CELBAN 2014, Winnipeg SPEAKING 1, Tell me something about your nursing practice? 2. Tell us something about the place where you came from? Describe your home town, 3. What are the difference between a nurse and a care aide? 4, How can you convince a depressed person to seek treatment? How can you convince that he is sick? 5. Role Play: Create situation from introduction to end of conversation. Situation-Patient hhas headache that started four days ago. Good moming how are you today. My name is ........ lam your nurse today. What brings you to the clinic? Remind that information will be helpful in exploring the cause of her symptoms. ‘The examiner will give you an assessment form as a guide to assessment question you are going to ask. Name, Age, Status, Occupation Reason for seeking care: Pain Health history: Functional activies: alcohol, smoke, exercise ‘Sample Interview Hi, how are you today? My name is John, Iam your nurse today. May [know your name? What should call you? How ean I address you? ‘What brings you to our clinic today? Thave some questions for you to complete this form. Remember that your answers are very important so that we can understand and explore the underlying cause of your health problem. I would like also to assure you that any information you share will be confidential between you, me and the doctor that will see you. BIOGRAPHICAL DATA Age, Bday, Status, Education, Job, Religion FAMILY HISTORYLet's talk about your health problem, You said (........complain........) P- (Provocative/better/ worse) What are you doing when.....s there any that you do/eat Q uality- What does it feels like? R- egion- location. Where is the.....location, S-everity- Seale 1/10 , How it affects ADL T-iming- When/how long you have been suffering, PAST HEALTH Iam going to ask you about your health history. Do you have any present medical condition? Serious illness?” Are you taking any medication? Where you hospitalized before? Any accident? Do you have any allergies? REVIEW OF SYSTEMS, Are there any changes you noticed...weight, appetite, bowel habits, How about your diet, what is your typical meal? FUNCTIONAL/LIFESTYLE Do you smoke, do you drink, take drugs? How often? How long? How many times do you exercise per week? SUMMARIZE then make a closing that the doctor is coming in a short while.6, Health teaching Case Patient is going home from hospital after back surgery. Include this point to your teaching: Hi! Thave a good news for you! 1, shower instead of bath (She said that she prefer bath.) 2. signs of infection (It is her back, you need somebody at home to check it for you) ‘Tylenol prescribed (She will say that it is not working) 4 Case: A day after surgery, post anesthesia care LISTE! iG 1. Lady is inquiring about her insulin. Honeymoon stage of disease 2. Black nurse is teaching how to dress an abdominal wound to a man. Purpose of cleaning the table. Sterility of wound and equipment. Wear gloves after opening the packings. Patient is receptive. 3. Patient asking medication about her asthma. Flovent, Tums. This conversation will be played again on “Writing part: Filling in bullet form”. 4. Patient has on and off confusion. Chemo....good/bad effects 5. Patinet had an accident in school. Coach is coming, listen if there are other complain, antle is swollen, listen if any other disease-none 6.. Multiple choice about chart of patients from bed 101A to .. ‘Name and bed number... .Diagnosis......Procedure Performed......Additional Comment 101A Ex. John. a) b) c) d) Appendectomy 102 Ex. Alma Bladder Infection a) febrile b) stable (watch out for the temp., some selection has no fever) Son is visting in 30 minutes, but the answer is ‘in about half an hour” WRITING 1 Filling the form in bullet type: ‘Name Age: Procedure: Laparoscopy and Hystoroscopy Mecication: Ibufropen, Naproxen for pain, rotator cuff...(I didn’t understand) Pre-op medication (day before surgery) : 2 puffs am and night 2 puffs am and night Medication (day of surgery): 2 puffs am only Post-surgery: general anesthesia. Please listen if through mask, iv, bp monitor (I didn’t hear it good)Case Study: Situation : headache and tiredness, look tired and pale, V/S BP 125/85, HR 82, T 38.2°C, 02Sat 98%, peanut allergy, epinephrine Medical Intervention: Blood lab, chest x-ray, saline solution, artificial respiration Lifestyle: teacher, runs marathons, trains 5x a day, vegetarian, does not drink or smoke Hi, how are you today? ‘My name is john. I am your nurse today. What brings you to our clinic today? Okey but before we go on, Thave some questions for you to answer and fill up this form. There 2 you need to remember. 1°, your answer would be a valuable source of information to know the underlying causes of your health problem. 2", information that you will provide are strictly confidential. BIOGRAPHICAL DATA / FAMILY HISTORY REASON FOR SEEKING CARE HISTORY OF PRESENT ILLNESS ~ PQRSTU, PAST HEALTH REVIEW OF SYSTEMS/ FUNCTIONAL Activities of Daily Living SUMMARY CELBAN POSSIBLE TOPIC QUESTIONS FOR SPEAKING TEST : PART 1 1. Describe Nursing programs in the Philippines ‘Nursing program in the Philippines is mostly patterned to the U.S. Nursing Curriculum. Medium of instruction is in English. Nursing Books and Manuals are authored by Americans, Ex. Lippincott, Mosby, etc. It is a4 years course and a baccalaureate degree. Not everybody can enroll into nursing. One of the requiremeyts is ) you should have an average of 80% mark from all your subjects in high school. ‘One you didn’t maintain the grade, the nursing schoo! will kick you out. This process goes from 1" year to 4" year, so really have to study our lessons. The exciting part is on the 2" year. ‘We have a ceremony of what they called “capping” or Florence Nightingale CappingCeremony. The female student will receive their nursing cap as a symbol that they are ready to assume nursing tasks. For male, itis just an ordinary pin and a candle. Then they will schedule our duty to a certain hospital, clinic or center as a student nurse. ‘The nursing education is not subsidized by government in the Philippines nor is student loan or grant offered. Parents need to pay for everything. Before graduating, we need to complete certain number of hours training in a specialty hospital like in my ease, the school sent me to Heart Center of the Philippines. Some went to Kidney Hospital, some to Lung Center. But all of us need to do a 2 months training in Mental Hospital and 2 weeks in Orthopedic Hospital. Aside from those trainings, we also need to complete assisting in $ minor surgical operation, 5 major surgical operations, 5 normal deliveries, 5 cesarean operations and 2 months immersion in a rural area. ‘There is no such term as graduate nurse. We need to pass the board exam before ‘we can practice and work as a nurse, 2, Differences Between Nurses & Physicians ‘Training Physicians and nurses undergo different types of training for their respective fields. The physicians typically undergo 8 to 10years of medical schooling, Nurse, on the other hand, usually undergo a four-year graduate program. Scope of Practice Physicians and nurses differ in terms of their scope of practice, Physicians can prescribe narcotic medications. Physicians can perform surgery. Nurses focus on primary care, implementing what the physicians ordered, taking care most of a patient's bedside health care needs and management of common and chronic illnesses. In hospitals, nurses are the limbs while doctors are the eyes and brains. Neither can work without the other's presence. ‘The doctors are limited to their specialized field whereas nurses are able to work across several wards or units depending on their job descriptions. The nurses inform the replacement doctor of the patient’s condition and subsequently follow up with the patient's progress until he/she leaves the hospital. ‘As you might have witnessed yourself, a doctor is the one who does the operations while the nurse is the one who assists him. SalaryNurse practitioners and physicians differ a great deal in the amount of money they earn, 3. OBESITY Obesity means having too much body fat. The way We eat over many years becomes a habit, eating more food than our body can use. Not getting enough exercise. More people today work desk jobs compared to more active jobs in the past. Sometimes, medical problems or treatments cause weight gain. Other things that can cause weight gain are quitting smoking, tress, anxiety, feeling sad, or not sleeping well. An active lifestyle and plenty of exercise, along with healthy eating, is the safest way to lose weight. Obesity can lead to diabetes, high blood pressure, heart disease, gallstones, and other chronic illnesses. Men with a waist circumference of 40 inches or greater and women with a waist circumference of 35 inches or greater are considered to have increased health risks related to obesity. Exercise Diet Healthy lifestyle 4. DIABETES Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level. In patients with diabetes, the absence or insufficient production of insulin causes hyperglycemia. ‘Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Diabetes is diagnosed by blood sugar (glucose) testing. ‘The major complications of diabetes are both acute and chronic. Acute complications: dangerously elevated blood sugar (hyperglycemia), abnormally low blood sugar (hypoglycemia) due to diabetes medications may occur Chronic complications: disease of the blood vessels (both small and large) which can damage the feet, eyes, kidnevs, nerves, and heart may occurType 1 diabetes is treated with insulin, exe: In autoimmune diseases, such as type 1 diabetes, the immune system mistakenly ‘manufactures antibodies and inflammatory cells that are directed against and cause damage to patients’ own body tissues. In persons with type 1 diabetes, the beta cells of the pancreas, which are responsible for insulin production, are attacked by the misdirected immune system. It is believed that the tendency to develop abnormal antibodies in type 1 diabetes is, in part, genetically inherited, though the details are not fully understood. Of all the people with diabetes, only approximately 10% have type 1 diabetes and the remaining 90% have type 2 diabetes. Acute symptoms of type 1 diabetes Lack of insulin also causes the inability to store fat and protein along with breakdown of ‘existing fat and protein stores, This dysregulation, results in the process of ketosis and the release of ketones into the blood. Ketones turn the blood acidic, a condition called diabetic ketoacidosis (DKA), Symptoms of diabetic ketoacidosis include nausea, ‘vomiting, and abdominal pain. Without prompt medical treatment, patients with diabetic ketoacidosis can rapidly go into shock, coma, and even death. ‘Type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. ‘When these measures fail to control the elevated blood sugars, oral medications are used. If oral medications are still insufficient, insulin medications and other injectable medications are considered. In type 2 diabetes, patients can still produce insulin, but do so relatively inadequately for their body's neods, particularly in the face of insulin resistance. In many cases this actually means the pancreas produces larger than normal quantities of insulin. A major feature of type 2 diabetes is a lack of sensitivity to insulin by the cells of the body (particularly fat and muscle cells). While there is a strong genetic component to developing this form of diabetes, there are other risk factors - the most significant of which is obesity. Acute complications of type 2 diabetes Blood glucose is essential for the proper functioning of brain cells. Therefore, low blood sugar can lead to central nervous system symptoms such as: dizziness,trem ‘The treatment of low blood sugar consists of administering a quickly absorbed glucose source, These include glucose containing drinks, such as orange juice, soft drinks (not sugar-free), or glucose tablets in doses of 15-20 grams at a time (for example, the equivalent of half a glass of juice). Even cake frosting applied inside the cheeks can work in a pinch if patient cooperation is difficult. Ifthe individual becomes unconscious, glucagon can be given by intramuscular injection. ‘What are the chronic complications of diabetes? Eye Comy ‘The major eye complication of diabetes is called diabetic retinopathy. Diseased small blood vessels in the back of the eye cause the leakage of protein and blood in the retina. Disease in these blood vessels also causes the formation of small aneurysms (microaneurysms), and new but brittle blood vessels (neovascularization). Spontaneous bleeding from the new and brittle blood vessels can lead to retinal scarring and retinal detachment, thus impairing Kidney damage Kidney damage from diabetes is called diabetic nephropathy. The kidneys lose their ability to cleanse and filter blood. The accumulation of toxic waste products in the blood leads to the need for dialysis. Nerve damage Nerve damage from diabetes is called diabetic neuropathy. The blood flow to the nerves is limited, leaving the nerves without blood flow, and they get damaged or die as a result (a term known as ischemia). Symptoms of diabetic nerve damage include numbness, burning, and aching of the feet and lower extremities, When the nerve disease causes a complete loss of sensation in the feet, patients may not be aware of injuries to the feet, and fail to properly protect them. Shoes or other protection should be worn as much 2s possible. Because of poor blood circulation, diabetic foot injuries may not heal. Sometimes, minor foot injuries can lead to serious infection, ulcers, and even gangrene, necessitating surgical amputation of toes, feet, and other infected parts. 5. DEPRESSION Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods, True clinical depression is an illness. It is a mood disorder in whieh feelings of sadness, loss, anger, or frustration interfere with daily life for weeks or longer. Depressive disorders arecharacterized not only by negative thoughts, moods, and behaviors but also by specific changes in bodily functions (for example, eating, sleeping, and sexual activity). Causes, incidence, and risk factors It is believed that chemical changes in the brain are responsible or it may be triggered by certain Depression may be brought on by: Alcohol or drug abuse Certain medical conditions, cancer, or Jong-term pain Certain medicines, such as steroids stressful life events such as death or illness of someone close to you, divorce, childhood abuse or neglect, loneliness (common in the elderiy), relationship breakup ‘Symptoms of depression can include: Agitation, restlessness, and irritability, anger Becoming withdrawn or isolated Fatigue and lack of energy Feeling hopeless and helpless, worthless, guilty, self-hate Loss of interest or pleasure in activities that were once enjoyed Sudden change in appetite, often with weight gain or loss Thoughts of death or suicide ‘Trouble concentrating Trouble sleeping or sleeping too much. Persistently sad, anxious, angry, irritable, or "empty" mood Social isolation, meaning the sufferer avoids interactions with family or friends Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and/or chronic pain Treatment MEDICINES ‘Antidepressants are medicines used to treat depression. They work by bringing back the chemicals in your brain to the right levels. This helps relieve your symptoms. WARNING: Children, teens, and young adults should be watched closely for suicidal behavior. TALK THERAPY ‘Talk therapy is counseling to talk about your feelings and thoughts, and help you learn how to deal with them.+ Psychotherapy can help you understand the issues that may be behind your thoughts and feelings, Prevention Do not drink alcohol or use illegal drugs. These substances make depression worse and may lead to thoughts of suicide. ‘Take your medicine exactly as your doctor instructed, Keep going to your talk therapy sessions. Counseling is just as effective as taking medicine. ‘What about self-help and home remedies for depression? + Eathealthy foods Make time to get enough rest to physically promote improvement in your mood. Express your feelings, ether to friends, in a journal, or using art to help release some negative feelings. Do not set difficult goals for yourself or take on a great deal of responsibility. Try to be with other people, which is usually better than being alone. Participate in activities that may make you feel better. Try exercising, going to a movie or a ball game, or participating in religious or social activities. Do not make major life decisions, such as changing jobs or getting married or divorced without consulting others who know you well. Limit your access to things that could be used to hurt yourself or others (for ‘example, do not keep excess medication of any kind, firearms, or other weapons in the home). Get more exercise. Maintain good sleep habits. Do activities that bring you pleasure. ‘Volunteer or get involved in group activities. Talk to someone you trust about how you are feeling. Try to be around people who are caring and positive6. Drug Addiction Understanding drug use, drug abuse, and addiction Addiction is a complex disorder characterized by compulsive drug use. Many first try ‘drugs out of curiosity, to have a good time, because friends are doing it, or in an effort to improve athletic performance or ease another problem, such as stress, axcxiety, or depression. No matter how often or how little you're consuming, if your drug use is causing problems in your life—at work, school, home, ot in your relationships—you likely have a drug abuse or addiction problem. The uncontrollable craving to use grows ‘more important than anything else, including family, friends, career, and even your own health and happiness. Causes People who use drugs for pain relief may become dependent. Peer pressure can lead to drug use or abuse, emotional distress, anxiety, depression, and environmental stress all can be factors. Children who grow up in an environment of illicit drug use may first see their parents using drugs. People who are more likely to abuse or become dependent on drugs include those who: Have depression, bipolar disorder, anxiety disorders, and schizophrenia. Have easy access to drugs + Have low self-esteem, or problems with relationships + Live a stressful lifestyle, economic or emotional + Live ina culture where there is a high social acceptance of drug use ‘How drug abuse and addiction can develop Drugs contain chemicals that tap into the brain's communication system and disrupt the ‘way nerve cells normally send, receive, and process information. There are at least two ways that drugs cause this disruption: (1) by imitating the brain's natural chemical messengers and (2) by overstimulating the “reward circuit” of the brain. Common signs and symptoms of drug addiction It’s common for an addict to miss work, neglect family obligations and have financial problems. Addiction consumes the addiet’s life, and finding the next high is the most important thing.If the drug has a powerful enough hold over the person, he or she may resort to stealing money to buy drugs ‘Some common symptoms include a decline in physical appearance, sudden weight loss or weight gain, dilated pupils and bad dental hygiene. Physical warning signs of drug abuse Bloodshot eyes, pupils larger or smaller than usual Changes in appetite or sleep patterns. Sudden weight loss or weight gain Deterioration of physical appearance, personal grooming habits Unusual smells on breath, body, or clothing Tremors, slurred speech, or impaired coordination Behavioral signs of drug abuse Drop in attendance and performance at work or school ‘Unexplained need for money or financial problems. May borrow or steal to get it. Engaging in secretive or suspicious behaviors ‘Sudden change in friends, favorite hangouts, and hobbies Frequently getting into trouble (fights, accidents, illegal activities) Psychological warning signs of drug abuse + Unexplained change in personality or attitude ‘= Sudden mood swings, irritability, or angry outbursts + Periods of unusual hyperactivity, agitation, or giddiness + Lack of motivation; appears lethargic or “spaced out” Appears fearful, anxious, or paranoid, with no reason Warning Signs of Commonly Abused Drugs + Marijuana: Glassy, red eyes; loud talking, inappropriate laughter followed by sleepiness; loss of interest, motivation; weight gain or loss. Depressants (including Xanax, Valinm, GHB): Contracted pupil difficulty concentrating; clumsiness; poor judgment; slurred speech; sleepiness. ‘Stimulants (including amphetamines, cocaine, crystal meth): Dilated pupils; hyperactivity; euphoria; irritability; anxiety; excessive talking followed by depression or excessive sleeping at odd times; may go long periods of time without eating or sleeping; weight loss; dry mouth and nose. Inhalants (glues, aerosols, vapors): Watery eyes; impaired vision, memory and thought; secretions from the nose or rashes around the nose and mouth, headaches and nausea; appearance of intoxication; drowsiness; poor muscle control; changes in appetite; anxiety; irritability; lots of cans/aerosols in the trash.Hallucinogens (LSD, PCP): Dilated pupils; bizarre and irrational behavior including paranoia, aggression, hallucinations; mood swings; detachment from people; absorption with self or other objects, slurred speech; confusion. Heroin: Contracted pupils; no response of pupils to light; needle marks; sleeping at unusual times; sweating: vomiting; coughing, sniffling; twitching; loss of appetite. When your teen has a drug problem Discovering your child uses drugs can generate fear, confusion, and anger in parents. It's important to remain calm when confronting your teen, and only do so when everyone is sober. Explain your conceras and make it clear that your concem comes from a place of love, It’s important that your teen feels you are supportive. Commonly abused substances include: © Opiates and narcotics are powerful painkillers that cause drowsiness (sedation) and sometimes feelings of euphoria. These include heroin, opium, codeine, meperidine (Demerol), hydromorphone (Dilaudid), and oxycodone (Percocet, Percodan, and Oxycontin). Central nervous system (CNS) stimulants include amphetamines, cocaine, dextroamphetamine, methamphetamine, and methylphenidate (Ritalin). These ‘drugs have a stimulating effect, and people can start needing higher amounts of these drugs to feel the same eflect (tolerance). Central nervous system depressants include alcohol, barbiturates (amobarbital, pentobarbital, secobarbital), benzodiazepines (Valium, Ativan, Xanax), chloral hydrate, and paraldehyde. These substances produce a sedative and anxiety- reducing effect, which can lead to dependence. Hallucinogens include LSD, mescaline, psilocybin ("mushrooms"), and phencyclidine (PCP or "angel dust”). They can cause people to see things that aren't there (hallucinations) and can lead to psychological dependence. Tetrahydrocannabinol (THC) is the active ingredient found in marijuana (cannabis) and hashish. Treatment ‘Treatment for drug abuse or dependence begins with recognizing the problem. ‘Acceptance that there is a problem, Treatment of drug dependency involves stopping rug use either gradually or abruptly (detoxification), support, and staying drug free (abstinence). ‘Treatment programs include counseling, both for the person (and perhaps family), and in group settings. Itis important to be evaluated by a trained professional to determine the best care.