WOUND DRAIN

1. Removal of wound drainage
2. Types
1. closed drain
1. drain attached to collection system
2. uses vacuum to draw drainage into system
3. example: Jackson-Pratt, Hemovac
4. specific nursing interventions
1. maintain patency of drain
2. empty collection system and reactivate suction device
3. record amount and characteristics of drainage
4. asepsis
5. standard precautions
2. open drain
1. removes drainage from wound, deposits it on skin surface
2. example: Penrose drain
3. safety pin usually attached to outside end of drain
4. specific nursing interventions
5. prevent inadvertent removal of drain
1. protect skin
2. record characteristics of drainage
3. asepsis
4. standard precautions
6. protect skin surface from irritating effects of drainage
7. wound vacuum
1. removes and collects infectious material from wound
2. computer controlled
3. requires a seal at wound site with pressure distributing wound packing
4. client may be discharged with device 

HIGH RISK GROUPS FOR POST-OP INFECTIONS

1. Impaired immunologic system
2. Extremes of age
3. Diabetes mellitus
4. Corticosteroid therapy
5. Chemotherapy
6. Infection elsewhere in the body
7. Malnutrition
8. Presence of staphylococcus aureus on client
9. Contaminated environment where injury or trauma occurred

CLASSIFICATIONS OF SURGICAL WOUNDS RELATIVE TO RISK OF INFECTION

The higher the class, the higher the risk: a class IV wound carries much more risk than a class I.

1. Class I (clean wound)
1. No break in sterile technique
2. No inflammation encountered
3. GI, Respiratory or GU tract not entered
2. Class II (clean-contaminated wound)
1. GI, GU or respiratory tract entered with no spillage of contents
2. Minor breaks in technique
3. Operations involving the biliary tract, appendix, vagina, and oropharynx
3. Class III (contaminated wound)
1. Acute inflammation without pus
2. Spillage from a hollow viscus occurs
3. Trauma from a clean source
4. Class IV (dirty)
1. Pus or a perforated viscus
2. Trauma from a dirty source
3. Organism causing infection present before surgery
4. Surgical variables that increase risk of infection
5. Prolonged preoperative hospital stay
6. Body location of surgery
7. Surgical technique: delayed wound closure, excess blood loss, presence of drain, improper suture tension
8. Presence of bacteria at closure

Principles of Surgical Asepsis

1. A sterile object remains sterile only when touched by another sterile object.
• Sterile touching sterile remains sterile.
• Sterile touching clean becomes contaminated.
• Sterile touching contaminated becomes contaminated.
• Sterile touching questionable is contaminated.
• Only sterile objects may be placed on a sterile field.
2. A sterile object or field out of range of vision, or an object held below a person's waist, is contaminated.
3. Never turn your back on a sterile field.
4. A sterile object or field becomes contaminated by prolonged exposure to air.
5. When a sterile surface comes in contact with a wet, contaminated surface, the object or field becomes contaminated by capillary action.
6. Always hold your hands above the level of your elbows.
7. The edges of a sterile field or container are considered contaminated.

Cardiovascular Anatomy and Physiology

CARDIOVASCULAR SYSTEM     

A. Anatomy

              1.Layers

                   a.Pericardium: fibrous

                   b.Epicardium: covers surface of heart

                   c.Myocardium: muscular portion of the heart

                   d.Endocardium: lines cardiac chambers and covers surface of heart valves

              2.Chambers of Heart 

                   a.Right atrium: collecting chamber for incoming systemic venous system

                   b.Right ventricle: propels blood into pulmonary system

                   c.Left atrium: collects blood from pulmonary venous system

                   d.Left ventricle: thick-walled, high-pressure pump that propels blood into system

              3.Heart Valves: membranous openings that allow one way blood flow

                   a.Atrioventricular valves: prevent backflow from ventricles to atria during systole

                   b.Tricuspid - right heart valve

                   c.Mitral - left heart valve

                   d.Semilunar valves prevent backflow from aorta and pulmonary arteries into ventricles during diastole

                        1.Pulmonic

                        2.Aortic 

             4.Blood supply to heart 

                   a.Arteries

                        1.Right coronary artery supplies right ventricle and  part of left ventricle

                        2.Left coronary artery supplies mostly left ventricle

                   b.Veins

                        1.Coronary sinus veins

                        2.Thebesian veins

              5.Conduction system 

                   a.SA (Sinoatrial) node

                   b.Junctional tissue

                   c.Bundle branch Purkinje system

        

B. Physiology

              1.Function of the heart is the transport of oxygen, carbon dioxide,  nutrients and waste products

              2.Cardiac cycle consists of:

                   a.Systole - The phase of contraction during which the chambers eject blood

                   b.Diastole - The phase of relaxation during which the chambers fill with blood. When heart pumps, myocardial layer contracts and relaxes.

              3.Blood flow: 

                   a.Deoxygenated blood enters the right atrium through the  superior and inferior vena cava

                   b.Enters the right ventricle via the tricuspid valve

                   c.Travels through the pulmonic valve to pulmonary arteries and lungs

                   d.Oxygenated blood returns from lungs through the pulmonary veins into left atrium and enters the left ventricle via bicuspid (mitral) valve.

                   e.From the left ventricle, through the aortic valve through the aorta to the systemic circulation

              4.The heart itself is supplied with blood by the left and right coronary arteries

              5.The vascular system is a continuous network of blood vessels.

                   a.The arterial system consists of arteries, arterioles and capillaries and delivers oxygenated blood to tissues

                   b.Oxygen, nutrients and metabolic waste are exchanged at the microscopic level

                   c.The venous system, veins and venules, returns the blood to the heart

How to schedule Prometric Exam (Saudi Council Exam) for Filipino Nurses

Step by Step Procedures

Go to the website: http://www.prometric.com

1. Under For Test Takers, tick the dropdown list box on Academic, Professional, Government & Corporate, scroll down and click Saudi Commission for Health Specialties.

2. You will be directed to a new window of SCHS: Saudi Commission for Health Specialties Testing and you may read on some articles there regarding the organization itself. On the Get Started Box click Start.

3. From the Program Name drop down list box: choose the Saudi Commission for Health Specialties (Non-elig) 

***NOTE: the other options apply only to those who are currently in the kingdom --- then choose Philippines then click Next.

4. You will then be directed to a new window. Click Schedule an Exam. A new window will appear showing the details of registration (requirements, scheduling, payment, etc.). Click Next.

5. You will tick "I Agree on the Policy Statement" and click Next.

6. Under Exam Selection you will choose Nurse technician --- There are actually 2 options for nurses: Nurse Specialist and Nurse Technician. 

Nurse Specialist - more than 3 years and beyond practice. 

Nurse technician - 2 years experience

***NOTE: Nurses from Saudi Recruitment Office (SRO) and recruitment agencies instruct applicants to take the Nurse Technician Exam regardless of years of experience.

7. For Test Center Selection, type Manila or Cebu then click Search. Check the information of the testing Centers below:

#8475 and #8479: MANILA, Philippines

Acess 2 Floor Ateneo Professional Schools, 

130 H. Dela Costa St., Salcedo Village, Makati City

Telephone No.: (632) 892-0383

For Manila the schedule of exams are from Tuesdays to Fridays.

Directions: Prometric Testing Center-Manila is located at the Ateneo Professional Schools Salcedo (APS Salcedo) on H.V. de la Costa Street, Salcedo Village, Makati City. APS Salcedo is between Tordesillas and Sanchez Streets. Across APS Salcedo are the Megaworld Center and GF Partners. From the EDSA – Buendia Metro Rail Transit (MRT) station or Gil Puyat – Light Rail Transit (LRT) station, take a jeepney going to Gil Puyat Avenue. Disembark at Yupangco Building or Mapua Information Technology, cross to the covered walk between ACT Tower and GF Partners to get to APS Salcedo at H. V. de la Costa Street.

#8473: CEBU CITY, Philippines

Tread, Inc., Suite 308, Centro Maximo D., 

Jakosalem St., Cebu City

Tel no. 032-2535514

For Cebu the schedule of exams are from Mondays to Thursdays.

Directions: Name of the building is Centro Maximo, it is located at the corner of Jakosalem and Ranudo Sts. Cebu City. It is across the AMWAY. Other landmarks are near the Bayantel Building and IAU Building.

8. Click Schedule an Exam. You will be prompted to select your desired exam month, date and time.

9. You will be directed to another window and you will type some additional information. Type the required information including your name, address, birth date, e-mail address, government identification card, etc.Type PRC ID.  You may use other government issued card like Driver’s License and Passport. --- and in the Government ID Issuing the Card, choose: Philippines.

10. After that, you will proceed to another window and you will be typing the necessary information under the Payment Information. Type the Card Number, the Security Code.. Take in mind that they would only accept credit card payment from major credit card companies such as MasterCard, Visa and America Express. Type in the Name (the owner of the card) and the Expiration Date of the card. Review the information and click Next.

Exam Cost: 90 USD

11. After that you will be asked to review the entered information once again and you will click Complete Registration.

PRINT the Appointment Summary or save it as PDF to print at a later time. You can also check your email for the Appointment Confirmation.

Prometric Exam by Saudi Commission for Health Specialties (Saudi Council Exam)

Prometric Examination for Nurses is the popular name for Saudi Council Examination. In order to ensure a better employment status in the Kingdom of Saudi Arabia, this is a priority requirement on all agencies sending nurses there. According to news in 2009 by the Manila Bulletin, the Philippine Overseas Employment Administration (POEA) emphasized that nurses must pass this kind of exam when intending to work in Saudi Arabia. There is a great reason why it is being encouraged since working in foreign lands may mean that nurses must be competent enough in meeting the different nursing needs of the international clients.

This type of examination is actually similar to the nursing licensure examination that nurses must pass in the Philippines. It is the Saudi Commission that mandates the existence and efficacy of this type of examination.

The Exam Parts:

The Prometric Examination for Nurses is composed of 70 questions in multiple choice formats. In about two hours, the examinee is required to finish the whole test set. In browsing the site of Prometric Exam, http://www.prometric.com/NurseAide/CT.htm you will find that the description for nurses belongs to the category nurse aide.

As a nurse technician the exam is made in order to comprise the following parts:

Nursing Fundamentals: 28%

Medical – 23%

Surgical – 20%

Pediatric – 16%

Community – 13%

For Nurse Specialists, there is a different way of dividing the exam. This is how it is broken down:

Assessment – 10%

Nursing Problem – 6%

Planning – 20%

Implementation – 50%

Evaluation – 14%

For nurse technicians, the passing rate is 45% while for nurse specialists it is 50%. What is interesting here is that the rate of the examinee is readily released after the examination. It is in a form of Score Report that the examinee will know if he or she has passed the examination.

Prometric Exam Location

The Saudi Commission for Health Specialties has granted the accreditation to this exam center:

Prometric Testing Center
Ateneo Professional Schools, 130 H. Dela Costa St., Salcedo Village, Makati City
Telephone No.: (632) 892-0383

and/or

Prometric Testing Center
Tread, Inc., Suite 308, Centro Maximo D., Jakosalem St., Cebu City
Tel no. 032-2535514

Prometric Exam Payment Procedures

Once you have decided to get this examination, another thought would come into your mind is the price of this exam. Registration may come in a form of online registration of through mail. Your type of registration determines the mode of payment that you will be applying.

For online registrants, take in mind that they would only accept credit card payment from major credit card companies such as MasterCard, Visa and America Express. Those who opted to send their applications via mail, they must also send the payment using the form provided as well as the payment is in a form of cheque.

According to recent reports, registrants in Saudi Arabia must pay an Examination Fee of $80.00. Those in Asia entail them to pay $90, while nurses coming from Africa, Europe, North America and the Middle East are required to pay $100.

Prometric Exam Registration Procedure

In order to start the registration process, please go to their website: http://www.prometric.com. A tab is allotted for exam takers, click it and browse the list box for the following items, Academics, Professional, Government and Corporate. Finally, choose among the items Saudi Commission for Health Specialties.

A new site will then pop out wherein the true process of registration starts as well as the selection of the job description is needed. For Nurses, the type of exam should be selected will be either Nurse Technician or Nurse Specialist.

A form is then supplied for you to fill in. Take in note all of the information you are entering so that in order to avoid incongruence. After that the payment information will be opened. Once you have entered the information being asked, review it and finally click the complete registration tab.

Schedule of examination and sitting arrangement can readily be available on the web. For more information about the Prometric Exam, just visit their official website http://www.prometric.com/