unconscious victim
-begin with primary survey to check the ABC’s
-check for responsiveness; if no response shout “help”
-position the victim
-check for breathlessness, if no breath, give two full breaths
- if you are unable to breath air into the victim, retilt the victims head and give two full
breaths again.
-perform 6-10 abdominal thrust
-do finger sweep
-two full breaths

Special Situations:
1. If you are alone
a. Position your own fist slightly above your navel
b. Grasp your fist with other hand and bend over a hard surface – a countertop or chain will do
c. Shove your fist inward and upward
2. Cleaning the airway of the pregnant woman or obese person
a. Position your hands a little bit higher than with a normal Heimlich maneuver, at the base of the breastbone; just above the joining of the lowest ribs
b. Proceed as with the Heimlich maneuver, pressing hand into the chest, with a quick thrust
c. Repeat until the food/ other blockage dislodged or the person becomes unconscious
3. When a conscious victim becomes unconscious
a. If a victim is choking loses consciousness while you are giving abdominal or chest thrust, you should shout for help and slowly lower the victim to the floor.
b. Have someone else call for medical attention
c. Do finger sweep
d. Open the airway and give two full breaths
e. Give 6 – 10 abdominal thrust if you are unable to breathe air into the victim’s lungs.



























7.DISLOCATION
- Is an injury to the joint and the ligament surrounding it
- The end of the bone are displaced making movement difficult and very painful.

COMMON CAUSES
- Fall
- Sports injuries
- Motor vehicle accidents
INDICATION
- There is a swelling, deformity, pain in joint, loss of movement and tenderness
FIRST AID FOR DISLOCATION
- Do care for shock
- Monitor ABC
- Splint and immobilized the affected joint in the position in which it us found
- Apply cold pack
- Secure medical attention promptly

8. STRAIN
- Are stretched or form muscles, frequently in the back. A person with a serious back strain should have medical attention before resuming activity.
COMMON CAUSE
- Are usually caused by lifting something improperly or lifting something too heavy.
INDICATION
- Sign and symptoms of strain include sharp pain, stiffness and possible swelling.
FIRST AID FOR STRAINS
- Do care for shock
- Monitor ABC
- Apply a sling if appropriate
- Apply cold pack
- Rest the affected part
- Secure medical attention promptly
- Splint and immobilize the affected part in the position in which it is found.

9. SPRAIN
- Is an injury to joint or ligament or a muscle tendon in the region of a joint
- Particularly common about the ankle, usually from turning the foot inward beyond the range of motion and in the knee from a wrenching movement or direct blow.
FIRST AID FOR SPRAIN
- Do not allow the victim to walk
- If swelling and pain persist, seek medical attention.
- In mild sprains, keep the injured part raised for at least 24 hrs.

- Do not soak with water
- If swelling and pain persist seek medical attention.

10. FRACTURES
- Breaks or cracks in a bone, complete or incomplete, or loss or normal bone continuity.

CLASSIFICATION OF FRACTURES
1. open fracture - the bone exits and is visible through the skin, or where a deep wound exposes the bone through the skin.
2. closed fracture - the bone is broken, but the skin is intact.

TYPES OF FRACTURES




• transverse - the break is in a straight line across the bone.
• spiral - the break spirals around the bone; common in a twisting injury.
• oblique - diagonal break across the bone.
• compression - the bone is crushed, causing the broken bone to be wider or flatter in appearance.
• comminuted - the break is in three or more pieces.
• Greenstick – when the bone is completely calcified as in children, the break is in complete.
Greenstick: incomplete fracture. A portion of the bone is broken, causing the other side to bend.


Spiral: the break spirals around the bone; common in a twisting injury.


Transverse: the break is in a straight line across the bone.


Oblique: diagonal break across the bone.


Compression: the bone is crushed, causing the broken bone to be wider or flatter in appearance.



Treatment may include:

• splint/cast - immobilizes the injured area to promote bone alignment and healing to protect the injured area from motion or use and the pain which such motion would cause.
• medication - for pain control or antibiotics to prevent infection if the fracture is open
• traction - the application of a force to stretch certain parts of the body in a specific direction. Traction consists or pulleys, strings, weights, and a metal frame attached over or on the bed. The purpose of traction is to stretch the muscles and tendons around the broken bone to allow the bone ends to align and heal.
• surgery - required to put certain types of broken bones back into place. Occasionally, internal fixation (metal rods or pins located inside the bone) or external fixation devices (metal rods or pins located outside of the body) are used to hold the bone fragments in place to allow alignment and healing.


FIRST AID FOR FRACTURES
- do not move the patient or limb unless in danger
- steady and support the injured part at once, and prevent movement
- reassure the patient and send for medical aid if possible
- apply splints
- arrange for suitable transport to hospital







FIRST AID CARE for SPRAINS, STRAINS, and FRACTURES

R-est
Have the victim stay off the injured part completely and not use the joint all.

I-ce
Cold relieves pain and prevents swelling and inflammation. Immediately put cold packs, or cold towels on the injured area or immerse it in ice water fro20-30 min. at a time every 2 hrs.

C- ompression
To limit internal bleeding and compression fluid from the injury site, wrap a compression bandage in a overlapping spiral that supports the entire injured area. The victim should wear the bandage continuously for 18-24 hrs, except when applying a cold pack.

E- levation
Limits circulation, reduces swelling, and encourage lymphatic drainage.

11. SHOCK
-is a circulatory deficiency within the body associated with the depression of essential organ function. This results from lowered cardiac output, not from lowered arterial pressure
TYPES OF SHOCK:
TYPES DESCRIPTION AND CAUSE
HEMORRHAGIC • Loss of blood, usually from multiple trauma and severe burns
• There is enough blood in the system to provide adequate circulation to all parts.

NEUROGENIC • Spinal or head injury resulting in loss of nerve control
• Blood vessels dilate and there is not enough blood to fill them
PSYCHOGENIC • something psychological affects the victim
• blood drains from the head and pools in the abdomen causing fainting
CARDIOGENIC • The cardiac muscle does not pump effectively enough to circulate blood
• Usually because of injury, heart attack, or heart disease
METABOLIC • Insulin shock, diabetic coma, vomiting, diarrhea, or some other condition causes loss of fluids and change in biochemical balance
SEPTIC • Toxins from severe infection cause dilation of blood vessels, pooling of blood in the small capillaries, and bacterial invasion of blood vessels.
ANAPHYLACTIC • Severe allergic reaction occurs, usually to insect sting, food or medicine
SIGNS AND SYMTOMS OF THE 3 STAGES OF SHOCK
STAGES WHAT HAPPENS SIGNS AND SYMTOMS
Compensatory • The body tries to use its normal defense mechanism to maintain normal function. • Minimal – normal blood pressure
• Increased pulsed
• Cool clammy skin
• Dull
• Pale skin
• Weakness
• Anxious
• restless
Progressive • body shunts blood away from the extremities and abdomen to the heart, brain and lungs, • extremely pale skin
• dropping blood pressure
• profuse sweating
• extreme thirst
• nausea and/or vomiting
• dizziness
• altered levels of consciousness
Irreversible • blood is shunted from the liver and kidneys to the heart and brain
• organs die
• blood pools away from vital organs
• death occurs • dull
• lusterless eyes
• dilated pupils
• shallow
• irregular breathing
• loss of consciousness


TREATMENT for CONSCIOUS PATIENT:
1. keep victim in supine position. This aids in the return of venous blood to the heart
2. assess and provide care as needed for breathing, circulation and exercise bleeding
3. loosen clothing and the victims body heart must be monitored and stay close to normal if possible.
4. Don’t give fluids or foods
5. Call for medical assistance.


TREATMENT for UNCONSCIOUS PATIENT:

1. Maintain blood flow of the patient’s vital organs (brain, heart, and lungs) by letting
patient lie flat and raise their legs about 6-12 inches (15-30cm) off the ground. Do
not incline the victim's head, chest, or pelvis, as this brings no improvement and
can cause harm the patient
2. Assess ABC(Airway, Breathing, Circulation). Should any change occur
compensate with required treatment.
3. As airway takes priority over other treatment, you should place them in the
recovery position in order to ensure a patent airway.
4.Let the patient rest after regaining consciousness.

TYPES OF SPLINTING
TYPE OF SPLINTING DEFINITION
RIGID SPLINTS such as wood, magazines, newspapers and other things that can be converted to support the fracture.
SOFT SPLINT such as pillows, rolled blankets and other soft materials
ANATOMICAL SPLINT using part of the body to support a fractured area can also be done.

Anatomical Splints:





RIGID SPLINT:






SOFT SPLINT:








MATERIALS NEEDED FOR A FIRST AIDER
-dressings
-bondages
-pair of scissors
-roll of gauze bondage
-roll of absorbent cotton
-roll of adhesive hypo allergic tape
-spirit of Ammonia bottle
-bottle of rubbing alcohol
-tweezers

Hot Sitz Bath and Perilite Exposure

Hot Sitz Bath and Perilite Exposure

OBJECTIVES:

After 4 hours of varied teaching learning activities, the level II students will be able to:

1. Define the following terms:
hot sitz bath radiation
perilite exposure convection
heat application conduction
dry heat episiotomy
moist heat perineorrhaphy

2. State the importance of:
hot sitz bath
perilite exposure

3. Discuss the process of heat transfer

4. Cite the physiological responses to heat

5. List variables that influences the effectiveness of heat

6. Discuss the therapeutic effect of administering the following:
hot sitz bath
perilite exposure

7. Enumerate the disadvantages/advantages of:
moist heat
dry heat

8. Identify the indications and contraindications of:
hot sitz bath
perilite exposure

9. Give the principles involved in:
hot sitz bath
perilite exposure

10. State the nursing responsibilities in:
hot sitz bath
perilite exposure

11. Explain the guidelines in:
hot sitz bath
perilite exposure

12. Demonstrate beginning skills in:
hot sitz bath
perilite exposure
Definition of Terms:

 Hot Sitz bath
– is a procedure whereby patient’s perineal area is submerged to water with solutions depending on the needs of the client.
- a bath in which only the pelvic area is immersed in warm fluid.

 Perilite Exposure
– application of dry heat to perineal area in order to provide comfort and increase blood circulation and hasten wound healing by means of perineal lamp.
- 20-50 centimeters or 18-24 inches away from the body to be exposed.

 Heat application
– is a process of applying heat through radiation and convection

 Dry heat
– requires a higher temperature and a longer period of heating

 Moist heat
- utilizes hot air that is heavily laden with water vapor

 Radiation
- is the transfer of heat through electromagnetic radiation. For any body the reflectivity depends on the wavelength distribution of incoming electromagnetic radiation and therefore the temperature of the source of the radiation.

 Convection
- is a combination of conduction and the transfer of thermal energy by fluid circulation or movement of the hot particles in bulk to cooler areas in a material medium.

 Conduction
- is the transfer of thermal energy from a region of higher temperature to a region of lower temperature through direct molecular communication within a medium or between mediums in direct physical contact without a flow of the material medium

 Episiotomy
– refers to an incision through the perineum that allows for less pressure on the fetal head during delivery and prevents lacerations of the perineum.

 Episiorraphy
-operation for repairing the episiotomy

 Perineorrhaphy
– Operation for repairing laceration of perineum usually following delivery






IMPORTANCE OF PERILITE EXPOSURE

1. Relief of pain and muscular spasm
2. -provides comfort by relief pain
3. -it relaxes muscles and capillaries making pain tolerable
4. Increases blood circulation
5. Hastens wound healing following an episiotomy repair
6. -increases circulation of blood
7. -increases supply of oxygen and nutrient which promotes wound healing
8. Reduces edema and soreness
9. -it releases dry heat and thus help reduce edema and soreness
10. -alleviated by relax muscles and capillaries


IMPORTANCE OF HOT SITZ
1. Reduces soreness
2. Relieves swelling and pain
3. brought about vasodilatations, increases circulation, increases capillary permeability, venous congestion of injured tissues
4. Hastens healing
5. increases blood circulation and with all its nutrients
6. Promotes comfort and relaxation
7. Cleanses and reduces inflammation of perineal, and areas of client
8. the presence of moist softens exudates and other hardened substances
9. Stimulates voiding
10. it stimulates voiding and elimination by peristaltic activity


Process of Heat transfer

 CONDUCTION
-the transfer of heat from a warm object to cooler object or vice versa by contact
-is the transfer of thermal energy from a region of higher temperature to a region of lower temperature through direct molecular communication within a medium or between mediums in direct physical contact without a flow of the material medium.

 CONVECTION
-heat transfer by means of movement of liquid or gas
-is a combination of conduction and the transfer of thermal energy by fluid circulation or movement of the hot particles in bulk to cooler areas in a material medium.
-this transfer occurs in sitz bath.

 RADIATION
- is the transfer of heat through electromagnetic radiation. For any body the reflectivity depends on the wavelength distribution of incoming electromagnetic radiation and therefore the temperature of the source of the radiation.






Physiological responses to heat

• Vasodilation or increase in capillary surfaces
- Heat causes vasodilation and increases blood flow to the affected area bringing oxygen nutrients, antibodies and leukocytes.
• Increase in capillary permeability
- heat increases capillary permeability which allows extra cellular fluid and substances such as plasma proteins to pass through the capillary walls and may result in edema or an increase in pre-existing edema.
• Increase blood flow
• Increase cell metabolism
• Increase supply of nutrients
• Increase removal of wastes
• Relaxation of muscles
• Softening of exudates
• Increase peristalsis
• Increase body temperature


Variables that influences the effectiveness of heat

• Individual tolerance
– tolerance is influenced to some degree by age, condition of skin, the
condition of nervous and circulatory system. Young children, elderly clients, diabetic clients and individuals with circulatory or sensory alterations have low tolerance for heat.
- The very young and the very old generally have the lowest tolerance. Persons
- who have neurosensory impairments may have a high tolerance, but the risk of injury is greater.

• General conditions of patient
– shock or metabolic disorders such as diabetes increase the hazard of tissue
damage. Impaired perception because of individual’s level of
consciousness, medications and mental impairment may make it difficult
to determine patient’s response to end potential damage from application
of heat.

• Intactness of the skin
- Injured skin areas are more sensitive to temperature variations

• Whether the heat is moist or dry
– moist heat penetrates more deeply than dry heat because water is a good
conductor of heat. Application of moist heat should be at a lower
temperature than applications of dry heat.

• Size of skin area to be treated
– the greater the body area to be treated, the lower the temperature should be.

• Environmental temperature
– in warm or in humid environment, heat can’t be dissipated through
evaporation to some degrees that it can dry or cool circumstances.

• Length of Exposure
- People feel hot applications most while the temperature is changing. After a period of time, tolerance increases.

• Location of area to be covered
– individual tolerance to heat depends on the number of heat receptors in body
parts. In general, the inner aspects of thighs and arms, the axillae, the chest
and the abdomen are more sensitive to heat than the other parts of the body.

- The back of the hand and foot are not very temperature sensitive. In contrast the inner aspect of the wrist and forearm, the neck, and the perineal area are temperature sensitive.


Therapeutic uses of heat

SEDATIVE EFFECT
- Heat is generally considered to produce a relaxation effect and increase the contractility of muscles.

RELIEVES PAIN
- Heat relieves pain by promoting muscle relaxation, increasing circulation, and promoting psychological
relaxation and a feeling of comfort.

REDUCES CONTRACTURE AND INCREASES RANGE OF MOTION
- This effect is achieved by allowing greater distention of muscles and connective tissue.

REDUCES JOINT STIFFNESS
- Heat reduces joint stiffness by decreasing viscosity of synovial fluid and increasing tissue distensibility.

PROVIDES WARMTH AND COMFORT


Dry Heat
ADVANTAGES:
Less risks of burns to skin than moist application
Retains temperature longer since not influenced by evaporation
Doesn’t cause maceration

DISADVANTAGES:
increases body fluid loss through sweating
Doesn’t penetrate deep into tissues
Increase drying of skin

Moist Heat
ADVANTAGES:
Moist application reduces drying of skin and softens wound exudates
Warm moist doesn’t promote sweating and insensible fluid loss
Moist heat penetrates deeply into tissue layers
Moist compresses comfort well to area of body being treated


DISADVANTAGES:
Moist heat creates a greater risk for burns to skin since moisture conducts heat
Prolonged exposure can cause maceration of skin
Moist heat will cool rapidly because of moist evaporation

-invisible heat rays readily seen in use of infrared; ultraviolet rays or electromagnetic waves






Hot Sitz Bath
INDICATIONS:
• Post partum mother with episiotomy wound
• With rectal or vaginal surgery


CONTRAINDICATIONS:
• Patients with hemorrhage
• Mother who had undergone CS delivery
• Multiparity with wound
• Before 24 hours of postpartum


Perilite Exposure
INDICATIONS:
• Patients who have undergone rectal or perineal surgery
• Post-partum patients with episiotomy wounds
• Patients having vaginal inflammation or bladder spasm
• Patients with painful or local irritation from hemorrhoids

CONTRAINDICATIONS:
• Patients with cardiovascular condition
• Presence of cyst or malignancy in the area
• Patients with open wounds with hemorrhage
• Patients with burns or fracture at the lower limbs
• Heat lamps are contraindicated in pressure ulcer care

Principles involved in Hot Sitz Bath

• HUMAN ANATOMY AND PHYSIOLOGY
- client who has episiotomy has painful hemorrhoids or vaginal inflammation may benefit from immersing pelvic area in warm water.
- -sitz bath requires special attention to body posture ad limb position to avoid cramping and constriction of circulation from pressure against edge of tub.

• MICROBIOLOGY
- application of heat to open wounds that may rupture may demand a sterile technique instruments should be sterile.

- application is for thermal effect and there’s no wound, materials should be kept cleaned to reduce transfer of bacteria.

• PSYCHOLOGY
• nurse should explain first the procedure to patient to gain cooperation
• nurse should know if patient is sensitive to warmness.

• CHEMISTRY
• heat generally is the speed of chemical reaction since metabolism is largely caused by chemical reactions, the application of heat speeds metabolism either locally or generally
• the solvent action of water maybe increased by adding other substances like soap.
• Magnesium Sulfate is used for preterm labor or commonly used for treatment of preeclampsia to slow uterine contractions.

• PHYSICS

• heat is most valuable and most versatile physical for treatment.
• water has also great capacity, it undergoes change more slowly than other substances. It also gives off more heat.
• heat maybe transferred from 1 place to another by conduction, convection and radiation.
• application of heat & cold employs physical agents; heat, light & electricity.










Principles involved in Perilite Exposure

• HUMAN ANATOMY AND PHYSIOLOGY
• through blood vessels and nerves, skin and connections they make with nerves and blood vessels of body, practically all parts of body maybe influenced by application of heat to skin.

• MICROBIOLOGY
• the application of heat to open wounds of lesions may rapture demands a sterile technique.

• BODY MECHANICS
• position of mother is dorsal recumbent with legs and knees flexed to allow proper exposure of area to be treated

• PHYSICS
• application of heat employs physical agents: heat, water and light. Heat maybe transferred from one place to another by radiation (perilite exposure) and convection (hot sitz) bath.

• PSYCHOLOGY
• nurse explains purpose of treatment in order to gain cooperation.

• SOCIOLOGY
• the patient needs to cooperate with nurse in order for treatment to be effective and to add patients early recovery.




Nursing Responsibilities in Hot Sitz Bath
BEFORE:
• Check doctors order for desired solution and body part to be soaked at a desired temperature.
• Assess the condition of skin of the body to be immersed
• Explain procedure to the patient.
• Nurse must have adequate knowledge about the procedure.

DURING:
• Check the temperature of water in a sitz bath before the patient enters into the tub (40.5-43.5 degrees Celsius)
• Assist the patient into the tub and position her properly
• Wrap a blanket around patients shoulder
• Don’t leave the patient alone unless certain that its safe to do so

AFTER:
• Assist the patient in going out of the tub after the procedure is complete
• Assist patient to her bed, its best for her to be down, avoid draft until normal condition and circulation returns
• Monitor patients general response to therapy and properly document significant data
• Do after care



Nursing Responsibilities in Perilite Exposure
BEFORE:
• Check the client’s condition before applying the procedure.
• Check all electrical equipment for defects or try to switch it on and off.
• Always handle equipment with dry hands
• Check physicians order for each area to be treated and duration of therapy
• Do perineal flushing

DURING:
• Position client comfortably with only area where heat is to be applied
• Position lamp at a safe distance from where it is to be applied
• Inspect skin and see to it that its clean and dry before applying heat
• Place bed cover over lamp but not allowing bed sheet to touch the light bulb
• Check skin every 5 minutes interval throughout duration of procedure
• Monitor any untoward response
• Perilite exposure should be given 24 hours after delivery
• Place bed cover after pulling lamp and provide privacy
• Position lamp at 18-24 inches away from the body part to be exposed.

AFTER:
• Assist the client
• Do after care
• Monitor clients response
• Do recording; record on patients chart
- time when it started
- patients reaction
- condition of perineum
- inspect sutures and episiotomy after procedure
• Inspect condition of part being treated



Guidelines for Hot Sitz Bath
• Check physicians order
• Nurse should explain the procedure
• Nurse should observe privacy
• Place towel at the patients back
• Adequate support during birth is essential
• She should make sure the perineal region is immersed
• Check temperature of water for hotness
• Observe patient closely for 15-20 minutes
• If client feels like fainting, discontinue procedure
• Monitor vital signs before and after



Guidelines for Perilite Exposure
• Explain procedure
• Instruct patient to do perineal flushing before perilite exposure
• Check the equipment for any defects
• Handle equipment with dry hands especially when your about to plug it.
• Provide privacy during procedure
• During exposure, keep lamp 20-50 cm away from perineum.
• Heat lamp should be left in place for 15 minutes then removed
• Perilite exposure process should be repeated 3-4 times a day
• Washable parts of lamp should be wiped with antiseptic solutions before its returned to storage area or used with another patient.

Thursday, August 13, 2009

SCRUBBING, GOWNING, GLOVING AND ARRANGING SURGICAL EQUIPMENT

SCRUBBING, GOWNING, GLOVING AND ARRANGING SURGICAL EQUIPMENT




Objectives: After 12 hours of varied teaching-learning strategies, the level 2 students will be able to :


1. Define following terms:
1.1 pre-operative nursing
1.1.1 pre-operative phase
1.1.2 intra-operative phase
1.1.3 post-operative phase
1.2 analgesia
1.3 anesthesia
1.4 antiseptic
1.5 asepsis
1.6 consent
1.7 disinfection
1.8 homeostasis
1.9 medical asepsis
1.10 resident bacteria
1.11 sterile
1.12 sterilization
1.13 surgery
1.14 surgical asepsis
1.15 surgical conscience
1.16 surgical team
1.17 surgically clean
1.18 transient bacteria
2. discuss the operating room as to its:
2.1 personnel
2.2 physical lay-out
2.3 attire
2.4 set-up
3. recognize the importance of the following:
3.1 scientific principles involved
3.2 basic rules of surgical asepsis
3.3 duties and responsibilities of scrub and circulating nurse
4. familiarize the following
4.1 basic instruments found in basic sets
4.2 major pack and minor pack
4.3 sites for skin penetration
4.4 operative operations
5. discuss the following:
5.1 classification of surgery
5.1.1 different layers of the abdomen
5.1.2 common abdominal incisions
5.1.3 different types of:
5.1.3.1 suture
5.1.3.2 suture needle
5.1.3.3 blades
5.2 sterilization process
5.3 anesthesia
5.3.1 types of anesthesia
5.3.2 stages of anesthesia (with nursing responsibilities)
6. show beginning skills in:
6.1 filling up the consent form pre-operative checklist
6.2 opening the sterile pack
6.3 packing and sterilization
6.4 perform the following OR techniques
6.4.1 surgical handwashing
6.4.2gowning and gloving
6.4.3 draping
6.4.4 serving instructions
6.4.5 assisting in the operation
6.4.6 circulating










DEFINITION OF TERMS

1.1 Pre-operative Nursing
- Wide variety of nursing activities carried out before, during, and after surgery. It incorporates the 3 phases of surgical experience.
1.1.1 Pre-operative phase
 Before the surgical procedure
 Begins when the decision is made to undergo surgical intervention and end up when the patient is transferred to the operating table
 Nursing assessment is done during this phase
1.1.2 Intraoperative phase
 During the surgical procedure
 Begins from the transfer of the patient to the operating table and extends to the time the patient is admitted to the recovery room
 The implementation component of the nursing process takes place during this phase.
1.1.2 Post-operative phase
 After the surgical procedure.
 Lasting from admission of the patient to the recovery room
 Evaluation takes place during this phase.

1.2 Analgesia
- Lessening of or insensibility to pain/ absence of pain.
- A condition in which nociceptive stimuli are perceived but are interpreted as pain.


1.3 Anesthesia
- A state characterized by loss of sensation
- Absence of normal sensation especially sensitivity to pain

1.4 Antiseptics
- An agent that inhibits the growth of some microorganisms

1.5 Asepsis
- A condition in which living pathogenic organisms are absent.

1.6 Consent
- Permission given voluntarily by a person in his own will.

1.7 Disinfection
- The act of destroying pathogenic microorganisms or to inhibit their growth and vital activity
- The destruction of pathogenic microorganisms including their toxins or vectors.

1.8 Homeostasis
- The process through which such bodily equilibrium is maintained.

1.9 Medical asepsis
- Practices that limit the transmission of microorganisms and their growth and spreading action.

1.10 Resident Bacteria
- Microorganisms that usually resides on the skin, mucous membranes, respiratory and gastrointestinal tract.

1.11 Sterile
- Aseptic; without microorganisms
- Free from microorganisms and their spores.

1.12 Sterilization
- refers to any process that effectively kills or eliminates transmissible agents from a surface, equipment, article of food or medication, or biological culture medium. Sterilization does not, however, remove prions. Sterilization can be achieved through application of heat, chemicals, irradiation, high pressure or filtration.

1.13 Surgery
- is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason.
- is a medical technology consisting of a physical intervention on tissues. As a general rule, a procedure is considered surgical when it involves cutting of a patient's tissues or closure of a previously sustained wound.

1.14 Surgical Conscience
- awareness that develops from a knowledge base of the importance of strict adherence to principles of aseptic and sterile techniques.
1.15 Surgically clean
- mechanically cleaned but unsterile. Items are rendered surgically clean by the use of chemical, physical or mechanical means that markedly reduce the number of microorganisms on them.

1.16 Surgical Asepsis
- complete removal of microorganisms

1.17 Surgical team
- members of the surgical health care team include the surgeon, surgical assistants, the anesthesiologists or nurse anesthetist the circulating nurse, the scrub nurse and other allied support personnel.

1.18 Transient Bacteria
- are different from resident microorganisms in that they do not take up permanent residence in the gastrointestinal tract. Instead, they establish small colonies for brief periods of time before dying off or being flushed from the intestinal system via normal digestive processes, and/or by peristaltic bowel action.


Personnel

SUBDIVISIONS of OR team

Sterile Team members

1. Surgeon
- Must have the knowledge, skill and judgment required to successfully perform the intended surgical procedure and any deviations necessitated by unforeseen difficulties.
- Responsibilities include preoperative diagnosis and care and performance of the surgical procedure and post-operative management of care.
- Is a licensed physician (MD), osteopath (DO), oral surgeon (DDS or DMD), or pediatrist who is to perform surgical procedures

2. Assistants to the surgeon
- Under the direction of the operating surgeon, one or two assistant help to maintain visibility of the surgical site, control bleeding, close wounds and apply dressings. The assistant handles tissues and uses instruments.
- The role of and need for an assistant will vary with the type of procedure or surgical specialty, the condition of the patient and type of surgical facility. In determining this need, the characteristics of the surgical procedure should be evaluated:
 Anticipated blood loss
 Anesthesia time for the patient
 Fatigue factors affecting the OR team
 Potential complications

3. First Assistant in Surgery
- Ideally is a qualified surgeon or a resident in an accredited surgical evaluation program
- Should be capable of assuming responsibility for performing the procedure for the primary surgeon

4. Non-physician first assistant
- are required to complete a formal education program for first assisting according to their practice discipline

5. Physicians Assistant (PA)
- Is a generic term with 2 subcategories:
 Assistant to the primary physician (PCCA or PA) Physicians clinical assistant
 Assistant to the surgeon (SA or PSA) Physicians surgical assistant
- Under the direct supervision of a surgeon

6. Registered Nurse First Assistant
- A certified preoperative nurse (CNOR) who has successfully completed an approved program based on the curriculum for the Registered Nurse First Assistant of AORN (Association of Preoperative Registered Nurses), may seek a position as a registered nurse first assistant (RNFA) with a private surgeon, hospital or clinic. The RNFA functions solely as the first assistant and should not simultaneously perform the functions of a scrub nurse.

7. Surgical Technologists First Assistant
- A certified surgical technologists (CST) may also trained to first assist. After successfully passing a national examination, the CST first assistant may use the acronym CST or CFA

8. Second Assistant to the Surgeon
- qualified nurses and surgical technologists may be used as second or third assistant for surgical procedures in which the surgeon deems their assistance is adequate and for which they have been trained. Second and third assistants are not involved in the actual performance of the procedure but primarily work with minimally invasive procedures, such as holding the endoscopic camera

9. Scrub person
- is a patient care staff member of the sterile team
- the scrub role may be filled by a registered nurse (RN), a licensed practical or vocational nurse (LPN or LVN), or a surgical technologists (ST)

Unsterile Team Members

1. Anesthesia Provider
- Is an MD or DO, preferably certified by the American Board of Anesthesiology, who specializes to the art and science of administering anesthetics to produce various states of anesthesia
- An anesthetist (local not general) is a qualified RN, dentist or physician who administers anesthetics. He works under the direct supervision of the anesthesiologists or the surgeon

2. Circulator
- Vigilant; documents the chart
- Is preferably an RN. A qualified ST may assist with circulating duties under the supervision of a RN. The circulator plays a role that is vital to the smooth flow of events before, during and after the surgical procedure.
SCIENTIFIC PRINCIPLES INVOLVED
Anatomy and Physiology
epidermis is the term used to designate the outer surface layer of the skin

Chemistry
rubbing alcohol combines with the albumins of the skin tissue and make it more resistant to pressure.

Microbiology
sterility is maintained throughout the procedure. Thorough hand washing should be done for protection of patient as well as the nurse and other sterile team members.

Pharmacology
drugs that act in the skin maybe classified as demulcents, protectives, astringents, antiseptic and disinfectants

Psychology
isolated patient must be well instructed.

Sociology
attitude of the isolated patient may depend on knowledge of the disease or problem.

Body Mechanics
proper body mechanics in order to prevent muscle strains for the nurse.

Responsibilities of scrubbed and circulating nurse
- These responsibilities may be divided into those who assumed and performed by the scrubbed members of the team and those assumed and performed by the circulating ones. They may further classified into those performed before the operation, during the operation and after the operation.

A. Responsibilities of scrubbed nurse before the operation

1. Physical attire
a. cap – all hair must be covered
b. mask – must cover the mouth and nose
c. dress – sleeves well above elbows
d. shoes – conductive rubber soles or shoe covers
e. Fingernails should be trimmed preferably without polish

2. Surgical scrub
There is much variation in this technique, but all methods are based upon the basic principle: namely, to remove bacteria from the skin. However, the surgical scrub only removes as many bacteria as possible from the hands and arms by mechanical washing or friction and chemical disinfection.

3. Procedures for dressing the person scrubbed vary as far as the gown and especially the glove technique are concerned.

a. Drying the hands and arms after scrubbing
b. Gowning and gloving: the sterile gown is worn to permit the wearer to come within the sterile field and carry out sterile technique during the operation.

4. prepare the sterile field for the operation

B. responsibilities of scrubbed nurse during the operation

1. pass the instruments
2. have all materials ready for use
3. anticipate the needs of surgical team
4. keep field neat, clean and dry
5. count sponges when necessary
6. prepare the sterile dressing which will be applies when the operation is complete

C. Responsibilities of scrubbed nurse after the operation

1. care for instruments- open used ones for the washing process
2. care for the immediate rinsing of rubber gloves
3. remove scalpel blades
4. care for tissue specimen
5. care for special instruments and equipment used
6. care for used basin
7. dispose of waste material properly

The circulating nurse must know all supplies, instruments and equipment as well as their location, use and care. They are responsible for the technique in their unit and must anticipate the needs of all persons functioning in that area.

D. Responsibilities of circulating nurse before the operation

1. prepare the operating room or unit
2. assist scrubbed personnel
3. count sponges before the operation begins
4. care of the patient during anesthesia
5. tie surgeon’s gown
6. assist with preparation of the patient

E. Responsibilities of circulating nurse during the operation

1. keep check to see that all equipment is in good working order
2. keep room neat and tidy
3. count sponges at appropriate time
4. take care of needs of the entire operating team throughout the operation
5. make out necessary forms

F. Responsibilities of circulating nurse after the operation

1. take care of the needs of the patient first
2. care of the tissue specimen
3. disconnect all special equipment and see that it is cared for
4. assist with general cleaning equipment and rearrangement for the operating room in preparation for the next operation in that room

Principles of surgical asepsis
-when beginning a surgically aseptic procedure, the nurse follows certain principles to ensure maintenance of asepsis. Failure to follow these principles places clients risk for infection. The following principles are important:

1. A sterile object remains sterile only when touched by another sterile object. The principle guides the nurse in placement of sterile objects and how to handle them.
2. Only sterile objects may be placed on a sterile field. All items are properly sterilized before use. Sterile objects are kept in clean, dry storage areas. The package or container holding a sterile object must be intact and dry.
3. A sterile object of field out of the range of the vision or an object held below a person’s waist is contaminated. Nurses never turn their backs on a sterile tray or leave it unattended.
4. A sterile object or field becomes contaminated by prolonged exposure to air. The nurse avoids activities that may create air currents, such as excessive movements or rearranging linen after a sterile object of field becomes exposed.
5. When a sterile surface comes in contact with a wet, contaminated surface, the sterile object of field becomes by capillary object. If moisture seeps through a sterile package’s protective covering, microorganisms travel to the sterile object.
6. fluid flows in the direction of gravity. A sterile object becomes contaminated if gravity causes a contaminated liquid to flow over the object’s surface.
7. the edges of a sterile field or container are considered to be contaminated. Frequently a nurse places sterile objects on a sterile towel or drape. Because the edge of the drape touches an unsterile surface, such as a table or bed linen, a 2.5 cm border around the drape is considered contaminated.

BASIC INSTRUMENTS FOUND IN BASIC SETS
IRIS SCISSORS
are used for remove necrotic tissue.






BANDAGE SCISSORS
used to:
• to cut through custom-fit bandages.
• to cut through medical gauze.
• to cut through bandages already in place






SUTURE SCISSORS
used to close a wound. They are used in an attempt to improve and speed healing. Pulling the edges of a wound together and stitching help in healing process. Sutures are used to close cuts from injuries or surgery. They are commonly used on the skin, internal tissues, organs, and blood vessels.






TOWEL CLUMP
towel clamps are used to maintain surgical towels and drapes in the correct position during an operation.






MAYO
used to cut heavy tissues(muscle, uterus)









METZEMBUAM
used to cut delicate tissue.









ALLIS
used to grasp tissue








BABCOCK
used for grasp delicate tissue(intestine, fallopian tube and ovary)









BASIC INSTRUMENTS FOUND IN THE BASIC SET

• Towel Clips
• Kelly curve
• Kelly straight
• Allis tissue forcep
• Babcock forcep
• 3 Kidney basin(1 big and 2 small)
• 1 pair of army navy
• Toothed forcep
• non-toothed forcep
• metzenbuam
• Mayo
• Suture scissor
• Bandage scissor
• Iris scissor
• Stevens
• Cautery
• Yankauer


CONTENTS OF MAJOR AND MINOR PACKS

A) MAJOR
• ♂ 5 O.R GOWNS
• ♂ 5 HAND TOWELS
• ♂ 1 MAYO COVER
• ♂ 1 LAPARATOMY SHEET
• ♂ 6 DRAPING TOWELS
• ♂ 1 LAP SHEET
• ♂ 20 (4X8) OPERATIVE SPONGES
• ♂ 20 O.S
• ♂ 6 TOWELS
B) MINOR
• ♀ 5 O.R GOWNS
• ♀ 5 HAND TOWELS
• ♀ DRAPING TOWELS
• ♀ 2 PLAIN SHEET
• ♀ 20 O.S
• ♀ 6 TOWELS





PATIENT’S SKIN PREPARATION ON THE OPERATING TABLE

AREA
- After patient has been anesthetized and positioned on operating table, an extensive area surrounding it is mechanically cleansed again with an antiseptic agent immediately prior to draping.


SITES:

1. Abdominal Preparation
- The area includes breast line to upper third thighs, from the table line, with patient in supine position.

2. Lateral Thoracoabdominal Preparation
- Area includes the axilla, chest, abdomen, from the neck to the chest of the ilium. The area extends beyond midline, anteriorly and posteriorly.

3. Chest and Radical breast Preparation
- Area includes shoulder, upper arm down to the elbow, axilla and chest wall to the table beyond the sternum to the opposite shoulder in lateral position.

4. Rectoperineal and Vaginal Preparation
- Includes the pubis, vulva, labia’s, perineum, anus, and adjacent areas, including the inner aspect of the upper third of thighs.

5. Hip Preparation
- Abdomen of the affected side, thigh to knee, buttocks to table line, groin and pelvis.

6. Knee and Lower leg Preparation
- Includes the entire circumference of affected leg and extends from foot to upper part of thigh.








COMMONLY USED OPERATIVE PATIENT POSITIONS

SUPINE
Flat on back with arms at side, palms down, legs straight with feet slightly separated.

PRONE
Patient lies on abdomen with face turned to one side, arms at side with palms pronated, elbows slightly flexed; feet elevated on pillow to prevent plantar flexion.

TRENDELENBURG
Head and body are lowered into a head-down position and held in place with padded shoulder braces; knees are flexed by breaking table.

REVERSE TRENDELENBURG
Head is elevated and feet are lowered.

LITHOTOMY
Patient lies on back with buttocks to edge of table; thighs and legs are placed in stirrups simultaneously to prevent muscle injury; head and arms are secured to prevent injury.

LATERAL
Patient lies on side; table maybe bent in middle.




LAYERS OF THE ABDOMINAL WALL

1. Skin
a. Epidermis -- the part we shed.
b. Dermis -- contains nerves, capillaries, sweat glands, hair follicles.
2. Subcutaneous
- is the layer of fat that lies between the dermis of the skin and underlying fascia.
- This layer is important because it regulates the temperature of the skin itself and the body.
3. Fascia
- soft tissue component of the connective tissue system that permeates the human body.
- It interpenetrates and surrounds muscles, bones, organs, nerves and blood vessels and other structures.
a. Superficial Fascia
- Is found in the subcutis in most regions of the body, blending with the reticular layer of the dermis.
- It serves as a storage medium of fat and water
b. Deep Fascia
- Is the dense fibrous connective tissue that envelopes all bone, blood vessels and become specialized in muscles and nerves.
c. Subserous Fascia
- a layer of loose connective tissue that serves as a glue to hold the peritoneum to the deep fascia.
4. Muscles
- Three flat muscles plus the longitudinal rectus sheath muscle.
a. External Abdominal Oblique -- muscle fiber direction is antero-inferior (like external intercostals -- hands in pocket).
- Originate at border of Thoracic ribs T5 - T12
- Extends to midline and attaches on linea alba. Also attaches to the iliac crest.
- Also forms the superficial inguinal ring, which allows passage of the spermatic cord (male) or round ligament (female).
-
b. Internal Abdominal Oblique
- Also has fibers that attach along the inguinal ligament to the pubic crest.
- Direction of fibers tends to go outward, from medial to lateral and a little bit inferiorly (inferolaterally).
- Borders on ribs 7 - 12.
c. Transversus Abdominis Deep most layer of flat muscles.
- Also borders on ribs 7 - 12. Extends down to the pubic crest and medially to the linea alba.
- It creates a diagonal pathway for the spermatic cord or round ligament to pass through.
- Fibers run transversely! -- horizontally from lateral to medial.
d. Rectus Abdominis: Straight muscle.
- Passes from Xiphoid Process inferiorly to pubic symphysis (inferior center of pubic bone).
5. Peritoneum
- is the serous membrane that forms the lining of the abdominal cavity- it covers most of the intra-abdominal organs.
a. Parietal peritoneum
- The outer layer
- Attached to the abdominal wall
b. Visceral Peritoneum
- Inner layer
- Wrpped around the internal organs that are located inside the intraperitoneal cavity.

Common Abdominal Incisions

A. Vertical incision:
1. Midline incision
- universally acceptable incision
- in the upper abdomen, the incision is made in the midline extending from the area of xiphoid and ending immediately above the umbilicus.
- In the upper abdomen, it is widely used for gastric and duodenal operations and gives adequate exposure for biliary and pancreatic surgery.
- In the lower abdomen it is commonly used for gynecologic, urologic, and colonic operations.





2. Paramedian incision
- vertical incision about 4cm lateral to the midline on either side of the abdomen.
- Provide access to the lateral structures such as the spleen and the kidney.







B. Transverse and oblique incision

1. Kocher’s subcostal incision
- Started at the midline, 2-5cm below the xiphoid and extends downwards, outwards and parallel to and about 2.5cm below the costal margin.
- On the right, this incision is frequently used for operation on the biliary tree, on the left, for splenectomy.




2. Mc. Burney’s Grid Iron or Muscle splitting incision
- The level and the length of the incision will vary according to the thickness of the abdominal and the suspected position of the appendix.
- Classically, the incision is made at the junction of the middle third and outer thirds of line running from the umbilicus to the anterior superior iliac spine.
- This incision, or some modification, is the most popular for appendiceal surgery.







3. Pfannenstiel Incision
- used frequently by gynaecologists and urologists for access to the pelvic organs, bladder, prostate and for caeserian section.
- The skin incision is usually 12cm long and is made in a skin fold approximately 5cm above symphysis pubis.
- Offers excellent cosmetic results because the scar is almost always hidden by the patient’s pubic hair postoperatively.






C. Retroperitoneal Incisions

1. Retroperitoneal Approach to Lumbar Area
- the skin incision begins at the level of umbilicus at the margin of the lateral rectus sheath and it is extended into the flank toward the twelfth rib for 12 to 20 cm.
- this incision is most frequently used for vena caval ligation, lumbar sympathectomy, or ureterolithotomy.
Explanation: you can see there the lower pole of yhe kidney, vena cava and the ureter.
During the incision, the patient is positioned in supine position with the right side elevated approximately 30-45 degrees and the right knee and hip flexed.


2. Retroperitoneal Approach to Iliac Fossa
- the incision extends from just medial to the iliac tubercle to just lateral to the pubic tubercle.
- The incision gives exposure to the pelvic ureter, iliac, hypogastric, and femoral vessels, and the bladder.

D. Abdominothoracic Incision
- either right or left, converts the pleural and peritoneal cavities into one common cavity and thereby gives excellent exposure.
- The right incision may be particularly useful in elective and emergency hepatic resection.
- The left incision may be useful effectively in resection of the lower end of the esophagus and proximal portion of the stomach.







Types Suture Needles
a. Points of needles
1. cutting point->may be preferred when tissue is difficult to penetrate (skin, tendon, tough, tissue in the eye). Degree of sharpness of cutting edge varies:
a) Conventional cutting needle -> have 2 opposing cutting edges with a 3rd edge configuration on the needle. The cutting edges are on the inside curvature of a curve needle.
b) Reversed cutting needle -> have triangular configuration that extends along the body of the needles.
c) Side cutting needle -> flat on top and bottom. Use primarily on ophthalmic surgery.
d) Trocar points -> sharp cutting tips are the points of tapered needles.
2. Taper points -> are used in soft tissues (intestines and peritoneum) which offer a small amount of resistance to the needle as it passes through. They tend to push the tissue aside rather than cut it.
3. Blunt points -> are designed with a rounded point at the tip. They are used for suturing pliable tissues (liver and kidney)
b. Surgical needles
• specification of needles
1. Strong enough that it doesn’t break easily
2. Rigid enough to prevent excessive bending, yet flexible enough to prevent from breaking after bending.
3. Sharp enough to penetrate tissue with minimal resistance, yet stronger than the tissue it penetrates.
4. Approximately in shape, size for the type, condition and accessibility of tissue is sutured.
5. Appropriate in shape, size for the type, condition and accessibility of tissue is sutured.
6. Free from the corrosion and burns to prevent infection and tissue trauma.
c. Eye of the needle
 Eyed needle -> the closed eye of an eyed surgical needle is like that of any household sewing needle. The shape of the enclosed eye may be round, oblong or square.
 French-eyed needle -> sometimes referred to as “spring eye” or “split eye”. It has a slit from the inside of the eye to the of the needle through which the suture strand is drawn.
 Eyeless needle -> a continuous until with the suture strand. The needle is swaged into the end of the strand in the manufacturing process. The diameter of the needle matches the size of the strand as closely as possible. The surgeon uses sharp needle with every suture strand.
 single armed attachment- has 1 needle swaged to the suture strand.
 double armed attachment-has a needle swaged to each end of the suture strand: the 2 needles are not necessarily the same size and shape.
 Permanently swaged needle attachment-is secured so that the needle will not separate from the suture strand under normal use
 Controlled release needle attachment-secured so that the suture strand doesn’t separate from the needle inadver but doesn’t rapidly when pulled off intentionally.



Types of Blades
A. cutting and dissecting
• scalpels
• knives
• scissors
B. Blades may vary by size and shape:
1. #10 blade
2. #11 blade
3. #12 blade
4. #15 blade
5. #23 blade
6.
Specification for suture materials
• Must be sterile when placed in tissue
• Must be predictably uniform in tensile strength by size and material
• Must be small in diameter and safe to use on each type of tissue
• Must have knot security remain tied and give support to tissue during the healing process.
• Must cause as little foreign body-tissue reaction as possible.

Types of suture material

1. Absorbable suture
• sterile strands prepared from collagen, derived from healthy mammals or from a synthetic polymer. They are capable of being absorbed by living mammallian tissue, but may be treated to modify resistance to absorption.
They may be colored by a color additive.
• are dissolved or digested by body enzymes hydrolyzed by body tissue
• types:
1. surgical gut (plain or chronic)
2. collagen
3. glycolic acid polymers
• -absorbable sutures are digested by enzymes first by losing their strength, then gradually disappearing from the tissue
>Natural sources of absorbable sutures
1. Surgical gult -> often referred to as catgut; is a collagen from submucosa of sheep intestine or serosa of beef intestines.
2. Collagen -> purest from of “gut”, are extruded from a homogenous dispersion of pure collagen fibrils from the flexer tendons of beef.
>Synthetic source of absorbable sutures
1. Polyglactin 910 (vircyl) -> the précised controlled combination of glycolide and lactide results in a copolymer with a molecular structure that maintains tensile strength longer that surgical gut, but not as long as polydioxanome
2. Polyglycolic acid (Dexon) -> the homopolymer of glycolic acid tensile strength more rapidly and absorbs significantly more slowly than polyglactin 910. Strands are smaller in diameter.
3. Polydioxanome (PDS) -> useful in tissues in which slow healing is anticipated as in the fascia, or when extended wound support is desirable. They may be used in the presence of infecton; they will not harbor bacterial growth beause of their chemical and nonfilament construction.

2. Non-absorbable Sutures
- Sutures when used in minimal inflammatory response is desired, as in skin sutures, also when the wound requires continuous support longer than 1-3 weeks.
Ex. With vascular anastomosis, abdominal closure and
intestinal anastomosis
● Natural sources of Non-Absorbable sutures
1) Cotton – infrequently used today, tends to split, used for muscle or fascia.
2) Silk – most commonly used, may be twisted or braided, compose of single filament and ties most easily and usually well-tolerated by patients
- used in ophthalmology, GIT, brain and
cardiovascular system and as skin closure.



STERILIZATION PROCESS

- process by which all pathogenic and non-pathogenic microorganisms, including the spores, are killed.
- this term refers only to a process capable of destroying all forms of microbial life, including spores.
- the sterilizer is a piece of equipment used to attain either physical or chemical sterilization.




ANESTHESIA

• the goals of anesthesia are to provide analgesia, sedation, and/ or muscle relaxation appropriate for the type of operative procedure, as well as to control the autonomic nervous system.

TYPES OF ANESTHESIA
1. General Anesthesia
- blocks the pain stimulus at the cortex of the brain and depress the central nervous system (CNS). Loss of reflexes and skeletal muscle tone ensues, along with analgesia, amnesia, and unconsciousness.
1.1 Intravenous Anesthesia
• gives simple, pleasant, and rapid induction.
• it is commonly used to induce unconsciousness before more potent inhalation anesthetics are given.
1.2 Inhalation Anesthesia
• is a mixture of anesthetic liquids in volatilized form or gases mixed with oxygen.
• Ether was one of the first inhalation anesthetics used, but now is seldom used.
• it is flammable gas and can irritate the eyes and skin, plus it causes considerable post-operative nausea and vomiting.

2. Regional Anesthetics
- is used when only one part of the body will be involved in surgery.
• the nurse's role is increased in the use of in the use of regional anesthesia because the patient is awake and may be alert throughout the surgical procedure.
2.1 Spinal anesthesia
• nerve blockage n the sub arachnoid space.
• is used for surgical procedures performed below the level of the diaphragm, such as hysterectomy, appendectomy, and hernia repair.
2.2 Saddle Block
2.3 Epidural Block
2.4 Caudal Block
2.5 Local Infiltration anesthesia
2.6 Local surface or Topical anesthesia

3. Balanced Anesthesia
- to obtain a desired general anesthetic effect, the combination of several drugs is commonly used. This “balanced anesthesia” should provide not only sleep but also analgesia, elimination of certain reflexes, and good muscular relaxation.

STAGES OF ANESTHESIA
Stage 1 – ANALGESIA
Is the onset of anesthesia and analgesia and is noted by loss of consciousness after the patient appears drowsy and wants to sleep. Sensations of smell and pain are abolished before the patient loses consciousness. He may experience dreams and auditory or visual hallucinations. Speech becomes difficult and incomprehensible. There may be a ringing in the ears and an inability to move(paralysis)sensation.



Stage 2- EXCITEMENT
is the excitement phase and is seen by an increase in autonomic activity (pulse increases), irregular breathing , and some struggling of the patient may shout, laugh, cry, swear or sing as autonomic activity increases.

Stage 3 – SURGICAL
is the surgical anesthesia phase and consists of four planes. The patient is completely unconscious and his muscles are relaxed, beginning with the small muscles and continuing to the point of loss of most muscle reflexes and depression of vital functions.

Stage 4 – DANGER
is called the danger or toxic phase and is exemplified by cessation of breathing and may lead to both respiratory and circulatory failure.