Trixia Lara B.

Diaz

Nursing Services Department

LEARNING AND GROWTH REPORT

IPSG

There are 6 goals in patient safety which are as follows: 1. Identify patients correctly 2. Improve
effective communication 3. Improve the safety of high alert medications 4. Ensure correct-site, correct-
procedure, correct-patient surgery 5. Reduce the risk of health care-associated infections 6. Reduce the
risk of patient harm resulting from falls. In order to implement safety we must apply the lessons learned,
adopt, innovate, educate providers and consumer, enhance error reporting and develop new economic
standards.

First Goal, identify patients correctly. We have 4 patient identifiers name, birthday, barcode and pin
number. We must always check our patient’s identity prior to procedure or treatment to avoid errors in
implementation that may harm our patient’s health.

Second Goal, improve effective communication. It develops a process to improve effective

verbal and or telephone communication among healthcare providers. Also, develops and implements a
process for reporting critical results of diagnostics. An effective verbal communication must be timely,
accurate, complete, unambiguous and understood. In a verbal communication, it is important to have a
feedback plus in taking telephone orders it is important to verify and read back to avoid errors.

Third Goal, improve the safety of high alert medications. When medications are part of the
patient treatment plan, appropriate management is critical to ensure patient safety. High-alert
medications are those medications involved in a high percentage of errors and/or sentinel events,
medications that carry a higher risk for adverse outcomes, as well as look-alike, sound-alike medications.
The most effective means to reduce or eliminate these occurrences is to develop a process for managing
high-alert medications that includes removing the concentrated electrolytes from the patient care unit
to the pharmacy.

Fourth Goal, ensure correct-site, correct-procedure, correct-patient surgery. Wrong-site, wrong-

procedure, wrong-patient surgery is an alarmingly common occurrence in health care organizations.
These errors are the result of ineffective or inadequate communication between members of the
surgical team, lack of patient involvement in site marking and lack of procedures for verifying the
operative site. In order to avoid this, we must apply our first goal that we must identify our patient
followed by identifying the procedure and if the patient is going to undergo srgery we must ensure
proper marking of the surgical site.
 Fifth Goal, reduce the risk of health care-associated infections. Infections common to many
health care settings include catheter-associated urinary tract infections, bloodstream infections, and
pneumonia. To eliminate these and other infections proper hand hygiene is one of the best solutions to
prevent these. Therefore, as healthcare providers we must comply with current published and generally
accepted hand hygiene guidelines.

Sixth Goal, reduce the risk of patient harm resulting from falls. Falls account for a significant
portion of injuries in hospitalized patients. The health care providers should evaluate its patients’ risk for
falls and take action to reduce the risk of falling using a fall-risk reduction program that based on
appropriate policies and or procedures. We therefore must assess and periodically reassess each
patient's risk for falling, including the potential risk associated with the patient's medication regimen,
and take action to decrease or eliminate any identified risks to avoid incidents of patient fall

Knowing these patient safety guidelines, I will be able to take care of my patients even more
avoiding all the said perceived adverse events that can happen if these guidelines are not followed. All
these guidelines are very applicable in my everyday duty in the pediatric ward to avoid harming our
pediatric clients in anyway such as falls, wrong procedure, surgical site, miscommunication which is
common in having telephone orders etc. This seminar has been helpful to remind us to help provide
optimum and safe quality care towards our patients.
Trixia Lara B. Diaz

Nursing Services Department

LEARNING AND GROWTH REPORT

Basic Course in Psychiatric Care

Mental health is defined as a state of well-being in which every individual realizes his or her own
potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to
make a contribution to her or his community. (as defined from WHO) Mental illness is like any other
illness commonly misunderstood and mistreated. Mental healt is composed of 3 factors biological which
is the disturbance of brain chemistry, psychological which is the emotions, thoughts and feelings, social
which affects stress level and life events.

One of the mental disorders discussed is Schizophrenia a group of severe disorders

characterized by disorganized and delusional thinking, disturbed perceptions and inappropriate
emotions and actions. Delusions are defined as false beliefs, often of persecution or grandeur that may
accompany psychotic disorders. On the other hand, hallucinations are sensory experiences without
sensory stimulation.

For mood disorders, we have depression wherein there is loss in interest, feeling of guilt, and
difficulty in concentrating. On the other hand we have manic episode wherein it is a mood disorder
marked by a hyperactive, wildly optimistic state. Another is bipolar disorder which is a mood disorder in
which the person alternates between the hopelessness and lethargy of depression and the overexcited
state of mania formerly called manic-depressive disorder.

For personality disorder disorders, it is characterized by inflexible and enduring behavior

patterns that impair social functioning. We have Class A, B, and C. In Class A we have paranoid
personality disorder wherein it is characterized by a pervasive distrust of others, including even friends
and partner. Another is Schizoid personality disorder, where the person is detached and aloof and prone
to introspection and fantasy. Another is Schizotypal disorder which is characterized by oddities of
appearance, behaviour, and speech, and anomalies of thinking similar to those seen in schizophrenia.
For Cluster B we have antisocial, borderline, histrionic, and narcissistic personality disorder. Antisocial
personality disorder is characterized by a callous unconcern for the feelings of others also disregards
social rules and obligations, is irritable and aggressive, acts impulsively, lacks guilt, and fails to learn from
experience. On the other hand, borderline personality disorder is when a person essentially lacks a
sense of self, and as a result experiences feelings of emptiness and fears of abandonment. Another is
histrionic personality disorder where there is lack a sense of self-worth, for which reason they depend
on the attention and approval of others. In narcissistic personality disorder the person has a grandiose
sense of self-importance, a sense of entitlement, and a need to be admired. He or she is envious of
others and expects them to be the same of him or her. For Cluster C we have avoidant, dependent, and
anankastic/OCD personality disorder. Dependent personality disorder is characterized by a lack of self-
confidence and an excessive need to be taken care of. Obsessive-compulsive or anankastic personality
disorder is characterized by excessive preoccupation with details, rules, lists, order, organisation, or
schedules; perfectionism so extreme that it prevents a task from being completed; and devotion to work
and productivity at the expense of leisure and relationships.

Having this Basic Psychiatric Course helped me refresh my knowledge with regard to psychiatric
patients and how to deal with patients with similar signs and symptoms. This seminar has reminded us
on how to handle difficult patients or those who manifest similar symptoms of depression, mania,
aggression, withdrawal etc. Also, we were thought on how to properly restrain patients who might
become out of hand which needed an order coming from a doctor on how many restraints and it must
be not too tight or loose there must be at least 2 finger breads that can fit to promote circulation. The
discussion was very helpful also to promoted effective coping and responding towards unforeseen
psychiatric or difficult situation.
Trixia Lara B. Diaz

Nursing Services Department

LEARNING AND GROWTH REPORT

Case Presentation: “EMESIS” A pediatric case about Cyclic Vomiting Syndrome

Cyclic Vomiting is a rare case which is common in girls; it is a chronic functional disorder of
unknown etiology that is characterized by paroxysmal, recurrent episodes of vomiting. Also, it is a
numerous episodes of vomiting interspersed with well intervals (≥4/hour), average of 12 episodes per
year, lasting 2-3 days. In the Medical City there were only 2 cases noted from 2013-2014. Our case was a
about a 7 years old male who has been diagnosed with cyclic vomiting syndrome for 4 years already. It’s
cause is unknown but there are certain events that trigger cyclic vomiting such as stress, anxiety, eating
certain foods, hot weather, overeating, fasting or eating right before bedtime and physical exhaustion or
too much exercise. Signs and symptoms are retching, abdominal pain, lack of appetite, fever, headache,
sensitivity to noise etc. There are 3 stages of cyclic vomiting syndrome are Prodromal phase where there
is change in mood, abdominal pain, dyspepsia, nausea, easy fatigability, anxiety, headache, dizziness.
Then, Emetic phase where there is vomiting in the morning, minimum of 4 vomiting per hour during
each episode, periumbilical or epigastric abdominal pain are the most common associated symptom also
photophobia and noise intolerance and lastly, well phase. Complications are the following: dehydration,
electrolyte imbalance, peptic esophagitis, hematemesis, and tooth decay.

I was assigned to make the pathophysiology of cyclic vomiting. Given this opportunity I was able
to read a lot about cyclic vomiting plus I have reviewed the mechanism of the digestive system. In the
pathophysiology of cyclic vomiting there is stimulation of the chemoreceptor trigger zone and
stimulation of the brain then activation of parasympathetic and sympathetic nervous system. As a
group, we have decided to include only processes that bring about to manifested signs and symptoms of
the patient. Also, we have incorporated laboratory results that are related to the manifested signs and
symptoms. I have learnt a lot in this case presentation together with our guest speaker Dr. Rizza de Leon
who has shared knowledge including the medical side of Cyclic Vomiting.

Given this case study, I have gained more knowledge on what is cyclic vomiting, its signs and
symptoms, treatment and nursing interventions. Also, the knowledge and treatments does not only
apply to patients who has cyclic vomiting but the learnings that I had can be applicable also to
dehydrated patients who are experiencing vomiting, abdominal pain and diarrhea. All in all, the case was
interesting to discuss and helpful for our professional growth as nurses knowledge wise as well as on
hands on nursing care plan implementation.
Trixia Lara B. Diaz

Nursing Services Department

LEARNING AND GROWTH REPORT

STOMA 101

Last March 21, 2015, I attended the Ostomy Care Program. We were taught about stoma
creation, types of stoma, preoperative counseling, pre-operative siting, post operative counseling,
colonic irrigation, siet and nutrition for ostomates, principles in management of stoma and wound
complications and managing stoma complications. These are the types of stomas ileostomy, colostomy
there are also a classification called end which is permanent while loop is a double barrel. Ileostomy
diverts the small intestine through an opening in the abdomen while colostomy is an opening in one end
of the large intestine out through an opening made in the abdominal wall. For Preoperative counselling
it is to help patients to cope with emotions, social and physical and physical problems of having a stoma.
These are some sample questions answered in the program “Will it show?”, “Will it smell?” etc. The
Goals of this counselling is to have the patient have appropriate and sufficient information and
guidance, confidence and help understand that he or she will live a normal life despite of having an
ostomy. Importance of preoperative marking was discussed as well as its preparation together with post
op stoma care.

Pressure ulcers were also discussed but it is already called pressure injury in replacement of the
hands on workshop since the stoma patients weren’t able to come due to some unforeseen
circumstances. In pressure ulcers, surveillance, proper assessment and determining factors is very
important. We must check the surface, have the patient keep moving and if there is incontinence
change of diaper frequently is advised as well as proper nutrition to promote healthy skin. A pressure
injury can be avoidable and unavoidable or extrinsic which comes from friction or intrinsic which comes
from immobility, sensory loss, age, and disease or body type. Stage 1 is when there is discoloration,
nonblanchable blister, Stage 2 partial thickness where there is dermis affectation, Stage 3 or full
thickness where there is subcutaneous tissue seen and stage 4 when there are bones already seen. On
the other hand we have also the Unstageable where the injury is covered with slough or eschar.

Being a participant of this program will help me improve my care with regards to wound care as
well as prevention of pressure injury towards my patients. I was reminded that it is not only mobility or
frequent turning that is important in prevention but also adequate nutrition and incase I will be given a
patient who has such stoma, I already have a basic knowledge on how to manage and take care of it.
Also, with regards to the preoperative counselling, I will be able to answer questions of patients who are
having anxiety towards their upcoming operation for stoma creation and make them understand that
even if they have this stoma they can still live a normal life.