NCLEX in Manila News Video

Test NCLEX di Manila, Philipina - Memudahkan Perawat Indonesia untuk langsung mengikuti Test NCLEX. Kalau Perawat Philipina per tahun 15.000 orang yang mengikuti test ini, mudah-mudahan setiap tahunnya Indonesia mencapai 10% nya (1.500) orang-nya. Sekarang mungkin masih di bawah 100 orang, wah sebuah tantangan dan peluang.

CPR / RJP-Resusitasi Jantung Paru pada orang dewasa terbaru dengan 30 kompresi

CPR / RJP-Resusitasi Jantung Paru pada orang dewasa terbaru adalah 30 kompresi pada jantung

CPR (Cardio pulmonary Resucitation)/RJP (Resusitasi Jantung – Paru) adalah hal yang penting diketahui tenaga kesehatan, termasuk perawat dalam menyelamatan pasien kegawat daruratan di RS ataupun di luar RS.

CPR/RJP merupakan tehnik dasar untuk safe and rescue jika terdapat korban yang mengalami henti jantung mendadak (cardiac arrest) atau henti napas (misalnya : near drowning). RJP dilakukan dengan 2 prinsip bantuan napas mulut ke mulut (mouth-to-mouth rescue breathing) dan kompresi jantung (chest compression), sampai pasien respon positif atau bantuan ambulance datang.


Apa yang terjadi saat jantung berhenti berdenyut ??

4 menit pertama jantung gagal memompakan darah terutama ke otak, maka akan mengalami kekurang suplai gula darah (utamanya) dan oksigen – otak mengalami iskemia. Lewat dari itu selama 10 menit akan menyebabkan kematian sel otak yang irreversible.(WAKTU KRITIS)
Apa yang mesti dilakukan saat menemukan korban henti jantung /serangan jantung mendadak ??

1. Lihat sekitar korban ada bahaya, singkirkan dan bawa korban ke tempat yang tenang Hati-hati copet mengintai,,,,
2. Periksa apakah korban atau pasien sadar : dengan panggil pasien misalnya : "Pak bangun pak ??? Baik-baik sajakah ??? sambil sentuh pundak/bahu pasien kalau dia tidak sadar. Kalau yakin pasien mengalami penurunan kesadaran, terus ke 3.
3. Minta bantuan teman atau telepon no darurat 118/112 (di Indonesia banyak banget), kalau Kuwait cukup 777 (pasti ambulance, polisi dan pemadam kebakaran akan datang kompak), atau di Negara lain Amerika Serikat misalnya 911.

Indonesia :
Nomor darurat telpon selular dan satelit : 112
Ambulans : 118 dan 119.
Badan Search and Rescue Nasional : 115.
Polisi 110
Posko bencana alam : 129.
Pemadam Kebakaran : 113 atau 1131.
Keracunan : (021) 4250767 atau (021) 4227875.
Pencegahan bunuh diri : (021)7256526, (021) 7257826, (021) 7221810.

Lantas kita Lakukan Prinsip ABC !!!!
A (Airway) – Jalan napas B (Breathing) – Napasnya C (Circulation) – Denyut nadi

Apa yang dilakukan di A - AIRWAY ???
Periksa jalan napas korban dengan cara :
Membuka mulut korban dengan 2 jari, lihat apakah ada benda asing, lidah yang drop atau darah. Kemudian taruh tangan penolong diatas jidat dan bawah dagu korban dan dongakkan kepalanya, hiperfleksi - (Head tilt chin lift), kalau kita curiga ada fraktur servikal maka pakai model jaw trust. Dan buka jalan napas

Selanjutnya B – BREATHING ???
Cek napas korban selama 10 detik dengan : Look – Feel – Listen (Letakkan pipi penolong di depan mulut korban, sambil rasakan dan lihat ke arah dada pasien apakah naik – turun (ekspansinya ada).
Kalau tidak ada napas – berikan mouth to mouth ventilation dengan cara tutup hidung korban dan berikan napas dua kali dengan jarak antaranya 5 detik, lakukan sampai terlihat rongga dada pasien ekspansi/naik. Ingat posisi pasien masih hiperfleksi (head till chin lift). Setelah itu kita periksa denyut nadi di arteri karotis sebelah kanan – kiri dekat jakun ( 2- 3 jari) selama 10 detik – rasakan.



Setelah itu C – CIRCULATION ???
Kalau ada denyut nadi, korban hanya henti napas maka lanjutkan Pulmonary Recusitation dengan berikan napas mulut ke mulut sampai 1 menit (berarti 12 kali), sampai napas OK (satu siklus).

Kalau denyut nadi tidak ada maka lakukan kompresi jantung (CPR-cardiac pulmonary resucitation) dengan letakkan ujung telapak tangan di kunci dengan telapak tangan yang lain di tulang dada (sternum) bisa sejajar/segaris antara putting payudara atau 3 jari diatas tulang muda di bawah sternum (prosessus xypoid), letakkan kedua bahu anda sejajar dan lakukan kompresi jantung.


Kompresi dilakukan dengan kedalaman 4 – 5 cm dengan 30 kompresi (dulu 15, yang terbaru 30 kompresi). Mau 1 atau 2 penolong semua 30 kompresi per siklus. Ini dilakukan selama 4 siklus (kurang lebih 1 menit menjadi 100 kompresi).

Di Inggris sendiri setelah 30 kompresi tidak dilakukan ventilasi (2 bantuan napas mulut – mulut), sedang di AS tetap , 30 kompresi : 2 Ventilasi.

Setelah 4 siklus tadi, cek kembali denyut nadi karotis sampai bantuan Ambulance datang, atau ada respon pasien, atau pasien terlihat mati biologis – tanda-tanda rigor mortis.


Kenapa meningkatkan Kompresi Dada menjadi 30 x persiklus ???
• Memberikan kesempatan jantung berdenyut lebih cepat, kalau terlalu banyak ventilasi ada fase silence
• Mengurangi ITP (Intra Thoracik Pressure) – Tekanan Dalam Rongga Dada karena ventilasi untuk mencegah regurgitasi /aspirasi
• Sebenarnya dengan mengkompresi jantung, secara tidak langsung memberikan ekspirasi napas

Kalau ada DC shock atau Automated External Defibrillator (AED), bisa diberikan kejut jantung sebanyak 200 joule, namun pada VF/VT. Sedangkan kalau henti jantung pukul saja rongga dada dengan model cardiac thumb.


source :

http://www.mayoclinic.com/health/first-aid-cpr/FA00061
http://depts.washington.edu/learncpr/quickcpr.html

Asian Nurses Anchor The Industry

Asian Nurses Anchor the Industry

Asian Americans are changing the face of nursing significantly in Southern California. About 15 percent of registered nurses in San Diego are Asian or Pacific Islander, compared to 12 percent of the total population.

SAN DIEGO -- The face of nursing is changing significantly in San Diego and elsewhere in Southern California. According to a survey by NurseWeek earlier this year, 15 percent of registered nurses in San Diego are Asian or Pacific Islander, compared to 12 percent of the total population.

At Kaiser, the ratio is double that. Of 1,565 nurses working for Kaiser Permanente in San Diego, a third, or 528, are Asian, according to Kaiser spokesperson Sylvia Wallace. And at UCSD Medical Center, where Crystal Hsaio works, the majority of nurses on her floor are Asian or Pacific Islander.

"When people see an Asian face they feel more comfortable," said nurse Hsiao, a native of Taiwan, adding that having someone available to translate for a patient can be critical. So is awareness of cultural differences. For example, some nationalities believe that washing a mother and baby after birth can be harmful to both by changing the temperature of the body and thereby altering the chi or flow of energy which, in turn, prevents elimination of toxins. Nurses need to know how to deal with a variety of cultural views such as that.

"Even if we are not the same (in nationality), we are more open-minded about cultural differences," Hsaio said. While the nationwide average of Asian Pacific Islander nurses, according to the NurseWeek survey, is still only 4 percent but increasing, Southern California has become a magnet for nurses from Pacific Rim countries.

While less and less Americans are enrolled in nursing, more and more nurses are emigrating or being recruited from countries such as India, Taiwan, China, and even Korea. The largest source, however, remains the Philippines.

Training as a nurse in the Philippines and coming to work in America is a tradition that began in the 1970s and 1980s, according to Ben Macapugay, spokesperson for Paradise Valley Hospital in Southeast San Diego.

Quality of labor and quality of training is another factor. The Philippines is known to produce more nursing graduates and have more nursing schools than any other country in the world – 186 with the combined ability to graduate 20,000 nurses a year, according to Dr. Jaim Z. Galvez-Tan of the University of the Philippines in Manila.

Supply also dictates salary. In the Philippines, a nurse can expect to earn between $150 and $250 a month. In the United States, where demand is greater, salaries range from $3,000 to 4,000 and often come with signing bonuses, according to Galvez-Tan.
Coming from a poor country makes coming to the United States an easy choice to make, especially when many people in the Philippines already have family here.

"People prefer places like San Diego, where they already have relatives," said John Pasamonte, a recruiter for International Nurses Solutions, one of many companies recruiting foreign nurses for U.S hospitals.Patt Mareschal, lead nurse at Fallbrook Hospital's Medical Surgical Unit, who has spent 30 years in the profession, sees an even greater shift.

For one, nurses have to work more effectively with fewer resources, caring for sicker patients for shorter periods of time. Their responsibilities extend well past a patient's general health and often include sociological and psychological issues, such as domestic violence or mental illness, according to Mareschal.In addition, today's nurses are older; the average age is 46. And they are increasingly male – 6 percent nationwide.

Despite the economic advantages, becoming a nurse in the United States isn't all that easy. No matter how well trained, foreign nurses must pass the NCLEX (National Council for Licensure Examination) and must demonstrate a proficiency in English. Still, the number of nurses passing the NCLEX exam rose to 16,490 in 2003, nearly double what it was in 2001, according to NurseWeek. Many believe a large part of that is the level of education supplied by such institutions as UCSD and United Education Institute of San Diego and El Cajon, which offers, among other things, training for medical assistants, pharmacy technicians and dental assistant, in addition to nursing careers.

For a hospital, the attraction of Asian and Pacific Islander nurses is two-fold: one cultural, one economic. "There is no question that cultural diversity is important, said Wallace. "At Kaiser we work hard to provide faces and cultures that reflect the community at large."
Culture aside, there is a critical need for skilled nurses, period.

"The nursing crisis is grave and only growing worse. Nationwide, there are 130,000 nursing vacancies, a deficit that is expected to double in the next five years. By 2012 it will be 1.1 million," said Pasamonte.

Here in this country, nursing school enrollments have dropped 16 percent in the last five years because of other opportunities opening up, according to Mareschal. "There are new avenues for women now. We no longer have to go the teaching, nursing route," she said.

Meanwhile, those trained as nurses don't always stay in the profession. Many leave in their 20s and 30s to raise families or to pursue other careers. Others go on to related careers such as nurse practitioners or physician assistants.

For their part, the nursing schools are working hard to respond to the crisis, but it has not been easy. "We can't get educated students fast enough," said Dottie Crummy, head of the nursing program at Point Loma Nazarene University. "All the nursing programs in the city are filled to more than capacity. This year we took in an extra five students. Last year we took in 10, and we still had to turn away qualified students."

While the vast majority of students in nursing programs are native born, a high percentage are Asian – a sharp change from past years. "The majority of our students were white Anglo-Saxon Protestants," said Crummy. "Now, Filipino/Pacific Islanders are our largest ethnic group, followed by Asians, then Hispanic."Many of the Filipinos, she added, are the children and nieces of the nurses who came here to practice their profession 20 or 30 years ago.

Michelle Capati, a nursing student at Grossmont College is one of them. When asked why she wants to be a nurse, her answer is simple: "My Mom."Capati's mother has been a nurse for more than 20 years, logging 12-hour shifts seven days a week. But she wouldn't have it any other way, her daughter said.

Hard work or the capacity for hard work may be another reason Asians and Pacific Islanders are swelling the nursing ranks."The Philippines is a third world country. People there are used to stress and hardship, Pasamonte said, adding that "Asians are also known for their compassion."
Mareschal agrees: "They work hard and are generous, caring people."

from :
news.newamericamedia.org

NCLEX Examinations Scheduling Opens July 13, 2007, for Philippines Test Center

NCLEX Examinations Scheduling Opens July 13, 2007, for Philippines Test Center
NCSBN will begin NCLEX testing in Manila, the capital city of the Philippines, at the international Pearson Professional Center on Aug. 23, 2007. Scheduling for examination appointments will begin on July 13, 2007.

Contact: Dawn M. Kappel
Director of Marketing and Communications
312.525.3667 direct
312.279.1034 fax
dkappel@ncsbn.org

CHICAGO - The National Council of State Boards of Nursing, Inc. (NCSBN) will begin NCLEX testing in Manila, the capital city of the Philippines, at the international Pearson Professional Center on Aug. 23, 2007. Scheduling for examination appointments will begin on July 13, 2007.

The Manila site was chosen in February by the NCSBN Board of Directors because of the deep commitment shown by the Philippine government to ensuring a secure test center. The placement of a test site in the Philippines will allow for greater customer service to nurses without compromising the goal of safeguarding the public health, safety and welfare of patients in the U.S.

Intended for the purposes of domestic nurse licensure in U.S. states and territories, all security policies and procedures currently used to administer the NCLEX examination domestically will be fully implemented at this new site. Administration of the NCLEX examination abroad does not contradict or circumvent any current board of nursing process or requirement.

All international candidates are required to apply to the board of nursing in the state or territory where they wish to be licensed before registering for the NCLEX examination. The NCLEX examination fee for all candidates is $200. Candidates who elect to take the NCLEX at an international site pay an additional $150 when they schedule their examination. State and territorial NCLEX examination fees remain at their current levels and are not being used to subsidize the international testing initiative.

Offered abroad since January 2005, the current international sites for NCLEX examinations are in London, England; Hong Kong; Sydney, Australia; Toronto, Montreal, and Vancouver, Canada; Frankfurt, Germany; Mumbai, New Delhi, Hyderabad, Bangalore, and Chennai, India; Mexico City, Mexico; Taipei, Taiwan; and Chiyoda-ku and Yokohama, Japan.

The National Council of State Boards of Nursing, Inc. (NCSBN) is a not-for-profit organization whose membership comprises the boards of nursing in the 50 states, the District of Columbia and four U.S. territories.

Mission: The National Council of State Boards of Nursing (NCSBN), composed of Member Boards, provides leadership to advance regulatory excellence for public protection.

source link :
https://www.ncsbn.org/1282.htm

Belajar Mudah Membaca EKG Untuk Perawat (2) - patologi gelombang P, kompleks QRS, dan gelombang T

Belajar Mudah Membaca EKG Untuk Perawat (2)
Gelombang P, Kompleks QRS dan Gelombang T

Kalau ingin melihat dan belajar mudah EKG disertai contoh-contoh gambaran gelombangnya, teman-teman perawat bisa mencoba melihat di www.ecglibrary.com
Atau belajar ECG bersama dr Alan Lindsay :
http://library.med.utah.edu/kw/ecg/
Atau latihan menjawab soal EKG
http://www.cvphysiology.com/index.html
Namun memang masih dalam bahasa inggris, soalnya memang belum ada ahli jantung indonesia yang mau dan ingin menuliskan/membuat website khusus.


Untuk mempelajari hasil rekaman EKG mestinya memang mencari hal yang simple saja dan prinsip. Bisa saja misalnya mengkonversikan satu kotak kecil dalam mm atau detik (ms) tapi itu RUMIT, nanti saja. Lebih baik kita melihatnya dalam gambaran kotak kecil atau kotak besar saja.

Tetap patokannya fokus pada 3 gelombang yaitu : P, kompleks QRS dan T dulu, baru melihat interval antar gelombang. Sekarang mari kita mengulang kembali gelombang tersebut dan bentuk kelainannya.

1. Gelombang P (kontraksi atrium/atrial depolarisasi) --- SA node/pace maker ke AV node – normal keatas dan kesamping 1 – 3 kotak kecil. – gelombang P selalu ke atas/positif

Kalau gelombang P meruncing keatas (peaked P wave) – jadi kesamping mungkin normal (1-3 kotak kecil) dan keatas (lebih dari 3 kotak kecil) berarti ada gangguan yang kemungkinan disebabkan oleh :
• COPD (Chronic Obstruction Pulmonary Diseases) – Astma bronkhiale, Emphysema atau Bronchitis kronik
• Kelainan katup jantung kiri (mitral) atau kanan (trikuspid) seperti MS (mitral stenosis) atau MI (Mitral insufisiensi)
• Atrial Hipertropi juga bisa; contoh (di lead II), dapat membentuk huruf seperti v (notchead P wave) seperti pada Left Atrial Hipertropi.

Kalau gelombang P melebar kesamping (lebih dari 3 kotak kecil) keatas bisa normal atau lebih dari 3 biasanya akibat : Sino atrial block/gangguan hantaran jantung

Kalau gelombang P negatif (kebawah) pada lead II biasanya disebabkan adanya pacemaker (pasien menggunakan alat pacu jantung) atau ectopic focus (adanya impuls diluar dari SA node).

Kalau gelombang P hilang /tidak ada : dapat terjadi pada VF – Ventrikel Fibrilasi atau VT – Ventrikel Tacycardia – jadi tidak ada impuls SA node dari atrium, ventrikel cuma bergetar- getar saja (BAHAYA BANGET, mengancam jiwa dan siapkan DC shock – 200 – 360 joules), dan CPR – kalau gagal bisa asystole atau flat atau KO IT (+).
Contoh gambaran di :

Pada hiperkalemia gelombang P bisa juga hilang atau kecil dan juga pada AF (Atrial Fibrilasi).


2. Kompleks Gelombang QRS - Ventrikel kontraksi/ventrikel depolarisasi
Pada kompleks gelombang QRS, yang perlu diperhatikan gelombang Q dan gelombang R saja, S abaikan nanti saat S-T interval baru penting). Kalau pada gelombang Q tajam dan runcing , dengan ukuran tinggi/attitude lebih dari 25% gelombang R , ini dikenal dengan Q pathologic pada Akut MI

Lebar kompleks QRS sendiri normal 1 – 2 kotak kecil kesamping, kalau lebih lebar dari itu kemungkinan pada gangguan Hiperkalemia, LBBB (Left bundle branch block) dan RBBB (Right bundle branch block)


3. Gelombang T - ventrikel relaksasi.
Pada gelombang T yang runcing keatas tajam (normal 1 – 5 kotak kecil) bisa terjadi pada hiperkalemia di semua lead. Sedangkan pada old MI/iskemia heart diseases (IHD) terjadi gelombang T negatif ke bawah. Ini bisa juga terjadi pada PVC (Premature ventricular contraction).


Selanjutnya nanti kita lihat interval antar gelombang yang penting terutama :
1. P - R interval
2. S - T interval
3. Q - T interval

Dan 8 rumus membaca EKG yang sederhana namun mendasar yaitu :
1. Rytme /irama : Regular/irregular
2. Menghitung HR (heart rate) – denyut jantung
3. Gelombang P
4. P – R interval
5. QRS kompleks
6. S – T interval
7. Diagnosa
8. Penatalaksanaan