The Professional Regulation Commission (PRC) announces the availability of the room assignment of applicants in Baguio City for the upcoming Nurse Licensure Examination scheduled to be given by the Board of Nursing in November 29 & 30, 2008. Subscription for the November 2008 Nursing Board Exam Result are available also in this site.

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1. The patient has the right to considerate and respectful care irrespective of socio-economic status.
2. The patient has the right to obtain from his physician complete current information concerning his diagnosis, treatment and prognosis in terms the patient can reasonably be expected to understand. When it is not medically advisable to give such information to the patient, the information should be made available to an appropriate person in his behalf. H has the right to know by name or in person, the medical team responsible in coordinating his care.
3. The patient has the right to receive from his physician information necessary to give informed consent prior to the start of any procedure and/or treatment. Except in emergencies, such information for informed consent should include but not necessarily limited to the specific procedure and or treatment, the medically significant risks involved, and the probable duration of incapacitation. When medically significant alternatives for care or treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information. The patient has also the right to know the name of the person responsible for the procedure and/or treatment.
4. The patient has the right to refuse treatment/life – giving measures, to the extent permitted by law, and to be informed of the medical consequences of his action.
5. The patient has the right to every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. Those not directly involved in his care must have the permission of the patient to be present.
6. The patient has the right to expect that all communications and records pertaining to his care should be treated as confidential.
7. The patient has the right that within its capacity, a hospital must make reasonable response to the request of patient for services. The hospital must provide evaluation, service and/or referral as indicated by the urgency of care. When medically permissible a patient may be transferred to another facility only after he has received complete information concerning the needs and alternatives to such transfer. The institution to which the patient is to be transferred must first have accepted the patient for transfer.
8. The patient has the right to obtain information as to any relationship of the hospital to other health care and educational institutions in so far as his care is concerned. The patient has the right to obtain as to the existence of any professional relationship among individuals, by name who are treating him.
9. The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment. The patient has the right to refuse or participate in such research project.
10. The patient has the right to expect reasonable continuity of care; he has the right to know in advance what appointment times the physicians are available and where. The patient has the right to expect that the hospital will provide a mechanism whereby he is informed by his physician or a delegate of the physician of the patient’s continuing health care requirements following discharge.
11. The patient has the right to examine and receive an explanation of his bill regardless of source of payment.
12. The patient has the right to know what hospital rules and regulation apply to his conduct as a patient.

Tungpalan, 1981

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A need is something that is essential to the emotional and psychological health and survival of humans. All people strive to meet basic needs at any given time and individual’s need may be met, partially met, or unmet. A person whose needs may be considered to be healthy and a person with one or more unmet needs is at increased risk of illness or health alterations in one or more of the human dimensions.

Maslow’s framework of basic needs is based on the theory that something is a basic need if:

• its absence results in illness

• its presence prevents or signals health

• meeting an unmet need restores health

Maslow arranges basic human needs in a hierarchy, in which certain needs are more basic than others. Although all the needs are present, the individual strives to meet certain of the needs at least to a minimal level before attending to the others.

PHYSIOLOGICAL NEEDS

The physical needs inherent in all human beings: among them are the needs for oxygen, food, fluids, sleep and procreation to assure the continuation of human existence. Physiological needs are sometimes referred to as basic needs. Physiological needs must be met at least minimally for life to continue. Below the level of substance, death occurs.

SAFETY NEEDS

The need for safety is subordinate only to basic physiological needs. Safety is both physiological and psychological. We need not only a safe physical environment, a shelter but also the feeling of psychological safety. To feel safe we need regular contact with people we trust and feel close to.

LOVE & BELONGING NEEDS

The security we gain from love and belonging enhances the feeling of safety. Our feeling of structure and security is reinforced when we know where we stand in relation to others, and who we are to them. We all need mutually meaningful relationships with other people.

SELF - ESTEEM NEEDS

Self – esteem is derived largely from the feeling that we are valued by those around us. We feel good about ourselves when the people who are important to us express acceptance and approval. But self – esteem comes from within; it is related to the assessments of our own adequacy, our performance and our capacity in the various arenas of lives, both personal and professional and that others hold one in high regard.

SELF - ACTUALIZATION NEEDS

The need to reach one’s potential through development of one’s unique capabilities. In general, each lower level of need must be met to some degree before this need can be satisfied. The process of self – actualization is on that continues throughout life. The following are qualities that indicate achievement of one’s potential:

• Acceptance of self and others as they are

• Focus of interest on problems outside of self

• Ability to be objective

• Feelings of happiness and affection for others

• Respect for all persons

• Ability to discriminate between good and evil

• Creativity as a guideline for solving problems and carrying out interests

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Rabies (from Latin: rabies, “madness, rage, fury.” Also known as “hydrophobia”) is a viral zoonotic neuroinvasive disease that causes acute encephalitis (inflammation of the brain) in mammals. It is most commonly caused by a bite from an infected animal, but occasionally by other forms of contact. If left untreated in humans it is almost invariably fatal. In some countries it is a significant killer of livestock.

The rabies virus makes its way to the brain by following the peripheral nerves. The incubation period of the disease depends on how far the virus must travel to reach the central nervous system, usually taking a few months.

In the beginning stages of rabies, the symptoms are malaise, headache, and fever, while in later stages it includes acute pain, violent movements, uncontrolled excitements, depressions, and the inability to swallow water (hence the name hydrophobia). In the final stages, the patient begins to have periods of mania and lethargy, and coma. Death generally occurs due to respiratory insufficiency.

In non-vaccinated humans, rabies is almost invariably fatal after neurological symptoms have developed, but prompt post-exposure vaccination may prevent the virus from progressing. There are only six known cases of a person surviving symptomatic rabies, and only two known cases of survival in which the patient received no rabies-specific treatment either before or after illness onset.

Etiologic Agent:

Rhabdovirus

1. It is a bullet-shaped filterable virus with strong affinity to the CNS.

2. It is sensitive to sunlight, ultraviolet light, ether, formalin, mercury, and nitric acid. The organism is resistant to phenol, merthiolate, and common antibacterial agents.

Incubation Period:

1. One week to seven and a half months in dogs.

2. Ten days to fifteen years in human.

3. Incubation period depends upon the following factors:

a. Distance of the bite to the brain

b. Extensiveness of the bite

c. Specie of the animal

d. Richness of the nerve supply in the area of the

e. Resistance of the host

Period of communicability:

The patient is communicable from three to five days before onset of symptoms until the entire course of illness.

Pathogenesis:

1. From the site of the bite, the organism proceeds to the CNS through the exoplasm of the peripheral nerves.

2. Experimental studies have shown that the virus stays for sometimes in the inoculation site, and the multiplication of the virus occurs in the myocytes.

3. It has been observe that the period between inoculation and nerve invasion is the only time when prophylactic vaccine is effective.

4. Once the virus infects the individual, the spread is both centripetal and centrifugal.

5. After infection of the CNS, the virus spreads though the peripheral nerves, to the salivary glands, and also to other organs such as the lungs, the adrenals, the kidneys, the bladder, and the testicles (priapism).

Pathology:

1. Rabies virus causes widespread changes throughout the CNS.

2. This consists of neural necrosis and mononuclear cellular infiltration specially in the thalamus, hypothalamus, pons, and medulla.

3. The cranial nerve nuclei are extensively damaged.

4. Neural changes are present in the spinal cord especially in the posterior horns.

5. Negri bodies are most abundant in the hypocampus, basal ganglia, pons, and medulla, and are found in the degenerating neurons of the salivary glands (pathologic sign for rabies).

Clinical Manifestations:

1. Prodromal/Invasion phase

a. The phase is characterized by fever, anorexia, malaise, sore throat, copious salivation, lacrimation, perspiration, irritability, hyperexcitability, apprehensiveness, restlessness, sometimes drowsy, mental depression, melancholia, and marked insomia.

b. There is pain at the original site of the bite. Headache and nausea may be present.

c. The patient becomes sensitive to light, sound and temperature.

d. There are pain and aches in different parts of the body.

e. Anesthesia, numbness, tingling, burning, and cold sensation maybe felt along the peripheral nerves involved and the site of the bite.

f. Mild difficulty in swallowing.

2. Excitement or neurological phase

a. This phase is characterized by marked excitation, and apprehension. Terror may even occur.

b. There is delirium associated with nuchal rigidity, involuntary twitching or generalized convulsions.

c. The patient may exhibit maniacal behavior, eyes are fixed and glossy, and the skin is cold and clammy.

d. There is a severe and painful spasm of the muscles of the mouth, pharynx, and larynx, on attempt to swallow water or food or even at the mere sight of them.

e. There is aerophobia or intense fear or dislike of flying.

f. There is profuse drooling of saliva.

g. There is tonic or clonic contraction of the muscles.

h. Death may occur during the episode of spasm or from cardiac/respiratory failure.

i. If patient survives during this phase, patient deteriorates rapidly and enters to the terminal phase.

3. Terminal/paralytic phase

a. The patient becomes quiet and unconscious.

b. There is loss of bowel and urinary control.

c. Spasm ceases with progressive paralysis.

d. There is tachycardia, labored, or irregular respiration.

e. Death occurs due to respiratory paralysis, circulatory collapse, or heart failure.

Diagnostic Procedures:

1. Virus isolation from the patient’s saliva or throat.

2. Fluorescent rabies anti-body (FRA) provides the most definite diagnosis.

3. Presence of negri bodies in the dog’s brain.

Modalities of Treatment:

1. Thoroughly wash the wounds from the bite and scratches of dog with soap and running water for at least three minutes.

2. Check the patient’s immunization status. Give tetanus toxoid if needed.

3. Give tetanus antiserum infiltrated around the wound-or given intramuscularly after a negative skin test.

4. Give anti-rabies vaccine, both passive and active, depending upon the site and extensiveness of the bite as well as the health condition of the biting animal.

Nursing Management:

1. Isolate the patient.

2. Give emotional and spiritual support.

3. Provide optimum comfort.

4. Darken the room and provide a quiet environment.

5. Patient should not be bathed and there should not be any running water in the room or within the hearing distance of the patient.

6. If IV fluid has to be given it should be wrapped and needle should be securely anchored in the vein to avoid dislodging in times of restlessness.

7. Concurrent and terminal disinfection should be carried out.

Prevention and Control:

The eradication of rabies should be on global scale and should include measures to prevent and control the disease in animals and wildlife.

1. Vaccination of all dogs

2. Enforcement of regulations for pickup and destruction of stray dogs

3. Confinement of any dog that has bitten a person for ten to fourteen days

4. Availability of laboratory facilities for observation and diagnosis

5. Providing public education, especially among children, in avoiding and reporting all animals that appear sick.

Post-exposure prophylaxis

Treatment after exposure, known as post-exposure prophylaxis or “P.E.P.”, is highly successful in preventing the disease if administered promptly, generally within six days of infection. Thoroughly washing the wound as soon as possible with soap and water for approximately five minutes is very effective at reducing the number of viral particles. “If available, a virucidal antiseptic such as povidone-iodine, iodine tincture, aqueous iodine solution or alcohol (ethanol) should be applied after washing.” Exposed mucous membranes such as eyes, nose or mouth should be flushed well with water. In the United States, patients receive one dose of immunoglobulin and five doses of rabies vaccine over a twenty-eight day period. One-half the dose of immunoglobulin is injected in the region of the bite, if possible, with the remainder injected intramuscularly away from the bite. This is much less painful compared with administering immunoglobulin through the abdominal wall with a large needle, as was done in the past. The first dose of rabies vaccine is given as soon as possible after exposure, with additional doses on days three, seven, fourteen, and twenty-eight after the first. Patients that have previously received pre-exposure vaccination do not receive the immunoglobulin, only the post-exposure vaccinations on day 0 and 3. Since the widespread vaccination of domestic dogs and cats and the development of effective human vaccines and immunoglobulin treatments, the number of recorded deaths in the U.S. from rabies has dropped from one hundred or more annually in the early twentieth century, to 1–2 per year, mostly caused by bat bites, which may go unnoticed by the victim and hence untreated.

P.E.P. is effective in treating rabies because the virus must travel from the site of infection through the peripheral nervous system (nerves in the body) before infecting the central nervous system (brain and spinal cord) and glands to cause lethal damage. This travel along the nerves is usually slow enough that vaccine and immunoglobulin can be administered to protect the brain and glands from infection. The amount of time this travel requires is dependent on how far the infected area is from the brain: if the victim is bitten in the face, for example, the time between initial infection and infection of the brain is very short and P.E.P. may not be successful.

Pre-exposure prophylaxis

Currently pre-exposure immunization has been used on domesticated and normal non-human populations. In many jurisdictions, domestic dogs, cats, and ferrets are required to be vaccinated. A pre-exposure vaccination is also available for humans, most commonly given to veterinarians and those traveling to regions where the disease is common, such as India. Most tourists do not need such a vaccination, just those doing substantial non-urban activities. However, should a vaccinated human be bitten by a carrier, failure to receive subsequent post-exposure treatment could be fatal, although post-exposure treatment for a vaccinated human is far less extensive than that which would normally be required by one with no pre-exposure vaccination.

In 1984 researchers at the Wistar Institute developed a recombinant vaccine called V-RG by inserting the glycoprotein gene from rabies into a vaccinia virus. The V-RG vaccine has since been commercialised by Merial under the trademark Raboral. It is harmless to humans and has been shown to be safe for various species of animals that might accidentally encounter it in the wild, including birds (gulls, hawks, and owls).

V-RG has been successfully used in the field in Belgium, France, and the United States to prevent outbreaks of rabies in wildlife. The vaccine is stable under relatively high temperatures and can be delivered orally, making mass vaccination of wildlife possible by putting it in baits. The plan for immunization of normal populations involves dropping bait containing food wrapped around a small dose of the live virus. The bait would be dropped by helicopter concentrating on areas that have not been infected yet. Just such a strategy of oral immunization of foxes in Europe has already achieved substantial reductions in the incidence of human rabies. A strategy of vaccinating “neighborhood dogs” in Jaipur, India, (combined with a sterilization program) has also resulted in a large reduction in the number of human cases.

Source:

http://wikipedia.org

Handbook of Common Communicable and Infectious Diseases

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Appendicitis is inflammation of the vermiform appendix caused by an obstruction attributable to infection, structure, fecal mass, foreign body, or tumor. Appendicitis can affect either gender at any age, but is most common in males 10 to 30. Appendicitis is the most common disease requiring surgery. If left untreated, appendicitis may progress to abscess, perforation, subsequent peritonitis, and death.

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Garamycin, Garamycin Ophthalmic, Genoptic

Classifications: antiinfective; aminoglycoside antibiotic

Action:

Broad-spectrum aminoglycoside antibiotic derived from Micromonospora purpurea. Action is usually bacteriocidal.

Indication:

Parenteral use restricted to treatment of serious infections of GI, respiratory, and urinary tracts, CNS, bone, skin, and soft tissue (including burns) when other less toxic antimicrobial agents are ineffective or are contraindicated. Has been used in combination with other antibiotics. Also used topically for primary and secondary skin infections and for superficial infections of external eye and its adnexa.

Dosage and Route:

Moderate to Severe Infection
Adult: IV/IM 1.5–2 mg/kg loading dose followed by 3–5 mg/kg/d in 2–3 divided doses Intrathecal 4–8 mg preservative free q.d. Topical 1–2 drops of solution in eye q4h up to 2 drops q1h or small amount of ointment b.i.d. or t.i.d.
Child: IV/IM 6–7.5 mg/kg/d in 3–4 divided doses Intrathecal >3 mo, 1–2 mg preservative free q.d.
Neonate: IV/IM 2.5 mg/kg q12–24h
Acute Pelvic Inflammatory Disease
Adult: IV/IM 2 mg/kg followed by 1.5 mg/kg q8h
Prophylaxis of Bacterial Endocarditis
Adult: IV/IM 1.5 mg/kg 30 min before procedure, may repeat in 8 h
Child: IV/IM < 27 kg, 2 mg/kg 30 min before procedure, may repeat in 8 h

Adverse Effects:

Special Senses: Ototoxicity (vestibular disturbances, impaired hearing), optic neuritis. CNS: neuromuscular blockade: skeletal muscle weakness, apnea, respiratory paralysis (high doses); arachnoiditis (intrathecal use). CV: hypotension or hypertension. GI: Nausea, vomiting, transient increase in AST, ALT, and serum LDH and bilirubin; hepatomegaly, splenomegaly. Hematologic: Increased or decreased reticulocyte counts; granulocytopenia, thrombocytopenia (fever, bleeding tendency), thrombocytopenic purpura, anemia. Body as a Whole: Hypersensitivity (rash, pruritus, urticaria, exfoliative dermatitis, eosinophilia, burning sensation of skin, drug fever, joint pains, laryngeal edema, anaphylaxis). Urogenital: Nephrotoxicity: proteinuria, tubular necrosis, cells or casts in urine, hematuria, rising BUN, nonprotein nitrogen, serum creatinine; decreased creatinine clearance. Other: Local irritation and pain following IM use; thrombophlebitis, abscess, superinfections, syndrome of hypocalcemia (tetany, weakness, hypokalemia, hypomagnesemia).

Contraindication:

History of hypersensitivity to or toxic reaction with any aminoglycoside antibiotic. Safe use during pregnancy (category C) or lactation is not established

Nursing Responsibility:

Assessment & Drug Effects

• Lab tests: Perform C&S and renal function prior to first dose and periodically during therapy; therapy may begin pending test results. Determine creatinine clearance and serum drug concentrations at frequent intervals, particularly for patients with impaired renal function, infants (renal immaturity), older adults, patients receiving high doses or therapy beyond 10 d, patients with fever or extensive burns, edema, obesity.
• Repeat C&S if improvement does not occur in 3–5 d; reevaluate therapy.
• Note: Dosages are generally adjusted to maintain peak serum gentamicin concentrations of 4– 10 g/mL, and trough concentrations of 1–2 g/mL. Peak concentrations above 12 g/mL and trough concentrations above 2 g/mL are associated with toxicity.
• Draw blood specimens for peak serum gentamicin concentration 30 min–1h after IM administration, and 30 min after completion of a 30–60 min IV infusion. Draw blood specimens for trough levels just before the next IM or IV dose. Use nonheparinized tubes to collect blood.

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Cerebrovascular accident or stroke (also called brain attack) results from sudden interruption of blood supply to the brain, which precipitates neurologic dysfunction lasting longer than 24 hours. Stroke are either ischemic, caused by partial or complete occlusions of a cerebral blood vessel by cerebral thrombosis or embolism or hemorrhage (leakage of blood from a vessel causes compression of brain tissue and spasm of adjacent vessels). Hemorrhage may occur outside the dura (extradural), beneath the dura mater (subdural), in the subarachnoid space (subarachnoid), or within the brain substance itself (intracerebral).

Risk factors for stroke include transient ischemic attacks (TIAs) – warning sign of impending stroke – hypertension, arteriosclerosis, heart disease, elevated cholesterol, diabetes mellitus, obesity, carotid stenosis, polycythemia, hormonal use, I.V., drug use, arrhythmias, and cigarette smoking. Complications of stroke include aspiration pneumonia, dysphagia, constractures, deep vein thrombosis, pulmonary embolism, depression and brain stem herniation.

Nursing Care Plan

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Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV). SARS was first reported in Asia in February 2003. Over the next few months, the illness spread to more than two dozen countries in North America, South America, Europe, and Asia before the SARS global outbreak of 2003 was contained.

Background:

This atypical pneumonia has been named Severe Acute Respiratory Syndrome (SARS) by World Health Organization (WHO). SARS is an infectious disease of the respiratory system characterized by atypical inflammation of the lungs (pneumonia). Scientists at CDC and other laboratories have detected a previously unrecognized coronavirus in patients with SARS. This new coronavirus is the leading hypothesis for the cause of SARS.

SARS appears to be primarily spread from person-to-person through droplet transmission when in direct close contact with a person with SARS. Potential ways in which SARS can be spread include touching the skin of other people or objects that are contaminated with infectious droplets and then touching your eye(s), nose, or mouth. SARS is an emerging disease. Knowledge about its clinical behavior, response to treatment, and modes and risks of transmission are continually evolving.

Early symptoms in patients with SARS have included fever (>100°F), muscle aches, dry cough, shortness of breath, or difficulty breathing. The illness usually begins with a fever (measured temperature greater than 100.4°F [>38.0°C]) which is sometimes associated with chills or other symptoms, including headache, general feeling of discomfort and body aches. Some people also experience mild respiratory symptoms at the outset.

After 2 to 7 days, SARS patients may develop a dry, nonproductive cough that might be accompanied by or progress to the point where insufficient oxygen is getting to the blood. Ten percent of 20 percent of SARS cases may progress to requiring the use of a respirator. No specific treatment recommendations can be made at this time, however, medical personnel is instructed to treat general clinical signs. CDC currently recommends that patients with SARS receive the same treatment that would be used for any patient with serious community-acquired atypical pneumonia. The virus suspected to be the cause of SARS (coronavirus) is being tested against various antiviral drugs to see if an effective treatment can be found.

Epidemiologic Criteria:

1. Travel (including transit in an airport) within ten days of onset of symptoms to an area with current or previously documented or suspected community transmission of SARS.

2. Close contact within ten days of onset of symptoms with a person known or suspected to have SARS.

Mode of Transmission:

1. The primary mode of transmission appears to be direct mucous membrane (eye, nose, and mouth)

2. Contact with infectious respiratory droplets and/or through exposure to fomites.

3. Transmission through casual and social contacts has occasionally occurred as a result of intense exposure to a case of SARS (in work place, in vehicles) or in high risk transmission settings, such as health care settings, and in household settings.

4. Contamination of inanimate materials or objects by infectious respiratory secretions or body fluids (saliva, tears, urine, and stool) which have been found to contain the virus.

For how long will the SARS virus exist on surfaces?

1. The virus is stable in urine and feces at room temperature for at least one to two days, in stool from patients with diarrhea for up to four days.

2. It survives on paper, on a plastered wall after 36 hours, on plastic surface and stainless steel after 72 hours, on a glass slide after 96 hours.

3. Hospital environmental samples from a number of sites, including walls and the ventilation system, tested positive for SARS virus.

4. Virus loses infectivity after exposure to different commonly used disinfectants and fixatives. Heat at 56ºC rapidly kills the virus.

5. Other risk factors:

a. Household contact with a probable case of SARS

b. Increasing age

c. Male sex

d. Presence of co-morbidities

What are the signs and symptoms of SARS?

1. Sudden onset of high grade fever, usually greater than 38ºC

2. Headache and overall feeling of discomfort and body aches

3. Mild respiratory symptoms at the start and after two days, the patient develops dry cough and have respiratory difficulty.

Treatment:

No specific treatment recommendations can be made at this time. Empiric therapy should include coverage for organisms associated with any community-acquired pneumonia of unclear etiology, including agents with activity against both typical and atypical respiratory pathogens. Treatment choices may be influenced by severity of the illness. Consultation is recommended.

Clinical Course and Management of SARS:

1. It is difficult to decide on the appropriate time to discharge a SARS patient.

2. SARS appears to have lingering after effects once the acute phase of the disease ends.

3. Psychosocial aspects of this illness “should not be underestimated.”

Preventive Measures:

1. Consult a doctor promptly if there are respiratory symptoms such as fever, malaise, chills, headache, joint pain, dizziness, rigors, cough, sore throat and runny nose. Early treatment is the KEY.

2. Build up good body immunity. This means taking proper diet, having regular exercise and adequate rest, reducing stress, and avoiding smoking.

3. Maintain good personal hygiene. Cover nose and mouth when sneezing or coughing.

4. Wear mask if you develop runny nose, sore throat and cough.

5. Wear protective mask in public areas, classrooms, computer rooms, public transports, and communal areas in hostels.

6. Wash hands properly and keep them clean. Use liquid soap for hand washing and disposable towels for drying hands.

Resources:

Handbook of Common Communicable and Infectious Diseases 2006 Ed

American Red Cross

Centers for Disease Control and Prevention (CDC)

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Leukemia is malignant neoplasms of the cells derived from either the myeloid or lymphoid line of the hematopoietic stem cells in the bone marrow. Proliferating abnormal and immature cells (blast) spill out into the blood and infiltrate the spleen, lymph nodes, and other tissue. Acute leukemias are characterized by rapid progression of symptoms. High numbers (greater than 50,000/mm3) of circulating blast weaken blood vessel walls, with high risk for rupture and bleeding, including intracranial hemorrhage.

Lymphocytic leukemias involve immature lymphocytes and their progenitors. They arise in the bone marrows but infiltrate the spleen, lymph nodes, central nervous system (CNS), and other tissues. Myelogenous leukemias involve the pluripotent myeloid stem cells and, thus, interfere with the maturation of granulocytes, erythrocytes, and thrombocytes. Acute myelogenous leukemias (AML) and acute lymphatic leukemia (ALL) have similar presentations and courses. Approximately half of new leukemias are acute. Approximately 85 % of acute leukemias in adults are AML, and incidence of AML increases with age. ALL is the most common cancer in children, with peak incidence between ages 2 and 9.

Although the cause of leukemias is unknown, predisposing factors include genetic susceptibility, exposure to ionizing radiation or certain chemicals and toxins, some genetic disorder (Down syndromes, Fanconi’s anemia), and human T-cell leukemia-lymphoma virus. Complications include infection, leukostasis leading to hemorrhage, renal failure, tumor lysis syndrome, and disseminating intravascular coagulation.

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We are now formally launching the Nursing Crib Forum.

The Nursing Crib forum will be an avenue or it will serve as a second information hub to all nursing students. The forum will be a valuable way of sharing your own nursing article, to ask a question with a fellow forumer, to meet new friends and to discuss certain nursing topics that you have in mind. This is still in relation to our continued commitment of providing quality tools and resources to help our nursing students achieve it’s goal of becoming a full-pledge and certified nurse.

In this forum, guest posting will not allowed. All are encouraged to read the forum guidelines and register before they can make their own post. By default, the email that you will be getting upon registration is something from servomec@box441.bluehost.com. It’s alright and don’t be confused. We are now working on to resolve this issue.

If you’re using Yahoo mail, please check your spam folder.

There are also several general topics in the forum in the meantime but we will definitely add a few more if it deemed necessary.

We also have our own set of forum name rankings and we have ranked them as follows:

• Newbie - 20 Posts
• Member - 45 Posts
• Site Leader - 75 Posts
• Site Manager - 90 Posts
• Site Senior Manager - 120 Posts
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Special forum name will be given to those users who consistently and actively partcipating on the discussion. They will be also given moderator access to forum later on.

If you have other suggestions and recommendations, let’s now all discuss it in our own Nursing Crib forum. Have a blessed day everyone!

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