Learn The Roles and Functions Of A Professional Nurse

Nurses are expected to perform a variety of roles in health care institutions whenever care are provided to the clients.  They maybe carried out simultaneously depending on the need of the client in a particular situation and case.

a.  Caregiver

   

As a caregiver, nurses are expected to assist the client’s physical, psychological, developmental, cultural and spiritual needs.  It involves a full care to a completely dependent client, partial care for the partially dependent client and supportive-educative care, in order to attain the highest possible level of health and wellness.

b.  Communicator

Communication is very important in nursing roles.  It is vital to establish nurse-client relationship.  Nurses who communicate effectively gets better information about the client’s problem either from the client itself or from his family.  With better information nurses will be able to identify and implement better interventions and or nursing care that promotes fast recovery, health and wellness. 

c.  Teacher

   

Being a teacher is an important role for a nurse.  It is her duty to give health education to the clients, families and community.  However, the nurse must be able to assess the knowledge level, learning needs and readiness of the clients, families and community to give appropriate and necessary health care education e.g. diseases, health, wellness, nursing care procedure, etc.  they need to do to restore and maintain their health.

d.  Client Advocate

   

A nurse may act as an advocator.  An advocator is the one who expresses and defends the cause of another or acts as representative.  Some people who are ill maybe too weak to do on his own and or even to know his rights to health care.  In this instance, the nurse may convey is client’s wish like change of physician, change of food, upgrade his room or even to refuse a particular type of treatment.

e.  Counselor

   

A nurse may act as a Counselor.  She provides emotional. Intellectual and psychological support.  She helps a client to recognize with stressful psychological or social problems, to develop and improved interpersonal relationship and to promote personal growth.

f.  Change Agent

   

As a change agent, oftentimes a nurse change or modify nursing care plan based on her assessment on the client’s health condition.  This change and modification will only happen when the intervention/s does not help and improve a client’s health e.g. caring of the pressure ulcer, change in medication, change of food, etc.

g.  Leader

   

Nurse often assumes the role of leader.  Not all nurses have the ability and capacity to become a leader.  It takes confidence, initiative and ability to innovate change, motivate, facilitate and mentor others.  As a leader it allows you to participate in and guide teams that assess the effectiveness of care, implement-based practices, and construct process improvement strategies.  You may hold a variety of positions like shift team leader, chairperson of a professional organization, ward in-charge, board of directors, sister, matron, etc.

h.  Manager

   

As a Manager, a nurse has the authority, power, and responsibility for planning, organizing, coordinating and directing work of others.  She is responsible for setting goals, make decisions, and solve problems that the organization may encounter.  It is also her responsibility to supervise and evaluate the performance of her subordinates.  The manager always ensure that nursing care for individuals, families and communities are meet.

i.  Case Manager

   

In some hospitals, a case manager is a primary nurse who provide direct care to the client or family.  For example a case manager for diabetic client.  She has the responsibility to give health education, measure the effectiveness of the nursing care plan and monitor the outcomes of intervention whether effective or not.

j.  Research Consumer

   

Nurses often do research to improve nursing care, define and expand nursing knowledge. 

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Learn The Procedure On How To Take Blood Pressure

I want to share again another nursing procedure that you might be interested to learn.  This is the manual type of taking blood pressure of a person using the sphegmomanometer, though digital is readily avalaible and easy to use but if you have sphegmomanometer at home might as well learn how to use it.  Besides that, it is best to monitor the changes of our  blood pressure especially if we have member/s of the family who is suffering the said illness to undertake necessary measures.  This will also benefit the nursing students who are looking for the the right procedure.

Blood pressure (BP) is the pressure (force per unit area) exerted by circulating blood on the walls of blood vessels, and constitutes one of the principal vital signs. The pressure of the circulating blood decreases as it moves away from the heart through arteries and capillaries, and toward the heart through veins. When unqualified, the term blood pressure usually refers to brachial arterial pressure: that is, in the major blood vessel of the upper left or right arm that takes blood away from the heart. Blood pressure may, however, sometimes be measured at other sites in the body, for instance at the ankle.

One measure records the pressure while the heart is in systole (when the heart is ejecting blood into the arteries);this is the higher systolic pressure.  The other measure records the pressure while the heart is in diastrole (when the aortic and pulmonary valves are closed and the heart is relaxed);this is the lower or diastolic pressure.  The range of normal blood pressure recording varies according to age and body size but in the normal young adult is approximately 100-120/70-80 mm Hg. 

Why we should perform the procedure?

1. To provide baseline data 
2. To monitor changes in blood pressure

Procedure
Assessment:

1. Assess client’s general condition.

• Client rest on the bed.
• Avoid strenuous activity.
• To select appropriate cuff size.

     2.  To select appropriate cuff size.

Planning:

1. Prepare the requirements (in a tray)

• Sphygmomanometer
• Stethoscope.
• Alcohol swab in gallipot (to clean stethoscope)
• Receiver
• Observation chart
• Pen (black and red)
• Ruler

     2. Prepare adequate working space.

Implementation:

1.  Greet and inform client about the procedure.
2. Perform hand wash (Prevents cross infection)
3. Provide privacy
4. To obtain accurate reading,  position the sphygmomanometer at heart level and ensure the mercury level at zero.
   
5. Expose the arm above the placement of cuff. 
6. Apply cuff 2.5cm above antecubital fossa.
7. Fold client’s sleeve above the placement of cuff.
8. Apply the cuff smoothly and firmly with the middle of the rubber bladder directly over the artery. (Too tight cuff will impede circulation whereas too loose will lead to false elevation of pressure.)
9. Secure the cuff by fixing the Velcro fastener. (Prevent unwrapping of cuff)
10. Close the valve of the inflation bulb.
11. Palpate the radial pulse.
12. Inflate the cuff until pulse is not palpable. (To estimate how high to pump the mercury)
13. Note the point which pulse disappears. (first reading)
14. Deflate the cuff slowly.
15. Palpate brachial artery and place the diaphragm lightly over the brachial artery.
16. Inflate the cuff further to 20mmHg.
17. Release the valve slowly.
18. First audible sound heard is systolic pressure. (First sound heard when the blood begins to flow through brachial artery)
19. Continue to deflate the cuff. The last sound heard is the diastolic pressure.
20. Deflate the cuff completely
21. Remove the cuff from client's arm.
22. Ensure client is in comfortable. (Advice client to rest if finding show high blood pressure)
23. Clean the stethoscope with alcohol swab
24. Tidy up unit
25. Document the reading in observation chart.

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Giving And Removing Bedpan To A Patient

Here we will learn on how to give and remove a bedpan to a patient.  But first we should know what is bedpan, its importance and why do we need the procedure.

What is bedpan?

Bedpan is an object used for the toileting of a bedridden patient in a health care facility, usually made of a metal, glass, or plastic receptacle. A bed pan can be used for both urinary and fecal discharge

Why they are necessary

1. 
   
    Many diseases can confine a patient to bed, necessitating the use of bedpans.
   
   
   
2. 
   
   Additionally, many patients may be confined to a bed temporarily as a result of a temporary illness, injury, or surgery, thereby necessitating the use of a bed pan.
   
   
   

 Procedure of giving and removing bedpan to a patient.

1.  Wear disposable glove.
2. If the bedpan is metal, warm it by rinsing it with warm water.
3. 
   
   Adjust the bed to a height appropriate to prevent back strain.
   
   
   
4. 
   
   Elevate the side rail on the opposite side to prevent the client from falling out of bed.
   
   
   
5. 
   
   Ask the client to assist by flexing the knees, resting the weight on the back heels, and raising the buttocks, or by using a trapeze bar, if present.
   
   
   
6. 
   
   Help lift the client as needed by placing one hand under the lower back, resting your elbow on the mattress, and using your forearm as a lever.
   
   
   
7. 
   
   Lubricate the back of the bedpan with a small amount of hand lotion or liquid soap to reduce tissue friction and shearing.
   
   
   
8. 
   
   Place a regular bedpan so that the client’s rest on the smooth, rounded rim. place a slipper pan with the flat, low end under the client’s buttocks.
   
   
   
9. 
   
   For the client who cannot assist , obtain the assistance of another nurse to help lift the client onto the bedpan or place the clients on his or her side , place the bedpan against the buttocks and roll the clients onto the bedpan.
   
   
   
10. 
    
    To provide a more normal position for the clients lower back elevates the client’s bed to a semi Fowler’s position. If permitted. If elevation is contraindicated, support the clients back with pillow as needed to prevent hyperextension of the back.
    
    
    
11. 
    
    Cover the clients with bed linen to maintain comfort and dignity.
    
    
    
12. 
    
    Provide toilet tissue, place the call light within reach, lower the bed to the low position, elevate the side rail if indicated and leave the client alone.
    
    
    
13. 
    
    Answer the call bell promptly
    
    
    
14. 
    
    Do not leave anyone on a bedpan longer than 15 minutes unless they are able to remove the pan themselves. Lengthy stays on a bedpan can causes pressure ulcer.
    
    
    
15. 
    
    When removing the bedpan, return the bed to the position used when giving the bedpan, hold the bedpan steady to prevent spillage of its content, cover the bedpan, and place it on the adjacent chair.
    
    
    
16. 
    
    If the client needs assistance, don glove and wipe the patient’s perineal area with several layers of toilet tissue. If a specimen proof is needed place the tissue in a receptacle other than the bedpan.
    
    
    
17. 
    
    Wash the perineal area of dependent patient with soap and water and thoroughly dry the area.
    
    
    
18. 
    
    For all patients, offer warm water soap, a washcloth. and a towel to wash the hands.
    
    
    
19. 
    
    Assist the pateints to a comfortable position, empty and clean the bedpan, and return it to the bedside.
    
    
    
20. 
    
    Remove and discard you gloves and wash your hands.
    
    
    
21. 
    
    Spray the room with air freshener as needed to control odor unless contraindicated because of respiratory problems or allergies.
    
    
    
22. 
    
    Document colour, odour amount and consistency of urine and feces and the condition of the perineal area
    
    
    

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Vacine Recommendations For A(H1N1)

When the vaccine for influenza A(H1N1) becomes available, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommends that the following groups be vaccinated:

• pregnant women
• people who live with or care for children less than 6 months old
• health care and emergency services personnel
• people between the ages of 6 months through 24 years of age
• people ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems

In the event of a vaccine shortage, the ACIP recommends that the following groups receive the vaccine before others:

• pregnant women
• people who live with or care for children less than 6 months of age
• health care and emergency services personnel with direct patient contact
• children between 6 months and 4 years of age
• children ages 5 through 18 years of age who have chronic medical conditions

To decrease the incidence of secondary pneumococcal pneumonia, the CDC is also recommending prophylactic administration of 23-valent pneumococcal polysaccharide vaccine (PPSV23) during the outbreak of novel influenza A(H1N1). The recommendations of the CDC's Advisory Committee on Immunization Practices (ACIP) are as follows:

• Vaccination for all persons over 65 years of age
• Vaccination for persons 2 to 64 years with the following medical conditions:
  
  
  • Chronic cardiovascular disease (congestive heart failure and cardiomyopathies)
  • Chronic pulmonary disease, including COPD and emphysema
  • Diabetes mellitus
  • Alcoholism
  • Chronic liver disease, including cirrhosis
  • Cerebrospinal fluid leaks
  • Functional or anatomical asplenia, including sickle cell disease and splenectomy
  • Immunocompromised conditions, including HIV infection, leukemia, lymphoma, Hodgkin's disease, multiple myeloma, generalized malignancy, chronic renal failure, nephrotic syndrome; those receiving immunosuppressive chemotherapy (including corticosteroids); and those who have received an organ or bone marrow transplant
  
  
  
  
• Vaccinations for persons 19 to 64 years who have asthma or smoke.

*Note: A single revaccination at least five years after initial vaccination is recommended for people 65 years and older who were first vaccinated before age 65 years as well as for people at highest risk, such as those who have no spleen, and those who have HIV infection, AIDS or malignancy.

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Learn How To Treat And Prevent A(H1N1)

The CDC has outlined specific antiviral guidelines for prevention and treatment of confirmed, probable, and suspected cases of patients with influenza A(H1N1) and their close contacts.

Current antiviral dosing recommendations are as follows:

oseltamivir (Tamiflu)

To prevent influenza A(H1N1).
 
Adults: 75 mg capsule by mouth (P.O.) once daily for 10 days
Children 12 months and older weighing greater than 40 kg: 75 mg P.O. once daily for 10 days
Children 12 months and older weighing 24 kg to 40 kg: 60 mg P.O. once daily for 10 days
Children 12 months and older weighing 16 kg to 23 kg: 45 mg P.O. once daily for 10 days
Children 12 months and older weighing 15 kg or less: 30 mg P.O. once daily for 10 days
Infants 6 to 11 months: 25 mg P.O. once daily for 10 days
Infants 3 to 5 months: 20 mg P.O. once daily for 10 days
Infants less than 3 months: Not recommended unless situation judged critical due to limited data on use in this age group.

To treat influenza A(H1N1).
 
Adults: 75 mg capsule P.O. twice daily for 5 days
Children 12 months and older weighing greater than 40 kg: 150 mg P.O. per day divided into two doses for 5 days
Children 12 months and older weighing 24 kg to 40 kg: 120 mg P.O. per day divided into two doses for 5 days
Children 12 months and older weighing 16 kg to 23 kg: 90 mg P.O. per day divided into two doses for 5 days
Children 12 months and older weighing 15 kg or less: 60 mg P.O. per day divided into two doses for 5 days
Infants 6 to 11 months: 25 mg P.O. twice daily for 5 days
Infants 3 to 5 months: 20 mg P.O. twice daily for 5 days
Infants less than 3 months: 12 mg P.O. twice daily for 5 days

Click here for complete prescribing information for oseltamivir (Tamiflu).
Click here for drug information from NDH2009

zanamivir (Relenza)

To prevent influenza A(H1N1)
 
Adults: Two 5 mg inhalations (10 mg total) once per day for 10 days
Children 5 years and older: Two 5 mg inhalations (10 mg total) once per day for 10 days

To treat influenza A(H1N1)
 
Adults: Two 5 mg inhalations (10 mg total) twice per day for 5 days
Children 7 years and older: Two 5 mg inhalations (10 mg total) twice per day for 5 days

Click here for complete prescribing information for zanamivir (Relenza).
Click here for drug information from NDH2009.

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How To Administer An Enema To A Patient

The other day was the presentation day for all the nursing procedure that Miss Tracey has given us. Each group presented their respective nursing procedure. so in few days i will be posting here some of the the different nursing procedure that we are going to undertake during our clinical posting.

The first nursing procedure i will give you is how to administer an enema to a patient.

An enema is a solution introduced into the large intestine. The action of an enema is to distend the intestine and sometime to irritate the intestinal mucosa , thereby increasing peristalsis and the excretion of feces and flatus.

Enema are classified into 4 groups: 

• Cleansing - Cleansing enemas are intended and remove feces.
• Carminative - A carminative enema is given primarily to expel flatus.
• Retention - A retention enema introduces oil or medication into the rectum and sigmoid colon
• Return- flow enema - A return- flow enema is used occasionally to expel flatus. 

Why You Should Perform The Procedure?
Purpose

• To achieve one or more of following actions; cleansing, carminative, retention or return-flow.

Assessment 

• When the client last had a bowel movement and the amount, color and consistency of the feces.
• Presence of abdominal distention ( the distended abdomen appears swollen and feels firm rather than soft when palpated)
• Whether the client has sphincter.
• Whether the client can use a toilet or must remain in bed and use a bedpan. 

Steps Of The Procedure?

• Introduce yourself and verify the client’s identity using agency protocol. Explain to the client what you are going to do.
• Perform hand hygiene, apply clean gloves, and observe appropriate infection control procedure.
• Provide for client privacy.
• Assist the adult client to a left lateral position, with the right leg as acutely flexed as possible and the linen-saver pad under the buttock
• Insert the enema tube. 

Insert the tube smoothly and slowly into the rectum, directing it towards the umbilicus.

If resistance is encountered at the internal sphincter, ask the client to take a deep breath, then run a small amount of solution through the tube to relax the internal anal sphincter.

never force the tube or solution entry.

•  Slowly administer the enema solution.

Compress a pliable container by hand.

During most low enemas hold or hang the solution than 30 cm (12 in) above the rectum.

Administer the fluid slowly.

Using the plastic commercial container, roll it up as the fluid is instilled. This prevent subsequent suctioning of the solution.

After the solution , close the clamp and remove the enema tube from the anus.

Place the enema tube in a disposable towel as you withdraw it.

• Encourage the client to retain the enema.
  

Request that the client retain the solution.

ask the client to remain lying down

• Assist the client to defecate.  

• Assist the client to a sitting position on the bedpan or toilet. A sitting position facilitates the act of defecation.
• Ask the client to using the toilet but not to flush because needs to observe the feces.

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Some Acronyms That Nursing Students May Encounter During Clinical Practice

Last Tuesday our clinical instructors have given us an assignment to look for the meaning of the acronyms that doctors often use. Nursing students should be able to identify and know these acronyms, in relation to patient's case, especially doctor's hand writings are sometimes unreadable.

So here are some of them that you should know:

Hb (Haemoglobin) - the iron-containing respiratory pigment in red blood cells of vertebrates, consisting of about 6% heme and 94% globin.

MRSA (Methicillin-Resistant Staphylococcus Aureus) - a strain of Staphylococcus aureus that is resistant to a large group of antibiotics called the beta-lactams, which include the penicillins and the cephalosporins.

IHD (Ischemic Heart Disease) - is also callled myocardial ischaemia, a disease characterized by reduced blood supply to the heart muscle, usually due to coronary artery disease (atherosclerosis of the coronary arteries). Its risk increases with age, smoking, hypercholesterolaemia (high cholesterol levels), diabetes, hypertension (high blood pressure) and is more common in men and those who have close relatives with ischaemic heart disease. In simple term it is a heart problem caused by narrowed heart arteries and is also called coronary artery disease or coronary heart disease.

SOB (Shortness Of Breath) - is also called Dyspnea, is characterized by a feeling that you are unable to breathe enough air, which lead to hurried, franctic breathing or heaving. This can lead to suffocation.

CBI (Continuous Bladder Irrigation) - a continuous infusion of a sterile solution into the bladder, usually by using a three-way irrigation closed system with a triple-lumen catheter. One lumen is used to drain urine; another is used to inflate the catheter balloon, and the final lumen carries the irrigation solution. CBI is primarily used following genitourinary surgery to keep the bladder clear and free of blood clots or sediment.

CBD (Common Bile Duct) - the duct formed by the union of the cyctic duct and the hepatic duct that carries bile from the liver and the gallbladder to the duodenum.

BP (Blood Pressure) - the pressure of the blood against the inner walls of the blood vessels, varying in the different parts of the body during different phases of contraction of the heart and under different conditions, exertions, etc.

CCF (Congestive Cardiac Failure) - is also called congestive heart failure, is a disorder where the heart loses its ability to pump blood efficiently. The result is that the body doesn't get as much oxygen and nutrients as it needs, leading to problems like fatigue and shortness of breath.

IV (Intravenous) - a drug, nutrient solution, o other substances administered into a vein.

NPC (Nasopharyngeal Carcinoma) - is a cancer originating in the nasopharynx, the uppermost region of the pharynx or "throat", where the nasal passages and auditory tubes join the remainder of the upper respiratory tract.

CPOD (Chronic Obstructive Pulmonary Disease) - refers to chronic bronchitis and emphysema, a pair of two commonly co-existing diseases of the lungs in which the airways become narrowed. This leads to a limitation of the flow of air to and from the lungs causing shortness of breath.

IO Chart (Intake and Output Chart) - a record of your food and liquid intake and output.

GIT (Gastrointestinal Tract) - the stomach and intestine - the system of organs within multicellular organisms that takes in food, digests it to extract energy and nutrients, and expels the remaining matter. The major functions of the gastrointestinal tract are ingestion, digestion, absorption, and defecation.

I & D (Incision and Drainage) - are minor surgical procedures to release pus or pressure built up under the skin, such as from an abscess, boil, or infected paranasal sinus. It is performed by treating the area with an antiseptic, such as iodine based solution, and then making a small incision to puncture the skin using a sterile instrument such as a sharp needle, a pointed scalpel or a lancet. This allows the pus fluid to escape by draining out through the incision.

TURP (Transurethral Resection of Prostate) - also known as TURP, plural TURPs and as a transurethral prostatic resection TUPR - is a urological operation. It is used to treat benign prostatic hyperplasia (BPH). It is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection. This is considered the most effective treatment for BPH. This procedure is done with spinal or general anesthetic. A large triple lumen catheter is inserted through the urethra to irrigate and drain the bladder after the surgical procedure is complete. Outcome is considered excellent for 80-90% of BPH patients.

PO (Per Orally or by Mouth)

GA (General Anaesthesia) - is a state of total unconsciousness resulting from general anaesthetic drugs

LA (Local Anaesthesia) - is any technique to render part of the body insensitive to pain without affecting consciousness. It allows patients to undergo surgical and dental procedures with reduced pain and distress.

ESRF (End Stage Renal Failure) - also known as chronic renal disease, is a progressive loss of renal function over a period of months or years.

PRN ( Pre Re Nata) - as the situation arises or take as needed or whenever necessary.

DM (Diabetes Mellitus) - often referred to simply as diabetes—is a condition in which the body does not produce enough, or properly respond to, insulin, a hormone produced in the pancreas. Insulin enables cells to absorb glucose in order to turn it into energy. In diabetes, the body either fails to properly respond to its own insulin, does not make enough insulin, or both. This causes glucose to accumulate in the blood, often leading to various complications.

ECG (Electrocardiogram) - or EKG is a transthoracic interpretation of the electrical activity of the heart over time captured and externally recorded by skin electrodes.

MI (Myocardial Infarction) - or acute myocardial infarction (AMI), commonly known as a heart attack, is the interruption of blood supply to part of the heart, causing some heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (like cholesterol) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death (infarction) of heart muscle tissue (myocardium).

Urine FEME ( Urine Full Microscopic Examination) - is a valuable diagnostic tool for the detection and evaluation of renal and urinary tract disorders and other systemic diseases.

T & S (Toilet and Suture) - the cleaning and stitching of the wound.

TWDC (Total White Differential Count)

C & S (Cultural and Sensitivity)

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How To Fast In A Healthy Way?

Everyone in the class asked me if i can fast or not and when i told them i can some were a surprised and wanted to see me fasting. As you all know, only 4 students in our group are non-Muslims ( 1 is Christian, 1 is Buddhist and 2 are Hindu) the rest are all Islam.

So since this month until the 20th day of September is the blessed day of Ramadan. I would love to share these information to all our Muslims brothers and sisters on how to fast in a healthy way. Below you will some information and what you will do to stay healthy while fasting.

Accordingly, all experts agree that "breaking the fast" is the critical phase of fasting. While your body is in the resting mode, your stomach shrinks and your intestines become idle, so solid food must be re-introduced very slowly to avoid kidney failure or digestive distress. In fact, after a 40-day fast, you should make a careful transition for at least three days before returning to eating meats or fats or normal foods.

Further, if you end your fast gradually, the beneficial physical and spiritual effects will linger for days. But if you rush into solid foods, you may lose much of your deep sense of peace and experience physical problems such as diarrhea, sickness, fainting, and frankly even death in some cases, due to shock!

Observe these 7 ways on how to fast in a healthy way:

1. Eat the suhur meal.

The Prophet Muhammad highly recommend eating this pre-dawn meal before a day of fasting. While you may want to pass to catch some more sleep, remember that you can always take a catnap while you're fasting, but you won't be able to eat or drink. To make it easier, set out utensils and dry food on the table before going to bed so you can quickly eat and go back to sleep after suhur.

2. Limit your fat intake.

That's right, limit it--don't cut it out. Otherwise you'll have to get rid of what's considered "traditional" iftar food in most Muslim cultures. If you're not sure what kind of food is being referred to, think fried, greasy and/or super sweet.

3. Follow the Prophet's golden rule of one-third.

This especially needs to be said in Ramadan. We should strive to have no more than one-third food, one-third liquid and one-third air in our stomachs when eating.

4. Encourage dip-dunking.

Fruits and vegetables get left to the wayside during regular days, let alone at iftar (the fast-breaking meal) time. But you can whip out those carrot sticks if you've got some tasty dips to eat them with. Check out some healthy recipes.

5. Walk after iftar.

Before you fall over from exhaustion after iftar and dinner, take a short walk around the block or just around your building. The change of environment and exposure to fresh air may just wake you up in time to go for the next activity listed below.

6. Pray tarawih (special evening prayers during Ramadan).

This is more great exercise, not to mention a wonderful way to build concentration, stamina and brotherhood/sisterhood.

7. Take a short afternoon nap.

Experts say you don't need more than a 15-minute siesta to really refresh you. During lunch hour, find a quiet spot, set the alarm on your watch or cell phone and nap. This can help your body adjust to the daily Ramadan schedule that requires waking up early for the suhur meal.

In terms of resuming any sort of exercise routine, the advice is the same. Start out slowly, allowing time for your body to re-adjust to its usual regime.

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What Is Ramadan?

To all our Muslim's brothers and sisters, from the 22nd day of August to 2oth day of September is the holy month of Ramadan.

Ramadan is the ninth month of the Islamic lunar calendar. Every day during this month, Muslims around the world spend the daylight hours in a complete fast. Which means abstaining from food, drink, and other physical needs during the daylight hours. As a time to purify the soul, refocus attention on God, and practice self-sacrifice. Ramadan is much more than just not eating and drinking.

Muslims are called upon to use this month to re-evaluate their lives in light of Islamic guidance. We are to make peace with those who have wronged us, strengthen ties with family and friends, do away with bad habits -- essentially to clean up our lives, our thoughts, and our feelings. The Arabic word for "fasting" (sawm) literally means "to refrain" - and it means not only refraining from food and drink, but from evil actions, thoughts, and words.

Every part of the body must be restrained. The tongue must be restrained from backbiting and gossip. The eyes must restrain themselves from looking at unlawful things. The hand must not touch or take anything that does not belong to it. The ears must refrain from listening to idle talk or obscene words. The feet must refrain from going to sinful places. In such a way, every part of the body observes the fast. Therefore, fasting is not merely physical, but is rather the total commitment of the person's body and soul to the spirit of the fast. Ramadan is a time to practice self-restraint; a time to cleanse the body and soul from impurities and re-focus one's self on the worship of God.

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Why Is Communication Important In Nursing?

Today we are given an assignment on "Why Communication In Nursing Is Important?". So i would love to share these with you.

We are always communicating, whether we’re speaking or not. A well-known UCLA study found that only around 7% of the meaning of spoken communication came from words alone, 55% came from facial expression and 38% came from the way the words were said.

Effective communication has many aspects. It is, for example, respectful, assertive, empathetic, clear, attentive, honest and non-judgmental.Effective communication is fundamental to nursing practice. It is a skill that can be learned and continually improved. Improvement requires keen observation, the willingness to be reflective, and the commitment to listen and learn.

What is communication in nursing?
Many definitions describe communication as a transfer of information between a source and a receiver. In nursing, communication is a sharing of health-related information between a patient and a nurse, with both participants as sources and receivers. The information may be verbal or nonverbal, written or spoken, personal or impersonal, issue-specific, or even relationship-oriented, to name a few possibilities.

Why is good communication important?
The power of creative and effective nursing care is strengthened by good communication skills. Patients share their stories, symptoms, and concerns by talking with us. Both the spoken word and the body language convey information about the patient’s experience.

Your words can do so much: put a patient at ease, set up a productive relationship, and carry out interventions. There is no other skill that is used more in nursing than communication.

Here’s a short quiz from Psychology Today to give you a quick assessment of your communication skills: Communication skills test.

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Why Communication In Nursing Is Important?

Today we are given an assignment on "Why communication in nursing is important?". So i would love to share these to you.

We are always communicating, whether we’re speaking or not. A well-known UCLA study found that only around 7% of the meaning of spoken communication came from words alone, 55% came from facial expression and 38% came from the way the words were said.

Effective communication has many aspects. It is, for example, respectful, assertive, empathetic, clear, attentive, honest and non-judgmental.

Effective communication is fundamental to nursing practice. It is a skill that can be learned and continually improved. Improvement requires keen observation, the willingness to be reflective, and the commitment to listen and learn.

What is communication in nursing?

Many definitions describe communication as a transfer of information between a source and a receiver. In nursing, communication is a sharing of health-related information between a patient and a nurse, with both participants as sources and receivers. The information may be verbal or nonverbal, written or spoken, personal or impersonal, issue-specific, or even relationship-oriented, to name a few possibilities.

Why is good communication important?

The power of creative and effective nursing care is strengthened by good communication skills. Patients share their stories, symptoms, and concerns by talking with us. Both the spoken word and the body language convey information about the patient’s experience.
Your words can do so much: put a patient at ease, set up a productive relationship, and carry out interventions. There is no other skill that is used more in nursing than communication.

Here’s a short quiz from Psychology Today to give you a quick assessment of your communication skills: Communication skills test.

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Great Relief For Mandarin Class

Yesterday all of us were relieved upon hearing the announcement of Miss Jenny that she won't be giving us an examination for her subject Mandarin language. Wow! We found it very difficult - the chinese characters and its pronunciation as well.

The purpose of learning Mandarin is for us to have a basic background of the language so that we will be able to communicate with our Chinese patients who can not speak both Bahasa Malayu and English.

She said we wont be able to pass if she will give exams since it will take several months to years to fully understand and learn how to read and write with the Chinese characters with its pinging.

Anyway thanks a lot and i could sleep soundly without thingking of Mandarin exams.

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Are Vaccines Ready For A(H1N1)?

Vaccines are not ready yet for A(H1N1) but work is well under way to develop such a vaccine. Making new influenza vaccines ready to immunize people generally takes five to six months after first identification of the pandemic virus. The pandemic influenza A (H1N1) 2009 virus was identified at the end of April 2009.

How quickly will pandemic influenza A (H1N1) vaccines be available for use?
The very first doses of influenza A (H1N1) vaccine usable to immunize people, from one or more manufacturers, are expected as early as September 2009.

What implications does the declaration of a pandemic (phase 6) have on influenza vaccine production?
When the WHO Director-General declared the influenza A (H1N1) pandemic on 11 June 2009, she noted that production of seasonal influenza vaccines would be completed soon and that full industrial production capacity would then be available to ensure the largest possible supply of pandemic vaccine in the months to come.

Which manufacturers will make pandemic influenza A (H1N1) vaccines?
There are currently around twenty vaccine manufacturers with licenses to produce seasonal influenza vaccines. There are other qualified vaccine manufacturers who are preparing to make influenza A (H1N1) vaccine, but do not yet have a licensed seasonal influenza vaccine.

What is the global manufacturing capacity for a potential influenza A (H1N1) pandemic vaccine?
Based on a global survey made by WHO on 15 May 2009, a maximum of 4.9 billion doses potentially could be produced in 12 months, but only if several assumptions are met. First, full global manufacturing capacity is devoted to this production. Second, production yields for influenza A (H1N1) vaccine are similar to those usually obtained for seasonal vaccines. Third, each manufacturer uses the vaccine formulation that is most "dose-sparing" (i.e. using a smaller quantity of active principle). A more conservative estimate of global capacity is at least 1 to 2 billion doses per year. The numbers of persons who might be vaccinated will not be known until it is determined whether one or two doses of the vaccine will be needed to achieve protection.

What technologies will be used to grow pandemic influenza A (H1N1) viruses to make vaccines?
Most of these vaccines will be produced using chicken eggs, while a few manufacturers are using cell culture technology for vaccine production.

How is the production capacity for influenza vaccines distributed geographically?
Around 70% of the global seasonal influenza vaccine production capacity today is located in Europe and North America, with further significant manufacturing capacity in Australia, Japan and China. During the past three years, six manufacturers in developing countries have begun to acquire the technology to produce influenza vaccines and have received technical and financial support from WHO. Since May 2009, five additional new producers have joined this initiative.

Will there be enough pandemic influenza A (H1N1) vaccine for everyone?
When pandemic vaccine first becomes available, it is anticipated that the demand will be greater than the supply. This gap will narrow as more vaccine becomes available over time.

Who will receive priority for vaccination?
WHO is working with the Strategic Advisory Group of Experts (SAGE) on Immunization and partners on the options for deciding in which target groups vaccination should begin first. At its July 7 meeting, SAGE recommended that health care workers worldwide should be immunized as a first priority (see: Pandemic (H1N1) 2009 briefing note 2 below). Ultimately, national authorities will identify priority groups for vaccination based on circumstances within the country.

Will developing countries have access to pandemic influenza vaccines?
The WHO Director-General has called for international solidarity to provide fair and equitable access for all countries to pandemic vaccine when it becomes available. WHO has requested that manufacturers set aside future influenza A (H1N1) vaccines for developing country populations, through donations or affordable pricing arrangements.

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What Shall I Do With A(H1N1)

What can I do to protect myself from catching influenza A(H1N1)?
The main route of transmission of the new influenza A(H1N1) virus seems to be similar to seasonal influenza, via droplets that are expelled by speaking, sneezing or coughing. You can prevent getting infected by avoiding close contact with people who show influenza-like symptoms (trying to maintain a distance of about 1 metre if possible) and taking the following measures:

• avoid touching your mouth and nose;
• clean hands thoroughly with soap and water, or cleanse them with an alcohol-based hand rub on a regular basis (especially if touching the mouth and nose, or surfaces that are potentially contaminated);
• avoid close contact with people who might be ill;
• reduce the time spent in crowded settings if possible;
• improve airflow in your living space by opening windows;
• practise good health habits including adequate sleep, eating nutritious food, and keeping physically active.

What about using a mask? What does WHO recommend?
If you are not sick you do not have to wear a mask. If you are caring for a sick person, you can wear a mask when you are in close contact with the ill person and dispose of it immediately after contact, and cleanse your hands thoroughly afterwards. If you are sick and must travel or be around others, cover your mouth and nose. Using a mask correctly in all situations is essential. Incorrect use actually increases the chance of spreading infection.

How do I know if I have influenza A(H1N1)?
You will not be able to tell the difference between seasonal flu and influenza A(H1N1) without medical help. Typical symptoms to watch for are similar to seasonal viruses and include fever, cough, headache, body aches, sore throat and runny nose. Only your medical practitioner and local health authority can confirm a case of influenza A(H1N1).

What should I do if I think I have the illness?
If you feel unwell, have high fever, cough or sore throat:

• stay at home and keep away from work, school or crowds;
• rest and take plenty of fluids;
• cover your nose and mouth when coughing and sneezing and, if using tissues, make sure you dispose of them carefully.
• Clean your hands immediately after with soap and water or cleanse them with an alcohol-based hand rub;
• if you do not have a tissue close by when you cough or sneeze, cover your mouth as much as possible with the crook of your elbow;
• use a mask to help you contain the spread of droplets when you are around others, but be sure to do so correctly;
• inform family and friends about your illness and try to avoid contact with other people;
• If possible, contact a health professional before traveling to a health facility to discuss whether a medical examination is necessary.

Should I take an antiviral now just in case I catch the new virus?
No. You should only take an antiviral, such as oseltamivir or zanamivir, if your health care provider advises you to do so. Individuals should not buy medicines to prevent or fight this new influenza without a prescription, and they should exercise caution in buying antivirals over the Internet.

What about breastfeeding? Should I stop if I am ill?
No, not unless your health care provider advises it. Studies on other influenza infections show that breastfeeding is most likely protective for babies - it passes on helpful maternal immunities and lowers the risk of respiratory disease. Breastfeeding provides the best overall nutrition for babies and increases their defense factors to fight illness.

When should someone seek medical care?
A person should seek medical care if they experience shortness of breath or difficulty breathing, or if a fever continues more than three days. For parents with a young child who is ill, seek medical care if a child has fast or labored breathing, continuing fever or convulsions (seizures).

Supportive care at home - resting, drinking plenty of fluids and using a pain reliever for aches - is adequate for recovery in most cases. (A non-aspirin pain reliever should be used by children and young adults because of the risk of Reye's syndrome.)

Should I go to work if I have the flu but am feeling OK?
No. Whether you have influenza A(H1N1) or a seasonal influenza, you should stay home and away from work through the duration of your symptoms. This is a precaution that can protect your work colleagues and others.

Can I travel?
If you are feeling unwell or have symptoms of influenza, you should not travel. If you have any doubts about your health, you should check with your health care provider.

Is it safe to travel?
Yes. WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus. Today, global travel is commonplace and large numbers of people move around the world for business and leisure. Limiting travel and imposing travel restrictions would have very little effect on stopping the virus from spreading, but would be highly disruptive to the global community.

Influenza A(H1N1) has already been confirmed in many parts of the world. The global response now focuses on minimizing the impact of the virus through the rapid identification of cases, and providing patients with appropriate medical care, rather than on stopping its spread internationally.

Although identifying signs and symptoms of influenza in travellers can help track the path of the outbreak, it will not reduce the spread of influenza, as the virus can be transmitted from person to person before the onset of symptoms.

Scientific research based on mathematical modelling shows that restricting travel would be of limited or no benefit in stopping the spread of disease. Historical records of previous influenza pandemics, as well as experience with SARS, validate this.

Does WHO recommend screenings at country entry and exit points to detect if ill people are travelling?
No. We do not believe entry and exit screenings would work to reduce the spread of this disease. However country-level measures to respond to a public health risk are the decision of national authorities, under the International Health Regulations 2005.

Countries that adopt measures that significantly interfere with international traffic (e.g. delaying an airplane passenger for more than 24 hours, or refusing country entry or departure to a traveller) must provide WHO with the public health reasoning and evidence for their actions. WHO will follow up with all of its Member countries on such matters.

Travellers should always be treated with dignity and respect for their human rights.

How can I protect myself from influenza A(H1N1) when I am travelling?
People who are ill should delay travel plans. Returning travellers who become ill should contact their health care provider.

Travellers can protect themselves and others by following simple prevention practices that apply while travelling and in daily life.

Are some people more at risk?
More study is needed to determine if some populations (i.e. younger or older people, or people with other medical conditions) could be affected by the outbreak, of if they are at higher risk for severe illness. WHO recommends that everyone take precautions to prevent the spread of infection.

Are there any special recommendations for pregnant women?
Yes, they are vulnerable. Like everyone, they should take all the necessary precautions.

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A (H1N1) Frequently Asked Questions - Part 1

The spread of A (H1N1) are already getting crazy. A lot of people are dying each day. In Malaysia alone there are already 38 death cases with a total number of 2,253 cases as of August 11, 2009 and still counting and few victims are children ages under 10 years old.

So it is high time for us to be vigilant and be cautious of our health and our environment. Below you will find Frequently Asked Questions on A(H1N1) hoping to eradicate and reduce the pandemic.

What is the new influenza A(H1N1)?
This is a new influenza A(H1N1) virus that has never before circulated among humans. This virus is not related to previous or current human seasonal influenza viruses. This pandemic influenza A (H1N1) 2009 virus was identified at the end of April 2009.

How do people become infected with the virus?
The virus is spread from person-to-person. It is transmitted as easily as the normal seasonal flu and can be passed to other people by exposure to infected droplets expelled by coughing or sneezing that can be inhaled, or that can contaminate hands or surfaces.

To prevent spread, people who are ill should cover their mouth and nose when coughing or sneezing, stay home when they are unwell, clean their hands regularly, and keep some distance from healthy people, as much as possible.

There are no known instances of people getting infected by exposure to pigs or other animals.

The place of origin of the virus is unknown.

What are the signs and symptoms of infection?
Signs of influenza A(H1N1) are flu-like, including fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting and diarrhoea.

Why are we so worried about this flu when hundreds of thousands die every year from seasonal epidemics?
Seasonal influenza occurs every year and the viruses change each year - but many people have some immunity to the circulating virus which helps limit infections. Some countries also use seasonal influenza vaccines to reduce illness and deaths.

But influenza A(H1N1) is a new virus and one to which most people have no or little immunity and, therefore, this virus could cause more infections than are seen with seasonal flu. WHO is working closely with manufacturers to expedite the development of a safe and effective vaccine but it will be some months before it is available.

The new influenza A(H1N1) appears to be as contagious as seasonal influenza, and is spreading fast particularly among young people (from ages 10 to 45). The severity of the disease ranges from very mild symptoms to severe illnesses that can result in death. The majority of people who contract the virus experience the milder disease and recover without antiviral treatment or medical care. Of the more serious cases, more than half of hospitalized people had underlying health conditions or weak immune systems.

Most eople experience mild illness and recover at home. When should someone seek medical care?

A person should seek medical care if they experience shortness of breath or difficulty breathing, or if a fever continues more than three days. For parents with a young child who is ill, seek medical care if a child has fast or labored breathing, continuing fever or convulsions (seizures).Supportive care at home - resting, drinking plenty of fluids and using a pain reliever for aches - is adequate for recovery in most cases. (A non-aspirin pain reliever should be used by children and young adults because of the risk of Reye's syndrome.)

Is it safe to eat pork and pork products?
Yes. influenza A(H1N1) has not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. The influenza A(H1N1) virus is killed by cooking temperatures of 160°F/70°C, corresponding to the general guidance for the preparation of pork and other meat.

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How To Improve Your Memory

As i am back to school, my most concern is my memory! Considering the fact that i had undergone caesarian operation and they said that anesthetic will affects your memory or decrease your memory. Maybe its true because i tends to forget a lot of things or i am just disorganize. However, because i want the best for my studies and dont want to fail as much as possible. I gather few information here and would love to share it with you. This is beneficial to those people who are poor in memory and or those who would love to improve their memory as well.

Here are ways that can help you improve your memory:

Use triggers, links, better known as mnemonics. Associate memories with stimuli, such as images, sounds, smells, touch, tastes, languages, emotions, etc. Make your triggers positive, as your memory tends to block negative images, exaggerate its size and importance, incorporate humor, view it all in vivid 3 dimensional colors, and use symbols to help recall more complex messages.

Intend to memorize it. Our memory is at its best when we WANT to memorize, and when we have a strong motivation to memorize. Ever read a text, then a minute later not remember it? Probably because you weren't that interested in it in the first place. To remember it, you have to WANT to remember it.

Learn to visualize your thoughts. Your brain can think in terms of words and in terms of images. Therefore, when memorizing an item, learn to recall it in ways that you can explain it, and in ways that you can see it.

Speak out loud! When you recite something or read something out loud, it brings more attention and motivation to it, which will help you remember it better. As well, the adding of another sense (sound) helps with memorization.

Eat the right food. Fiber and vitamin C rich foods such as cantaloupe, blueberries, asparagus, and sweet potatoes can help enhance your memory. Foods containing beta carotene, such as red foods, help with memory as well. Some of these foods are watermelon, strawberries, tomatoes, cherries, and radishes.

Use technology to your advantage. Although technology is a reason that our existence is inflicted with so much information, and thus test our memory like never before, it can also be a very useful tool to help with your memory. Use organizers, day planners, computers, alarm clocks, and the likes to help you recall and remember things that you would normally not.

more information....next posting

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Imperfect and Funny Thursday!

Mrs. Yanni gave us 4 crossword puzzles today. 3 of them are about animals and 1 is about nationality. It was a simple puzzle but no body got it perfect! You know why? We don't know an animal with spikes all over its body - a HEDGEHOG! I thought i would get a prize from her which she promise whoever got a perfect answer! Shame...lol.

Our class with her today was fun! She group us into 6 groups. Each one of us were required to go the board and draw a picture representing a word or group of words which the group should identify. The group are very competitive and everybody got it right! What so funny about was the way we draw and she made funny comments on our drawings! She is a friendly lecturer after all!

On the afternoon class, Mrs. Siva group us again into 6 groups. The group were Emergency Ward, Labor Ward, Clinic, Psychiatric Ward, Giving Medicine and Out-Patient group. Each group should act according to the situation of the respective groups.

All of us were doing fine but the most funny group was the labor ward where they made Hafiz, deliver a baby.

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I Missed My Daughter!

As the days pass by in nursing class, i cannot help myself missing my naughty daughter. Once in a while i call her and you can heard her saying bye - her favorite words when she is on the phone are bye and hi, hello. She will always follow our actions every time we talk on the phone. She put her hands on her waists and keep on walking and go to the balcony and mumble words which we dont understand.

But am happy in a way that she is okay with our maid, Niwi. She has been with us for 2 years. Alisha was 10 days old that time and until now. She is close to Alisha and she is not the type who will hit a child. With out us around she is a behave child and she put on weight a bit and can her chubby face now.

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Medical Terminologies

C

Communication - is commonly defined as "the imparting or interchange of thoughts, opinions, or information by speech, writing, or signs". Communication can be perceived as a two-way process in which there is an exchange and progression of thoughts, feelings or ideas towards a mutually accepted goal or direction.

N

Nursing - is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from birth to the end of life.

Nursing care - is the application of evidence-based concepts to patient problems in a particular setting.

Nursing care plan - is an outlines the nursing care to be provided to a patient. It is a set of actions the nurse will implement to resolve nursing problems identified by assessment.

Nursing assessment - is the gathering of information about a patient's physiological, psychological, sociological, and spiritual status.

Nursing process - is a process by which nurses deliver care to patients, supported by nursing models or philosophies. The nursing process was originally an adapted form of problem-solving and is classified as a deductive theory.

Nursing process is a patient centered, goal oriented method of caring that provides a frame work to the nursing care.

It involves five major steps of assessement, nursing diagnosis, planning, implementation/intervention and evaluating. A- Assess (what is the situation?) D- Diagnose (what is the problem?) P- Plan (how to fix the problem) I- Implement (putting plan into action) E- Evaluate (did the plan work?) All together equaling ADPIE

Nursing diagnosis - is a standardized statement about the health of a client (who can be an individual, a family, or a community) for the purpose of providing nursing care. Nursing diagnoses are developed based on data obtained during the nursing assessment.

O

Otoscope or auriscope - is a medical device which is used to look into the ears.

Ophthalmoscope (or funduscope) - is an instrument used to examine the eye. Its use is crucial in determining the health of the retina and the vitreous humor.

P

Pulse oximeter - is a medical device that indirectly measures the oxygen saturation of a patient's blood (as opposed to measuring oxygen saturation directly through a blood sample) and changes in blood volume in the skin, producing a photoplethysmograph.

Photoplethysmograph (PPG) - is an optically obtained plethysmograph, a volumetric measurement of an organ. A PPG is often obtained by using a pulse oximeter which illuminates the skin and measures changes in light absorption (Shelley and Shelley, 2001). A conventional pulse oximeter monitors the perfusion of blood to the dermis and subcutaneous tissue of the skin.

Plethysmograph - is an instrument for measuring changes in volume within an organ or whole body (usually resulting from fluctuations in the amount of blood or air it contains).

S

Snellen chart - is an eye chart used by eye care professionals and others to measure visual acuity. Snellen charts are named after the Dutch ophthalmologist Herman Snellen who developed the chart in 1862.

T

Therapeutic communication - is defined as the face-to-face process of interacting that focuses on advancing the physical and emotional well-being of a patient.

This kind of communication has three general purposes:

• collecting information to determine illness
• assessing and modifying behavior
• providing health education.
  

By using therapeutic communication, we attempt to learn as much as we can about the patient in relation to his illness.

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New Day A New Beginning

This is it! My first day in class!

I woke up very early today since my first class will start at 8:30 AM. I need to get up together with my husband because he will send me to the college. It is expensive for me to go to school riding in a taxi or cab. It will only take us 10-15 minutes drive from home to school but it would be far for my husband going to his office.

Anyway, somehow rather i felt excited looking forward on my first day. I would be mixing with new and young faces through out the 3 year nursing classes. Its a nice feeling once again to be a student. Yes once again cause i already had my bachelor of science in forestry. I did my BS Forestry at Mindanao State University, Marawi City, Philippines, 1989 and graduated on 1994. Wow that was long ago. Yes and had my 10 years working experience in DENR, Philippines. Got married and have a kid....and now back to school again! Yepee!

Well, to make it short, until August 30, 2009 our class is concentrated on nursing orientation make us familiarize about what would be like in nursing world, language class for english and mandarin.

English language class is more about reviews of the basic English grammar, pronunciation and reading. While mandarin lecturer, teaches us the basic mandarin language where we can use it for our Chinese patients. This is the most challenging for me. Am poor in other language! Especially mandarin will make my tongue stiff.

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Nursing Orientation Day

July 27, 2009 @ 10AM was the nursing orientation day. We were brief about the ins and outs of the college from dress code, IT, Library, who is in-charge of this and that! But to my dismay, i won't be able to wear jeans and t-shirt as the the dress code is strict fro nursing student. Anyway as an obedient student i keep my shout and conince myself that it would be okay.

Come to the introduction of students. Ha! am the oldest amongst our class. 80% are fresh from high school 18, 19, 20 and few are 23 years old. What to do though it's a bit late for me but never mind i level myself with the class. They were all surprised that i am 36 years old and married with 1 daughter! Hahaha our class in-charge became curious of my background. anyway i told them the truth!

So everything were clear to us, the rules, terms and conditions and etc. And the next day would be our proper class day.

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