Head nurse

Job Description: 1) Supervises and coordinates nursing activities in hospital unit: Assigns duties and coordinates nursing service. 2) Evaluates nursing activities to ensure patient care, staff relations, and efficiency of service. 3) Observes nursing care and visits patients to ensure that nursing care is carried out as directed, and treatment administered in accordance with physician's instructions. 4) Directs preparation and maintenance of patients' clinical records. 5) Inspects rooms and wards for cleanliness and comfort. 6) Accompanies physician on rounds, and keeps informed of special orders concerning patients. 7) Participates in orientation and training of personnel. 8) Orders, or directs ordering of drugs, solutions, and equipment, and maintains records on narcotics. 9) Investigates and resolves complaints, or refers unusual problems to superior.

NURSING AIDE

Nature of Job: Nursing Aidesare responsible forhospital maintenanceand provide assistance to patients. They are under the supervision of nursing and medical tasks. They often provide the cleanliness and orderliness in the hospital. Basic Tasks: Prepare and change beddings, towels, pillows that will be used by patients. Deliver messages from the doctors to the patients or vice versa. Assist patients with their demands and needs. Bathe and dress patients Prepare the meal of the patients; feed them if necessary. Collect used utensils such as plates; also collect used medicine bottles, needles, gloves to dispatch. Prepare the dose of the patients. Clean hospital rooms; disinfect to avoid contaminations. Takes and records patients temperature, blood pressures and respiration rates. Do hospital errands. Follow tasks assigned by chief nurse or doctors.

Staff Nurse JOB DESCRIPTION

Job Summary: Under general direction, manages and directs nursing care activities and coordinatesRequirements: care planning Skills and Competency with other disciplines. Knowledge and ability in hospital settings. CHARACTERISTIC JOB TASKS AND RESPONSIBILITIES May include any and/or all of the following: 1. Must have wide knowledge and ability on attending patients. Knowledge and ability to perform hospital duties such as preparing for meals and medication of patients. Ensures efficient and coordinated clinic flow by coordinating and planning clinic activities; communicates patients needs; makes referrals; serves as person of insurance a resource Knowledge and ability to perform hospital information. errands particulary changing beddings and Delivers direct patient care; assesses patients physical, psychosocial and/or emotional needs; disinfecting used rooms. provides patient and family teaching; triages patients and informs physician of patient status; Ability to assist orders patients to bathe and help responds to phone messages from patients and informs physicians as needed; supplies; stocks and maintains patients rooms; sterilizes instruments. them dress and undress. person Knowledge and of ability to take blood Administers medications as assigned; serves as a resource for knowledge medication uses, side effects, and dosage; checks for proper medication pressures, order; documents medications; temperatures and check other obtains required consent forms to administer immunizations; notifies pharmacies of physician vital signs. approved prescriptions; reviews drug samples to insure they not exceeded the expiration have Report observations to head nurse or date; labels sample drugs and educates patients of medication administration. doctors. Performs other duties as assigned. Ability to communicate well.

2.

3.

4.

KNOWLEDGE, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS Work Environment: Nursing Aidesworks in routines, they often do the Knowledge of medical terminology cleaning for the entire rooms in the hospitals. Part of Customer service skillsAbility to maintain confidentiality their task is to assist patients to take a bath and Ability to instruct/teach/tutor feed them. For entry levelNursing Aides, the tasks Ability to receive telephone inquiries in a tactful, helpful manner are quite tiring, but they will get used to it inthe long Ability to respond to emergency situations and unpleasant elements run.

Another Misdiagnosis which Led to Death? From: joyce marie c. alvarez jm_joycec@yahoo.com Subject: Another Misdiagnosis which Led to Death? Medical Malpractice: Dr. Malaria On April 27, 2005, my mother complained that she was not feeling well and vomited. We brought her to Capitol Medical early morning. The doctors at the emergency room asked her medical history. We told them she had ischemia. The doctors gave her medicine for dizziness only and just let her lie down on the emergency bed. My husband and I were there the whole time. After a few hours, around 11 am, my mother said she was fine, (though she still looked weak), and wanted to go home. I asked the doctor if she could go home and they allowed us to go home with a diagnosis of vertigo, and just reminded us to see her doctor after a few days for follow- up. Dr. Malaria's License must be Revoked Subject:

Thanks for the effort to inform the public about malpractice of doctors in the Phils. What happened to me seems trivial as compared to what was done or not done to others. I went to the medicare center in our town here in Palawan because of high fever and intolerable headache. The doctor on duty asked me questions: "Dr: Anong nararamdaman mo? Me: Mataas po ang lagnat ko, tsaka masakit po ang ulo ko. Dr.: Masakit ba ang sikmura mo? Me: Hindi po.

But after a few days, my mother died. Dr.: Mapula ba ang ihi mo? Me: Opo. I woke her up that Friday morning, April 29 but she didnt wake up anymore. We were all so surprised with her sudden death because she never complained of anything except that time we brought her to Capitol which they said was just vertigo. We brought her back to Capitol that Friday morning (since it was the nearest hospital), and I saw the resident who gave that diagnosis, and you know what I told her: " You said that my mother was fine and now she's dead". In her death certificate, they wrote as cause of death: myocardial infraction. I was not able to get the resident's name but I would still remember her face. I also remembered after her death, her blood pressure was not checked before we left the hospital. Maybe, if they checked her BP or did some other tests or observed her more, maybe they could have detected something else and not just vertigo. After giving her medicine for dizziness, they just left us and did not do anything anymore. Dr: Nahihilo ka ba? Me: Opo. Dr.: Ay, malarya yan!" He then called the nurse who gave him a pen and a sheet of paper. He proceeded to write a "shopping list" of meds, etc. Then he left, leaving the paper to the nurse. I asked the nurse to show me the paper. There was no name of the patient (me), no date, no signature of the doctor. Only names of medicines. No other info like number or pieces of each. The nurse then told my "bantay, neng sunod ka na kay doc, baka magsara na ang botika nila!" I said, "paano ang bayad?" Nurse: "saka na lang po." When my "bantay" returned, she has a bag of what she got from the botika. It was pretty obvious that the doctor's wife in the botika knew the pack to prepare. All for malaria. So that first night, I was given anti-malarial drugs like 'fancedar' and 'chloroquine'. Same until the 2nd day. Later in the afternoon, I complained because my condition did not improve a bit. Take note, there was no blood smear or urine test at least. I asked the nurse why so. The lab tech was on leave. I showed signs of irritation to the nurse. That was only the time when someone took my blood and urine samples. No one told me the results until I asked the nurse again. To the doctors, we seek for your advice because we believe in your expertise. Do not let your patients lose faith in you or the hospital where you are serving because you also carry the hospital's name whenever you treat a patient. Joyce Me: "Anong result ng test? may malaria ba ako?" Nurse: Negative "po". Me: "O, e bakit pinapainum nyo ako ng para sa malaria? Nurse: "Yon po kasi order ni doc." I told her that I want to change my doctor... and I did after

I am not a doctor but I believe that there may have been a misdiagnosis or they didnt care much to the patient (who was my mother) because she was just complaining of dizziness and vomiting water and they had other things to do. Its been three years but I guess your email gave me an opportunity to let you or others know especially the doctors to take time when looking into their patients and be responsible.

much "kulitan". The new doctor confirmed my suspicion. "Wala akong malaria. UTI ang meron." He gave me antibiotics and in less than 4 hours, I was relieved of fever. Imagine, for 2 days they administered 'chloroquine' to me? All the while I have UTI "pala..." Not only this. There was this patient in the same hospital who has fever when she arrived. "May lagnat ka? Malarya yan. Yon pala, ang dalagita, nadulas dahil maputik ang daan sa kanila." Two more cases were judged with malaria. This doctor is known here pala as DR MALARIA. "Kasi laging malaria ang sakit na nakikita sa patients nya. At sa store lang nila bibili ng gamot ha! " thanks for your time.. . Unfortunately, the contributor has requested anonymity. However, any reaction can be posted in the blogspot or passed on to: victims.medmalpractic@gmail.com Posted by Victims of Medical Malpractice (Philippines)at 10:53 PM Labels: Dr. Malaria's License must be Revoked 1. A nurse is administering IV furosemide to a patient admitted with congestive heart failure. After the infusion, which of the following symptoms is NOT expected? A. Increased urinary output. B. Decreased edema. C. Decreased pain. D. Decreased blood pressure. 2. There are a number of risk factors associated with coronary artery disease. Which of the following is a modifiable risk factor? A. Obesity. B. Heredity. C. Gender. D. Age. 3. Tissue plasminogen activator (t-PA) is considered for treatment of a patient who arrives in the emergency department following onset of symptoms of myocardial infarction. Which of the following is a contraindication for treatment with t-PA? A. Worsening chest pain that began earlier in the evening. B. History of cerebral hemorrhage. C. History of prior myocardial infarction. D. Hypertension.

4. Following myocardial infarction, a hospitalized patient is encouraged to practice frequent leg exercises and ambulate in the hallway as directed by his physician. Which of the following choices reflects the purpose of exercise for this patient? A. Increases fitness and prevents future heart attacks. B. Prevents bedsores. C. Prevents DVT (deep vein thrombosis). D. Prevent constipations. 5. A patient arrives in the emergency department with symptoms of myocardial infarction, progressing to cardiogenic shock. Which of the following symptoms should the nurse expect the patient to exhibit with cardiogenic shock? A. Hypertension. B. Bradycardia. C. Bounding pulse. D. Confusion. 6. A patient with a history of congestive heart failure arrives at the clinic complaining of dyspnea. Which of the following actions is the first the nurse should perform? A. Ask the patient to lie down on the exam table. B. Draw blood for chemistry panel and arterial blood gas (ABG). C. Send the patient for a chest x-ray. D. Check blood pressure. 7. A clinic patient has recently been prescribed nitroglycerin for treatment of angina. He calls the nurse complaining of frequent headaches. Which of the following responses to the patient is correct? A. "Stop taking the nitroglycerin and see if the headaches improve." B. "Go to the emergency department to be checked because nitroglycerin can cause bleeding in the brain." C. "Headaches are a frequent side effect of nitroglycerine because it causes vasodilation." D. "The headaches are unlikely to be related to the nitroglycerin, so you should see your doctor for further investigation." 8. A patient received surgery and chemotherapy for colon cancer, completing therapy 3 months previously, and she is now in remission. At a follow-up appointment, she complains of fatigue following activity and difficulty with concentration at her weekly bridge games. Which of the following explanations could account for her symptoms?

A. The symptoms may be the result of anemia caused by chemotherapy. B. The patient may be immunosuppressed. C. The patient may be depressed. D. The patient may be dehydrated. 9. A clinic patient has a hemoglobin concentration of 10.8 g/dL and reports sticking to a strict vegetarian diet. Which of the follow nutritional advice is appropriate? A. The diet is providing adequate sources of iron and requires no changes. B. The patient should add meat to her diet; a vegetarian diet is not advised. C. The patient should use iron cookware to prepare foods, such as dark green, leafy vegetables and legumes, which are high in iron. D. A cup of coffee or tea should be added to every meal. 10. A hospitalized patient is receiving packed red blood cells (PRBCs) for treatment of severe anemia. Which of the following is the most accurate statement? A. Transfusion reaction is most likely immediately after the infusion is completed. B. PRBCs are best infused slowly through a 20g. IV catheter. C. PRBCs should be flushed with a 5% dextrose solution. D. A nurse should remain in the room during the first 15 minutes of infusion. 11. A patient who has received chemotherapy for cancer treatment is given an injection of Epoetin. Which of the following should reflect the findings in a complete blood count (CBC) drawn several days later? A. An increase in neutrophil count. B. An increase in hematocrit. C. An increase in platelet count. D. An increase in serum iron. 12. A patient is admitted to the hospital with suspected polycythemia vera. Which of the following symptoms is consistent with the diagnosis? A. Weight loss. B. Increased clotting time. C. Hypertension. D. Headaches. 13. A nurse is caring for a patient with a platelet count of 20,000/microliter. Which of the following is an important intervention? A. Observe for evidence of spontaneous bleeding. B. Limit visitors to family only.

C. Give aspirin in case of headaches. D. Impose immune precautions. 14. A nurse in the emergency department assesses a patient who has been taking longterm corticosteroids to treat renal disease. Which of the following is a typical side effect of corticosteroid treatment? Note: More than one answer may be correct. A. Hypertension. B. Cushingoid features. C. Hyponatremia. D. Low serum albumin. 15. A nurse is caring for patients in the oncology unit. Which of the following is the most important nursing action when caring for a neutropenic patient? A. Change the disposable mask immediately after use. B. Change gloves immediately after use. C. Minimize patient contact. D. Minimize conversation with the patient. 16. A patient is undergoing the induction stage of treatment for leukemia. The nurse teaches family members about infectious precautions. Which of the following statements by family members indicates that the family needs more education? A. We will bring in books and magazines for entertainment. B. We will bring in personal care items for comfort. C. We will bring in fresh flowers to brighten the room. D. We will bring in family pictures and get well cards. 17. A nurse is caring for a patient with acute lymphoblastic leukemia (ALL). Which of the following is the most likely age range of the patient? A. 3-10 years. B. 25-35 years. C. 45-55 years. D. over 60 years. 18. A patient is admitted to the oncology unit for diagnosis of suspected Hodgkin's disease. Which of the following symptoms is typical of Hodgkin's disease? A. Painful cervical lymph nodes. B. Night sweats and fatigue. C. Nausea and vomiting. D. Weight gain.

19. The Hodgkin's disease patient described in the question above undergoes a lymph node biopsy for definitive diagnosis. If the diagnosis of Hodgkin's disease were correct, which of the following cells would the pathologist expect to find? A. Reed-Sternberg cells. B. Lymphoblastic cells. C. Gaucher's cells. D. Rieder's cells 20. A patient is about to undergo bone marrow aspiration and biopsy and expresses fear and anxiety about the procedure. Which of the following is the most effective nursing response? A. Warn the patient to stay very still because the smallest movement will increase her pain. B. Encourage the family to stay in the room for the procedure. C. Stay with the patient and focus on slow, deep breathing for relaxation. D. Delay the procedure to allow the patient to deal with her feelings. Answer Key 1. Answer: C Furosemide, a loop diuretic, does not alter pain. Furosemide acts on the kidneys to increase urinary output. Fluid may move from the periphery, decreasing edema. Fluid load is reduced, lowering blood pressure. 2. Answer: A Obesity is an important risk factor for coronary artery disease that can be modified by improved diet and weight loss. Family history of coronary artery disease, male gender, and advancing age increase risk but cannot be modified. 3. Answer: B A history of cerebral hemorrhage is a contraindication to tPA because it may increase the risk of bleeding. TPA acts by dissolving the clot blocking the coronary artery and works best when administered within 6 hours of onset of symptoms. Prior MI is not a contraindication to tPA. Patients receiving tPA should be observed for changes in blood pressure, as tPA may cause hypotension. 4. Answer: C Exercise is important for all hospitalized patients to prevent deep vein thrombosis. Muscular contraction promotes venous return and prevents hemostasis in

the lower extremities. This exercise is not sufficiently vigorous to increase physical fitness, nor is it intended to prevent bedsores or constipation. 5. Answer: D Cardiogenic shock severely impairs the pumping function of the heart muscle, causing diminished blood flow to the organs of the body. This results in diminished brain function and confusion, as well as hypotension, tachycardia, and weak pulse. Cardiogenic shock is a serious complication of myocardial infarction with a high mortality rate. 6. Answer: D A patient with congestive heart failure and dyspnea may have pulmonary edema, which can cause severe hypertension. Therefore, taking the patient's blood pressure should be the first action. Lying flat on the exam table would likely worsen the dyspnea, and the patient may not tolerate it. Blood draws for chemistry and ABG will be required, but not prior to the blood pressure assessment. 7. Answer: C Nitroglycerin is a potent vasodilator and often produces unwanted effects such as headache, dizziness, and hypotension. Patients should be counseled, and the dose titrated, to minimize these effects. In spite of the side effects, nitroglycerine is effective at reducing myocardial oxygen consumption and increasing blood flow. The patient should not stop the medication. Nitroglycerine does not cause bleeding in the brain. 8. Answer: A Three months after surgery and chemotherapy the patient is likely to be feeling the after-effects, which often includes anemia because of bone-marrow suppression. There is no evidence that the patient is immunosuppressed, and fatigue is not a typical symptom of immunosuppression. The information given does not indicate that depression or dehydration is a cause of her symptoms. 9. Answer: 3 Normal hemoglobin values range from 11.5-15.0. This vegetarian patient is mildly anemic. When food is prepared in iron cookware its iron content is increased. In addition, dark green leafy vegetables, such as spinach and kale, and legumes are high in iron. Mild anemia does not require that animal sources of iron be added to the diet. Many nonanimal sources are available. Coffee and tea increase gastrointestinal activity and inhibit absorption of iron.

10. Answer: D Transfusion reaction is most likely during the first 15 minutes of infusion, and a nurse should be present during this period. PRBCs should be infused through a 19g or larger IV catheter to avoid slow flow, which can cause clotting. PRBCs must be flushed with 0.45% normal saline solution. Other intravenous solutions will hemolyze the cells. 11. Answer: B Epoetin is a form of erythropoietin, which stimulates the production of red blood cells, causing an increase in hematocrit. Epoetin is given to patients who are anemic, often as a result of chemotherapy treatment. Epoetin has no effect on neutrophils, platelets, or serum iron. 12. Answer: B, C, and D Polycythemia vera is a condition in which the bone marrow produces too many red blood cells. This causes an increase in hematocrit and viscosity of the blood. Patients can experience headaches, dizziness, and visual disturbances. Cardiovascular effects include increased blood pressure and delayed clotting time. Weight loss is not a manifestation of polycythemia vera. 13. Answer: A Platelet counts under 30,000/microliter may cause spontaneous petechiae and bruising, particularly in the extremities. When the count falls below 15,000, spontaneous bleeding into the brain and internal organs may occur. Headaches may be a sign and should be watched for. Aspirin disables platelets and should never be used in the presence of thrombocytopenia. Thrombocytopenia does not compromise immunity, and there is no reason to limit visitors as long as any physical trauma is prevented. 14. Answer: A, B, and D Side effects of corticosteroids include weight gain, fluid retention with hypertension, Cushingoid features, a low serum albumin, and suppressed inflammatory response. Patients are encouraged to eat a diet high in protein, vitamins, and minerals and low in sodium. Corticosteroids cause hypernatremia, not hyponatremia. 15. Answer: B The neutropenic patient is at risk of infection. Changing gloves immediately after use protects patients from contamination with organisms picked up on hospital surfaces. This contamination can have serious consequences for an immunocompromised

patient. Changing the respiratory mask is desirable, but not nearly as urgent as changing gloves. Minimizing contact and conversation are not necessary and may cause nursing staff to miss changes in the patient's symptoms or condition. 16. Answer: C During induction chemotherapy, the leukemia patient is severely immunocompromised and at risk of serious infection. Fresh flowers, fruit, and plants can carry microbes and should be avoided. Books, pictures, and other personal items can be cleaned with antimicrobials before being brought into the room to minimize the risk of contamination. 17. Answer: A The peak incidence of ALL is at 4 years (range 3-10). It is uncommon after the mid-teen years. The peak incidence of chronic myelogenous leukemia (CML) is 45-55 years. The peak incidence of acute myelogenous leukemia (AML) occurs at 60 years. Two-thirds of cases of chronic lymphocytic leukemia (CLL) occur after 60 years. 18. Answer: B Symptoms of Hodgkin's disease include night sweats, fatigue, weakness, and tachycardia. The disease is characterized by painless, enlarged cervical lymph nodes. Weight loss occurs early in the disease. Nausea and vomiting are not typically symptoms of Hodgkin's disease. 19. Answer: A A definitive diagnosis of Hodgkin's disease is made if Reed-Sternberg cells are found on pathologic examination of the excised lymph node. Lymphoblasts are immature cells found in the bone marrow of patients with acute lymphoblastic leukemia. Gaucher's cells are large storage cells found in patients with Gaucher's disease. Rieder's cells are myeloblasts found in patients with acute myelogenous leukemia. 20. Answer: C Slow, deep breathing is the most effective method of reducing anxiety and stress. It reduces the level of carbon dioxide in the brain to increase calm and relaxation. Warning the patient to remain still will likely increase her anxiety. Encouraging family members to stay with the patient may make her worry about their anxiety as well as her own. Delaying the procedure is unlikely to allay her fears.