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Tuesday

Insulin Chart

Generic Name
Brand Name Onset (hr) Peak (hr) Duration (hr)
Insulin aspart


Novolog
0.25
1-3
3-5
Insulin lispro
Humalog
0.25
0.5-1.5
3-4
Regular human Insulin


Humulin R
Novolin R
0.5
0.5
2-4
2.5-5
6-8
8
Human insulin isophane
suspension


NPH
1.5
4-12
24
Human insulin zinc
suspension
Lente
2.5
7-15
22
Human insulin extended
zinc suspension




Ultralente
4-6
8-20
28
Insulin glargine
Lantus
2-4
None
24
70% insulin aspart
protamine suspension/30%
insulin aspart
Novolog Mix 70/30
0.25
1-4
24
75% insulin lispro
protamine suspension/30%
insulin lispro
Humalog Mix 75/25
0.251-2
24
70% Human insulin
isophane suspension
(NPH)/30% regular insulin
Humulin 70/30
Novolin 70/30
0.5
0.5
2-12
2-12
24
24
50% Human insulin
isophane suspension
(NPH)/50% regular insulin

Humulin 50/50
0.5
3-5
24


Technorati Tags

SATA Questions in NCLEX-RN

ESRD DIET
• Restricted protein intake
• Increase CHO
• Low K, P
• Restrict Na

SUPERIOR VENA CAVA OCCLUSION
• Sx occur in the morning
• Edema of face, eyes & tightness of
shirt/ (Stoke’s sign)
• Late sx: edema of arms, hands,
dyspnea, erythema, epistaxis

NORMAL IN 8 MONTH OLD
CHILD
- can sit with out support
- can roll from front to back
- can hold a bottle
- closure of ant. fontanel
- can say mama and dada
- 2 teeth present

ULCERATIVE COLITIS
Sx:
• Severe diarrhea with blood & mucus
• Abdominal tenderness & cramping
• Anorexia
• Wt. Loss
• Vit. K deficiency
• Anemia
• Dehydration
• Electrolyte imbalance
• Low residue & high protein diet

DILANTIN
• do not floss throughout the day
• do not use hard bristled
toothbrush
• Gingivitis S/E

ANAPHYLACTIC REACTION
(steps)
• Stop medication
• Maintain airway
• Notify MD
• Maintain IV access of 0.9 NSS
• Place in supine position with legs elevated
• Monitor VS
• Administer prescribed emergency drugs

BLADDER CA
Risk Factors:
• Hx of smoking
• Exposure to radiation
• Working in industrial Factory

S/S OF DKA
• Fruity breath Odor
• Oliguria
• Kusmaull'’s (deep & nonlabored)

SITE FOR IM INJECTION ADULT
• Deltoid
• Ventrogluteal
• Vastus Lateralis
• Gluteus Maximus
S/S OF BACTERIAL MENINGITIS
• N & V
• Seizures
• Stiff Neck
• Photophobia
• Positive Brudzinski sign
TB
• Waking up sweating at night
• Low grade fever
• Dull aching chest pain
• Cough streaked with blood
• Weight loss
• Anorexia
• Fatigue
LIVER CIRRHOSIS
• N & V
• Edema
• Ascites




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Nurse's Thoughts

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Saturday

Dopamine and Dobutamine Computations

for DOPAMINE, the constants are
single dose = 13.3 (translates to 200/250 or 400/500)
double dose = 26.6 (translates to 400/250 or 800/500)

... for DOBUTAMINE, the constants are
single dose = 16.6 (translates to 250/250 or 500/500)
double dose = 33.3 (translates to 500/250 or 1000/500)

the formula for the above computation is always...

DOSAGE x WT
___________
constant

FOR THE EXPLANATION OF CONSTANT:
notice in the sample computation of double-dose dopamine: pt wt. 176lbs. doctor ordered 5mcg/kg/MIN. available is 400/250 DOPAMINE in D5 water. how many ml/hr to give?

(5 mcg / kg min) x (80 kg) x
(250 ml / 400 mg) x (1 mg / 1000 mcg) x (60 min / 1 hr)

if we summarize the 2nd line, this can be reduced to:
(5 mcg / kg min) x (80 kg) x (0.0375 ml min / mcg hr)

the short-cut it is:

(5 mcg / kg min) x (80 kg)
________________________________
26.6 <-- (this is the RECIPROCAL of 0.0375)


: so in actuality the unit of 26.6 is (mcg hr / ml min)

WHY IS THERE A NEED TO KNOW THE CONSTANT?
IN SOME CASES, 400/250 IS NOT BEING MENTIONED IN NCLEX... SOMETIMES THE QUESTION WOULD BE LIKE

pt wt. 176lbs. doctor ordered 5mcg/kg/MIN. available is DOUBLE-DOSE DOPAMINE in D5 water. how many ml/hr to give? so in this case we know that we will be using 26.6...


for the rest of the computation... just remember to elimitate the UNITS thru multiplication process in order to come up with the CORRECT DESIRED UNITS... REMEMBER YOUR CONVERSION FACTORS FOR TIME,WEIGHT & VOLUME......


lets have an example...

Infuse Nitroprusside 25 mg in D5W 250 ml at 50mcg /min using microdrip tubing.Determine the ml/hr and the gtts/min.

Given:
25 mg/250 ml ( there is 25 mg NA Nitroprusside PER 250 ml...based on the given)
50 mcg/min
60 mcgtts/1 ml <---- microdrip

Find: ml/hr :
(250ml/25mg) x (1 mg/1000 mcg) x (50mcg/min)

= 0.5ml/min
= (0.5ml/min) x (60min/1 hr) = 30 ml/hr <---answer

Find: gtts/min :
(30ml/hr)x(60gtts/ml)x(1hr/60min)
= 30 gtts/min <----answer


example 2

Infuse Dobutamine 500 mg in 250 ml D5W at 5 mcg/kg/min using microdrip tubing.The client weighs 182 lbs. Determine the ml/hr and the gtts/min.

Given:
500mg/250ml (this is double-dose dobu)
5 mcg/kg/min
182 lbs
60gtts/ml <------- microdrip

Find:ml/hr
182 lbs x (1kg/2.2lbs) = 82.7kg

(5 mcg/kg min) x (82.7kg) = 413.5 mcg/min

413.5 mcg/min x 1mg/1000mcg = .4135 mg/min

.4135 mg/min x 250ml/500mg <--- ML is the numerator since were looking for ML/HR
= 0.20675ml/min

= 0.20675ml/min x (60 min / 1 hr) = 12.4 ml/hr <--ans

... using the short-cut: 33.3 is constant for double dose dobutamine...
5mcg/kg-min x 82.7kg divide by 33.3 = 12.41 ml/hr <--same answer.^^


Find: gtts/min
12.41 ml/hr x (1 hr/60 min) x (60gtts/ml) =
= 12 gtts/min... <---answer (Drops Per Minute MUST always be in WHOLE NUMBERS while ml/min, ml/hr,etc may have decimal points)

Thursday

Various BON

California Board of Registered Nursing 1625 North Market Boulevard, Suite N-217 Sacramento, CA 95834-1924 Phone: 916.322.3350 Fax: 916.574.8637 Contact Person: Ruth Ann Terry, MPH, RN, Executive Officer

Florida Board of Nursing Mailing Address: 4052 Bald Cypress Way, BIN C02 Tallahassee, FL 32399-3252 Physical Address: 4042 Bald Cypress WayRoom 120 Tallahassee, FL 32399 Phone: 850.245.4125 Fax: 850.245.4172 Contact Person: Rick GarcĂ­a, MS, RN, CCM, Executive Director

Georgia Board of Nursing 237 Coliseum Drive Macon, GA 31217-3858 Phone: 478.207.2440 Fax: 478.207.1354 Contact Person: Sylvia Bond, RN MSN, MBA, Executive Director
Guam Board of Nurse Examiners Regular mailing address: P.O. Box 2816 Hagatna, Guam 96932 Street address (for FedEx & UPS): 651 Legacy Square Commercial Complex, South Route 10Suite 9Mangilao, Guam 96913 Phone: 671.735.7406 Fax: 671.735.7413 Online: N/A Contact Person: Margarita Bautista-Gay, RN, BSN, MN, Acting Nursing Administrator

Maryland Board of Nursing 4140 Patterson Avenue Baltimore, MD 21215 Phone: 410.585.1900 Fax: 410.358.3530 Contact Person: Patricia Ann Noble, MSN, RN Executive Director

New Jersey Board of Nursing P.O. Box 45010124 Halsey Street, 6th FloorNewark, NJ 07101 Phone: 973.504.6430Fax: 973.648.3481 Contact Person: George Hebert, Executive Director

New Mexico Board of Nursing 6301 Indian School Road, NESuite 710 Albuquerque, NM 87110 Phone: 505.841.8340 Fax: 505.841.8347 Contact Person: Allison Kozeliski, RN, Executive Director

Nevada Board of Nursing 5011 Meadowood Mall Way, Suite 300 Reno, NV 89502 Phone: 775.688.2620 Fax: 775.688.2628Online: Contact Person: Debra Scott, MS, RN, Executive Director

New York State Board of Nursing Education Bldg.89, Washington Avenue 2nd Floor West Wing Albany, NY 12234 Phone: 518.474.3817, Ext. 280 Fax: 518.474.3706 Contact Person: Barbara Zittel, PhD, RN, Executive Secretary

Northern Mariana Islands Commonwealth Board of Nurse Examiners Regular Mailing Address: P.O. Box 501458 Saipan, MP 96950 Street Address :(for FedEx and UPS)#1336 Ascencion DriveCapitol HillSaipan, MP 96950 Phone: 670.664.4812 Fax: 670.664.4813 Online: N/A Contact Person: Rosa M. Tudela, Associate Director of Public Health & Nursing

Pennsylvania State Board of Nursing P.O. Box 2649 Harrisburg, PA 17105-2649 Phone: 717.783.7142 Fax: 717.783.0822 Contact Person: Laurette D. Keiser, RN, MSN, Executive Secretary/Section Chief

South Carolina State Board of Nursing Mailing Address: P.O. Box 12367Columbia, SC 29211 Physical Address: Synergy Business Park, Kingstree Building110 Centerview Drive, Suite 202Columbia, SC 29210 Phone: 803.896.4550 Fax: 803.896.4525 Contact Person: Joan K. Bainer, RN, MN, CNA BC, Administrator

Texas Board of Nursing 333 Guadalupe, Suite 3-460Austin, TX 78701 Phone: 512.305.7400 Fax: 512.305.7401 Contact Person: Katherine Thomas, MN, RN, Executive Director

Vermont State Board of Nursing Office of Professional Regulation National Life Building North F1.2 Montpelier, Vermont 05620-3402 Phone: 802.828.2396Fax: 802.828.2484 Contact Person: Anita Ristau, MS, RN, Executive Director

Virgin Islands Board of Nurse Licensure P.O. Box 304247, Veterans Drive Station St. Thomas, VI 00803 Phone: 340.776.7131 Fax: 340.777.4003 Contact Person: Diane Ruan-Viville, Executive Director

Virginia Board of Nursing Department of Health Professions Perimeter Center 9960 Mayland Drive, Suite 300 Richmond, Virginia 23233 Phone: (804) 367-4515 Fax: (804) 527-4455 Contact Person: Jay Douglas, RN, MSM, CSAC, Executive Director

Washington State Nursing Care Quality Assurance Commission Department of Health HPQA #6310 Israel Rd. SETumwater, WA 98501-7864 Phone: 360.236.4700 Fax: 360.236.4738 Contact Person: Paula Meyer, MSN, RN, Executive Director

Wisconsin Department of Regulation and Licensing 1400 E. Washington Avenue, RM 173Madison, WI 53708 Phone: 608.266.0145 Fax: 608.261.7083 Contact Person: Kimberly Nania, PhD, MA, BS, Director, Bureau of Health Service Professional

Click here for more State Board of Nursing Addresses

Bronchitis







Hypernatremia




Tuesday

Upgrading RN in Canada

Before our scheduled interview in the Canadian Embassy, I started to browse the net on how I can upgrade my nursing in Canada. We were planning to go to Edmonton. Alberta Canada coz thats the only place where my husband's cousins are living. It is so hard to move when you dont know anybody right? We wanted to go to Vancouver at first coz thats one of the beautiful place to live according to some people.

So I check the website of College and Association of RN of Alberta (CARNA). Everything you want to know is there. I just download and print the application form, form for school and for the PRC. After I passed the IELTS exam I didnt send it to them yet coz Im still not sure if they going to reply. After 8 months I received a letter from them telling me that they got all my credentials except my IELTS result. So I mailed it to them through IDP.

September of 2006 when I got a letter saying I need to take the Substantially Equivalent Competence (SEC) Assessment Exam. It's a 5 days exam where they test your nursing knowledge and skills in all the different fields of nursing such as Med-Surg, Maternity and Child, Pediatrics and Psychiatric Nursing. It's a pencil and paper based multiple choice exam in each field plus a short answer portion. There is also the "Triple Jump Assessment", a case presentation type. Another component of the assessment is the "clinical judgment one on one exam" which is like an oral exam and the last part is the return demonstration where the examiners will tell you to do certain procedures in a clinical setting. I tell you its difficult and its downright crazy if you are not familiar with what they are asking! I will give you some details about that on my next blog.

As soon as we arrived here in Edmonton, Canada, I phoned the one who is in charge of the assessment exam appointment. We talked and she booked me for Aug 12-16 exam in Mt. Royal College in Calgary. Calgary is the biggest city here in Alberta, travel time is 3 hours by bus from Edmonton. I have to wait for 3 months again before I can take that exam. I'm so eager to challenge their exam coz I just reviewed in KAPLAN for NCLEX. I think I have enough knowledge but Im not confident with my skills. Sort of saying .... Maybe I got the knowledge but not enough of the skills!

While waiting for that, I have to look for a job. I applied as Nursing Assistant (NA) in a continuing care facility under the Capital Care Group. Luckily, I was hired. Right now, I'm still working as an NA pending compliance of all the requirements needed to be an RN here in Canada.

Monday

Applying as a Canadian Immigrant

I applied as immigrant in Canada after I finish my Nursing in Davao Doctors College. If you ask me why, hmmm... I don’t even know why. My Mom wanted me to go and work abroad. I was easy go lucky then and I don’t even care of working abroad. So my mom kept on insisting about it, so I went to one of the agencies in Davao who caters about living in Canada. I submitted all the necessary requirements they needed and paid all the processing and filing fee. It cost me around 45K. After 4 years, I received a letter from the Canadian Embassy, telling about the scheduled interview. I was already married then and Have a son. I didn’t update my files coz I’m not expecting it anymore. When I asked my husband about it, He said NO. I can’t blame him, he is a Doctor and we managed our family business. Financially, we were fine then. So what I did was I went to my agency and told them that I will not resume my application and so they sent a letter to the Embassy. After a year the embassy sent me a letter giving me another chance for an interview. This time, I convinced my husband that we will attend the interview and see what will happen next. The hardest part about it is raising additional funds coz the embassy demands a certain amount for a family of three to immigrate to Canada. This comes to roughly around 800K. On the day of the interview, I was so nervous. I hate interviews! I was even shaking when they asked me to take an exam coz I didn’t have an English exam yet. When the Consul interviewed us, it was fine. We are able to answer all her practical questions. She was trying to tell us that life in Canada is not easy coz we have to start from nothing. Finally she told me to take IELTS exam in order for me to get the points I needed. Canada is a “points system”, there are certain points for your age, course, diploma, language and if you have immediate family in Canada. She said if I got a passing score in IELTS then they will send us for medical exam after. That interview was last Oct 2005, 2 months after, I took the IELTS EXAM and January 2006 I got my result. I passed! I sent my result to the Canadian Embassy then on March I got a letter for our Medical exam. April 22 when we had our medical exam at Davao Doctors Hospital. It’s going to be expire after a year, so we better fly to Canada before one year. While waiting, I decided to take CGFNS Exam. September 2006 when I took it and I luckily passed it. My husband finally got his Nursing Diploma but he did not take the Nursing Board Exam. It was December, when I received a call from the Embassy. They were asking for our passport for the visa. We went to Singapore for a Christmas vacation and I told them that I'll send our passport on January 2007. Carlo, my hubby took and passed his IELTS last February. I was also reviewing at KAPLAN for NCLEX. Me and my hubby finally got our ATT and we both scheduled for NCLEX at Saipan in March 13. We both passed it with flying colors. It’s April 11, 2007 when we arrived in Canada.

Sunday

Paulo Coelho Quotes - fave author

Paulo Coelho is one of my favorite authors (I hate to think he's comparable to JK Rowling and Bob Ong, hehehe). Here are the quotes that might help you understand why I read his books:
“Everyone seems to have a clear idea of how other people should lead their lives, but none about his or her own”
“People need not fear the unknown if they are capable of achieving what they need and want”
“There is only one thing that makes a dream impossible to achieve: the fear of failure”
“Usually the threat of death makes people a lot more aware of their lives”
“Stop thinking all the time that you're in the way, that you're bothering the person next to you. If people don't like it, they can complain. And if they don't have courage to complain, that's their problem”
“...there were two things that prevent us from achieving our dreams: believing them to be impossible or seeing those dreams made possible by some sudden turn of the wheel of fortune, when you least expected it. For at that moment, all our fears suddenly surface: the fear of setting off along a road heading who knows where, the fear of a life full of new challenges, the fear of losing for ever everything that is familiar”
“A warrior accepts defeat. He does not treat it as a matter of indifference, nor does he attempt to transform it into a victory. The pain of defeat is bitter to him; he suffers at indifference and becomes desperate with loneliness. After all this has passed, he licks his wounds and begins everything anew. A warrior knows that war is made of many battles: he goes on”
“Tragedies do happen. We can discover the reason, blame others, imagine how different our lives would be had they not occurred. But none of that is important: they did occur, and so be it. From there onward we must put aside the fear that they awoke in us and begin to rebuild”
“You have to take risks. We will only understand the miracle of life fully when we allow the unexpected to happen”
“We can never judge the lives of others, because each person knows only their own pain and renunciation. It's one thing to feel that you are on the right path, but it's another to think that yours is the only path”
“But there is suffering in life, and there are defeats. No one can avoid them. But it's better to lose some of the battles in the struggles for your dreams than to be defeated without ever knowing what you're fighting for”
Hope you read some of his books; it might help us deal with life.

Thursday

I am Reborn!

As you can see, I am doing my best to make this blog more interactive and fun... I almost deleted this one because I cannot maintain two blogs at the same time. But when I saw that its PageRank is 2/10, I decided to revive this (It is hard to get Google PageRank, you know...) I was not that aware that this blog has a lot of readers.

Anyways, Thanks to all of you. I invited friends who are in medical fields as co authors. I want them to share their experiences around the world so that we have idea what its like to be in their places.

Bear with me as I am trying my best to make this blog something to look forward to.

Wednesday

Tremendous Increase in H-1B Visa Fee

While the Bridge Amendment is still for discussion in the House. The Senate and the House will be meeting on November one to discuss some bills which includes the increase 3500 for the H-1B Visa Fee. The Employers are protesting because it will cost them too much to hire and shoulder all the expense for health workers.

I hope everything will turn out right in favor to the foreign health workers.

More latest updates at Hammond Law Group