NCM 118:

The Disaster Continuum

- emergency management cycle
- major and basic phases
Major Phase
● Pre-impact- initial, prior, warning is given
● Impact- actual disaster, hardships and injury, holding on until help arrives,
minutes to hours
● Post-Impact- recovery begins to return of normal community functioning, 4 stages
of emotional response (Denial, Strong Emotional Response, Acceptance,
Recovery)

Basic Phases of Disaster

● Preparedness- planning efforts, evaluate vulnerabilities, warning
● Mitigation- reduce harmful effects of disaster
● Prevention- activities to prevent occurence of disaster
● Response- implement disaster plan, organization of activities to address disaster
● Recovery- stabilizing and return of community to normal
● Evaluation- least attention

Major Phase and Disaster Continuum:

● Pre-Impact- Preparedness/Planning, Prevention and Warning
● Impact- Response, Emergency Management, Mitigation (Reduction)
● Post-impact- recovery, rehab, reconstruction, evaluation

TRIAGE
Disaster Triage System:
1. Red- Immediate (chest wounds, shocks, fracture but STABLE)
2. Yellow- Delayed (Stable, eye and CNS injuries)
3. Green- Minimal (minor wounds and bleeding)
4. Black- Expectant (Unresponsive absent pulse and breathing, high spinal cord
injury)
(Yellow comes after red, green comes after yellow, and black comes after green)

HEPATIC ENCEPHALOPATHY:
- Life threatening due to liver failure, ammonia in blood potentially reaching the the brain
causing neuropsychiatric manifestations.
- Damaged liver, ammonia accumulates and reaches the brain creating depression in
CNS hence mental changes (neuropsychiatric)
- Mental status monitoring, motor disturbance (+babinski, asterixis (hand flaps),
hyperactive to absent tendon reflexes, constructional apraxia (cannot draw with fingers),
fetor hepaticus (breath smells fecaly), EEG
1. Stage 1- normal consciousness, reversal sleeping pattern, constructional apraxia,
2. Stage 2- drowsiness, disoriented, agitated, asterixis, fetor hepaticous, abnormal EEG
 3. Stage 3- stuporous, difficult to arouse already, confusion with incoherent speech,
increased tendon reflexes, abnormal EEG
4. Stage 4- comatose, absent asterixis and reflexes, flaccid extremities
- Interventions:
1. Correct complications and reverse underlying cause
2. Administer lactulose 2-3x a day (monitor potassium)
3. IV administration of glucose
4. Antibiotic (metronidazole, neomycin, rifaximin)- reduce ammonia produce
bacteria
5. Mental status assessment- daily record handwriting and arithmetic
6. Serum ammonia taken daily
7. Assess edema and bleeding → decreased vitamin K due to liver cells inability
8. Small frequent meals and 3 small snacks plus late snacks before bed
9. Protein intake- 1.2-1.5g/kg
10. Nitrogen (Amino Acids)- protein intolerant

DIABETIC KETOACIDOSIS
- Absence or inadequate insulin
- Hyperglycemia → osmotic diuresis → electrolyte loss/ dehydration→ acidosis
- Lack of insulin → fat breakdown → increased ketone bodies → acetone breath, poor
appetite, nausea → acidosis → increased respirations (compensatory)
- Blood glucose @ 300-800 mg/dl
- pH 6.8-7.3 (acidic)
- Low serum bicarb- 0-15 mEq/L
- Goal: 1. Correct electrolyte loss 2. Hyperglycemia with insulin
Interventions
1. Rehydration- Saline first and then D5W when blood glucose @ 250-300 mg/dL
2. Fluid volume monitoring- I/O monitoring
3. Glucose and electrolyte monitoring- monitor potassium due to rehydration
monitor q2 and administer potassium 40 mEq/hr, monitor thru ECG for
arrhythmias.

HHNS
- Metabolic disorder in Type 2 diabetes, sequelae of an illness
- No ketosis as insulin is present but low
- Severe hyperglycemia → osmotic diuresis (electrolyte imbalance) → intracellular fluid
depletion
- s/s same with DKA but no ketosis
- Blood glucose → 600-1200 mg/dl (higher than DKA_)
- Insulin at low rare but less important
- IV fluid replacement

BASIC LIFE SUPPORT and ADVANCED LIFE SUPPORT

- Compression, Airway, Breathing
- Adult Chain of Survival- review
- Pediatric Chain of Survival- review
- Adult BLS Algorithm
- Pediatric BLS Algorithm
NCM 119:
Management- getting things done thru people, supervise people and use of recources (7M)
Management Process and Function:
● (Data Gathering)
● Planning
● Organizing- Staffing and Scheduling
● Directing
● Controlling
Purpose:
● Achieve continuity of care
● Achieve opportunity of work collaboratively
● Achieve scientifically- holistic

Levels of Nurse Managers:

● Top Level- chief nurse
● Middle Level- supervisors, head nurse
● First Line- charge nurses

Areas of Nursing Management:

1. Patient Care Management- standards of care, nursing audit
2. Human Resource Management- staffing, scheduling, staff development, evalutaion
3. Operational Management- supplies, equipments, budgeting, utilization review,
environment

CODE FOR NURSES AND ETHICS

Code for Nurses- Mexico City, May 1973, RA 9173
1. Nurses and People
2. Nurses and Practice- accountable, follow standards of practice, advocates, nurses
responsibility to physicians,
3. Nurses and Society- duty to public → laws and regulations, education, health and dietary
habits
4. Nurses and Co-workers- not interfere with care of another nurse
5. Nurses and Profession- Constitution and By-laws, Standards of Nursing Practice, Duty to
Profession and other professionals

Responsibility of Nurses
● Promotiong of health, prevention of illness, alleviation of suffering, rehabilitation,
sestoration of health, assist in dignified death

Basic to nursing- understanding of man

Inherent in nursing- respect for life, dignity and rights of man

Universal Principles
Primary Principles:
 ● Autonomy- personal liberty, self determination (ability to decide, power to act and
respect for individual autonomy of others), restriciton (communicable disease,
violence to others), therapeutic privelege (emergency, client incompetence,
waiver, implied consent-pregnant), issue on paternalism (intentional limitation)
● Beneficence- bill of rights, prevent/remove evil or hamrs,
● Non-maleficence- cause no harm, not ot inflict harm
● Justice- just, fair and equal, triage in ER, medicare priveleges of HCW, discount
Secondary Principles:
● Veracity- truthfulness, issue on benevolent deception,
● Fiddelity- keeping promise
● Confidentiality- a form of priveleged communication (information obtained by
nurse during client care), revealing on confidential information (with permisison,
medic-legal case of NBI or police, communicable disease concerning public
safety, HCW if relevant to care, lawful order of court

End-of-life Issues:
● Euthansia- Voluntary (Active, Passive), Involuntary
● DNR- reviewed in the chart, do not involve withholding of food and medication
● Advance Directives- lIving will, medical power of attorney (designate another
person), directive to physician and family or surrogate (document wishes)
● Ethical Dilemma- 2 unfavorable issues

Patient Care Categories:

1. Minimal Care- do self-care
2. Moderate/ Partial/ Intermediate Care- some help of nurse IV, catheter, dressings,
colostomy care
3. Total Care- assitance with all activities of daily living
4. Intensive Care- critically ill or in constant danger of death
- Modalities of Care:
1. Functional Nursing- task nursing, nurses are assigned to perform tasks in all
patients, # of client > nurses
2. Case Method/ Total Patient Care- all aspects of care in one or more client, critical
or post anesthesia units
3. Team Method/ Team Nursing- small groups
4. Primary Nursing- all registered nurses, 24 hour care admission to discharge
5. Case Management- interdisciplinary
6. Modular Method- RN provide care with assistance

Board of Nursing
- Chairperson (appointed by President with master’s degree) and 6 members
- Members must represent three areas (education, practice and community health

Core Values of Professional Nurse:

1. Altruism- concern for welfare and well-being of others
 2. Autonomy- self-determination
3. Human Dignity- respect of inherent uniqueness of individuals
4. Integrity- acts according to code of ethics and standards of practice
5. Social Justice- moral, legal and humanistic principles

NCM 111:
RESEARCH PHASES:
● Phase 1: Conceptual Phase - Formulating and delimiting the problem - Reviewing the
related literature - Undertaking clinical fieldwork - Defining the framework and definitions
- Formulating hypothesis
● Phase 2: Design and Planning Phase - Selecting the research design - Developing
intervention protocols - Identifying the population - Designing the sampling plan -
Specifying methods to measure variables - Procedures to safeguard participants -
Finalizing the research plan
● Phase 3: Empirical phase - Collecting data - Preparing the data for analysis
● Phase 4: Analytic Phase - Analyzing the data - Interpreting the results
● Phase 5: Dissemination Phase - Communicating the findings - Utilize the findings in
practice
RESEARCH DESIGN:
Qualitative:
1. Ethnography- social phenomenon, culture, human ways of life
2. Phenomenology- lived experiences
3. Grounded Theory- generate theory from data thru comparative analysis
Quantitative Design:
1. Experimental- gold standard
a. Basic- posttest, pre-post
b. Factorial- 2 or more variables simlutaneous
c. Crossover- same people more than 1 intervention
2. Quasi-Experimental- lack randomization, control group
a. Non-equivalent- randomization
b. Time Series- extended period of time
3. Non-experimental
a. Descriptive
i. Survey Design
ii. Time Dimensional
iii. Case Study
b. Correlational
i. Descriptive
ii. Cause-Probing

Quantitative Sampling:
1. Probability Sampling- equal probability
a. Simple Random Sampling
 b. Stratified Random Sampling- stratum or groups sharing the same characteristics,
representativeness
c. Systematic Sampling- every nth subject
d. Cluster Sampling- sampling unit = collection of element, economical and
practical, broad groups
2. Non-probability Sampling
a. Convenience Sampling- conveniently available, weakest (bias)
b. Quota Sampling- opinion polls, identify strata and then the sample (Stratified and
then Convenience Sampling)
c. Snowball Sampling- network or chain sampling, referral, bias no cross section of
population
d. Consecutive Sampling- best for rolling environment in an accessible population,
recruiting all people from an accessible population
e. Purposive Sampling- judgmental sampling, handpicked by researchers

Types of Statistical Test:

Correlational
● Pearson- continuous
● Spearman- ordinal
● Chi-square- categorical
Comparison of Means- tests for the difference between means
● Paired T-test- related variables
● Independent T-test- independent variables
● ANOVA-
Regression- change in one variable predicts the change of another
● Simple Regression- one variable causes change of another variables
● Multiple Regression- one or more variable changes another variable
Non-parametric
● Wilcoxon Rank-sum- independent
● Wilcoxon Sign-rank- related variables
● Sign Test-