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COURSE OUTLINE

I.
HEALTH PERCEPTION HEALTH MANAGEMENT PATTERN
A. Care of Clients with Cancer
1. Incidence and Mortality
a. Risk factors
2. Pathophysiology
a. Normal cell growth
b. The Cell Cycle
3. Etiology
a. Theories of Carcinogenesis
b. Known Carcinogens
c. Types of Neoplasms
d. Characteristics of malignant cells
e. Tumor invasion and metastasis
4. Psychophysiologic Effects of Cancer
a. Disruption of Function
b. Hematologic Alterations
c. Infection
d. Hemorrhage
e. Anorexia Cachexia Syndrome
f. Paraneoplastic Syndrome
g. Pain
h. Physical Stress
i. Psychologic Stress

B. Nursing Care of Clients with Cellular Aberration


1. Assessment
a. Subjective
a.1. Risk Factors heredity, age, gender, poverty, stress, diet, occupation,
infection, tobacco use, alcohol use, recreational drug use, obesity, sun
exposure
a.2. Health History
b. Physical Assessment
2. Nursing Diagnosis
a. Risk for infection as evidenced by tissue trauma or impaired immune response
b. Ineffective Health Maintenance as evidenced by lack of preventive care or health
screening
c. Ineffective Protection as evidenced by impaired immunity related to cancer
therapy or HIV disease
d. Risk for trauma as evidenced by high risk personal behaviors
3. Planning
a. Planning for Health Promotion and Maintenance

Cancer Prevention and Control


Prevention, Screening and Early Detection
Approaches to Cancer Prevention

b. Planning for Health Restoration


- Surgery
- Radiation Therapy
- Chemotherapy
- Immunotherapy
4. Implementation

a. Pharmacological Therapy anti neoplastic drugs


b. Nutrition and Diet Therapy ACS Dietary Guidelines to Prevent Cancer
c. Complementary Therapies
Botanical Agents
Nutritional Supplements
Dietary Regimens
Mind - Body Modalities
Energy Healing
Spiritual Approaches
Miscellaneous Therapies
SHOCK, SYSTEMIC INFLEMMATORY RESPONSE SYNDROME, AND MULTIPLE ORGAN
DYSFUNCTIONS
A. Shock
1. Classification of Shock
2. Stages of Shock
3. Diagnostic Studies
4. Collaborative Care
a. General Measures
- Oxygen and Ventilation
- Fluid Resuscitation
- Drug Therapy
- Nutritional therapy
b. Specific Measures
5. Nursing Management
a. Nursing Assessment
b. Nursing Diagnosis
c. Planning
- Health Promotion
- Restoration and Maintenance
d. Acute Intervention
e. Ambulatory and Home Care
6. Evaluation
B. SYSTEMIC INFLAMMATORY RESPONSE SYNDROME AND MULTIPLE ORGAN
DYSFUNCTION SYNDROME
1. Etiology
2. Pathophysiology
3. Clinical Manifestations of SIRS and MODS
4. Nursing and Collaborative Management
a. Prevention and Control of Infection
b. Maintenance of Tissue Oxygenation
c. Nutrition and Metabolic Demands
d. Support of Failing Organs
RESPIRATORY FAILURE AND ACUTE RESPIRATORY DISTRESS SYNDROME
1. Respiratory Failure
a. Etiology and Pathophysiology
b. Clinical Manifestations
c. Diagnostic Studies
d. Nursing and Collaborative Care
- Nursing Assessment
- Nursing Diagnoses
- Planning:
- Prevention
- Restoration

Respiratory Therapy Oxygen Therapy; mobilization of secretion; positive


pressure ventilator
- Drug Therapy
- Medical supportive therapy
- Nutritional therapy
e. Evaluation
2. Acute Respiratory Distress Syndrome
a. Etiology and Pathophysiology
b. Clinical Progression and Manifestation
c. Complications
d. Nursing and Collaborative Management
- Nursing Assessment
- Nursing Diagnoses
- Planning
-Respiratory Therapy
- Medical Supportive Therapy
Critical Care
A. Hemodynamic Monitoring
1. Terminology
- Cardiac Output and cardiac Index
- Preload
- Afterload
- Vascular Resistance
- Contractility
2. Principles
- Referencing
- Zeroing
3. Types
- Invasive Pressure Monitoring
a. Arterial Blood Pressure
b. Pulmonary Artery
- Flow-Directed Catheter
- Non-invasive Oxygenation Monitoring
4. Nursing Management in Hemodynamic Monitoring
B. Circulatory Assist Devices
1. Intraaortic Balloon Pump
2. Ventricular Assist Devices (VAD)
3. Implantable Artificial Heart
4. Nursing Management in Circulatory Assist Devices
C. Artificial Airways
1. Endotracheal Tubes
2. E.T. Intubation Procedures
3. Nursing Management Artificial Airway
D. Mechanical Ventilation
1. Types
2. Settings of Mechanical Ventilation
3. Modes of Volume Ventilation
4. Modes of Pressure Ventilation
5. Other Ventilatory Maneuvers
6. Complications of Positive Pressure Ventilation
7. Weaning from Positive Pressure Ventilation and Extubation
8. Chronic Mechanical Ventilation

INTERMEDIATE
COMPETENCIES
Given an adult client
(young, middle, old, oldold adult) with cellular
aberration, the students
will be able to utilize
the nursing process to:
1. assess functional
status of a client with
cancer,
2. prioritize nursing
diagnosis based on
assessment data,
3. design and prove
individualized client and
family teaching to
restore, promote, and
maintain clients
functional health status
4. implement
appropriate nursing
interventions during
cancer diagnosis,
treatment and
rehabilitation,
5. administer
chemotherapeutic
medications
knowledgeably and
safely,
6. incorporate evidencebased research into the
plan of nursing care
7. include cultural

CONTENT

I. HEALTH PERCEPTION HEALTH MANAGEMENT


PATTERN
A. Care of Clients with Cancer
1. Incidence and Mortality
a. Risk factors
2. Pathophysiology
a. Normal cell growth
b. The Cell Cycle
3. Etiology
a. Theories of Carcinogenesis
b. Known Carcinogens
c. Types of Neoplasms
d. Characteristics of malignant cells
e. Tumor invasion and metastasis
4. Psychophysiologic Effects of Cancer
a. Disruption of Function
b. Hematologic Alterations
c. Infection
d. Hemorrhage
e. Anorexia Cachexia Syndrome
f. Paraneoplastic Syndrome
g. Pain
h. Physical Stress
i. Psychologic Stress

B. Nursing Care of Clients with Cellular Aberration


1. Assessment
a. Subjective
a.1. Risk Factors heredity, age,
gender, poverty, stress, diet,
occupation, infection, tobacco use,
alcohol use, recreational drug use,

TEACHING
LEARNING
ACTIVITIES
a. Lecture Discussion
b. Video clip
presentation
c. Picture
Presentation
d. Group discussions
e. Read Brunner and
Suddarths Medical Surgical Nursing,
pages 336 346.
f. Critical Thinking
Questions

INTEGRATED
VALUES

NO. OF
HOURS

EVALUATIO
N

The following
values shall be
incorporated:
1. Commitment to
Vincentian
Excellence
2. Social
Responsibility
3. Respect for
Human Dignity
4. Compassionate
Service
5. Competence

8 hours

1. Paper and
pencil test
2. Graded
recitation
3. Outputs

4 hours

variation and diverse


values in designing and
implementing
individualized plans of
care

obesity, sun exposure


a.2. Health History
b. Physical Assessment
2. Nursing Diagnosis
a. Risk for infection as evidenced by tissue
trauma or impaired immune response
b. Ineffective Health Maintenance as
evidenced by lack of preventive care or
health screening
c. Ineffective Protection as evidenced by
impaired immunity related to cancer therapy
or HIV disease
d. Risk for trauma as evidenced by high
risk personal behaviors
3. Planning
a. Planning for Health Promotion and
Maintenance

Cancer Prevention and Control


Prevention, Screening and Early
Detection
Approaches to Cancer Prevention
b. Planning for Health Restoration
- Surgery
- Radiation Therapy
- Chemotherapy
- Immunotherapy
4. Implementation
a. Pharmacological Therapy anti
neoplastic drugs
b. Nutrition and Diet Therapy ACS Dietary
Guidelines to Prevent Cancer
c. Complementary Therapies
Botanical Agents
Nutritional Supplements
Dietary Regimens

Formulation of NCP

4 hours

4 hours

8 hours

Read pages 346


359 of Brunner

Given an adult client


(young, middle, old, oldold adult) with acute
responses to Acute
Biologic Crisis, the
students will be able to:
1. apply knowledge of
normal anatomy and
physiology and
assessment techniques
in caring for clients with
acute biologic crisis,
2. assess the health
status of a client:
a. conduct a health
history and Functional
Health Status of clients
at risk for or with acute
biologic crisis
b. interpret deviations
from normal findings in
physical assessment,
and diagnostic and
laboratory
examinations,
c. monitor results of
diagnostic tests and
report abnormal
findings
3. utilize the assessed
data to:

Mind - Body Modalities


Energy Healing
Spiritual Approaches
Miscellaneous Therapies

SHOCK, SYSTEMIC INFLAMMATORY RESPONSE


SYNDROME, AND MULTIPLE ORGAN DYSFUNCTIONS
A. Shock
1. Classification of Shock
2. Stages of Shock
3. Diagnostic Studies
4. Collaborative Care
a. General Measures
- Oxygen and Ventilation
- Fluid Resuscitation
- Drug Therapy
- Nutritional therapy
b. Specific Measures
5. Nursing Management
a. Nursing Assessment
b. Nursing Diagnosis
c. Planning
- Health Promotion
- Restoration and Maintenance
d. Acute Intervention
e. Ambulatory and Home Care
6. Evaluation
B. SYSTEMIC INFLAMMATORY RESPONSE
SYNDROME AND MULTIPLE ORGAN
DYSFUNCTION SYNDROME
1. Etiology
2. Pathophysiology
3. Clinical Manifestations of SIRS and MODS
4. Nursing and Collaborative Management
a. Prevention and Control of Infection
b. Maintenance of Tissue Oxygenation

a. Lecture Discussion
b. Video clip
presentation
c. Picture
Presentation
d. Group discussions
e. Read pages 313
332 of Brunner.

The following
values shall be
incorporated:
1. Compassionate
2. Competence
3. Coresponsibility
4. Respect for
Human Dignity
5.Commitment to
Vincentian
Excellence

4 hours

4 hours
a. Lecture Discussion
b. Video clip
presentation
c. Picture
Presentation
d. Group discussions

The following
values shall be
incorporated:
1. Compassionate
2. Competence

a. prioritize nursing
diagnosis
b. discuss the
pathophysiological
responses to acute
biologic crisis
c. plan of care of clients
utilizing evidence-based
nursing research
d. achieve the best
clinical outcomes
utilizing ethico moral
and legal principles
e. plan effective care
f. implement
individualized nursing
care safely and
knowledgeably
administer prescribed
medications and
treatments alternative
and complementary
treatments,
g. actively participate in
planning and
coordinating culturally
sensitive
interdisciplinary care
h. provide appropriate
client education and
health maintenance and
community-based care
of clients efficiently and
effective
i. effectively utilize
available resources in

c. Nutrition and Metabolic Demands


d. Support of Failing Organs
RESPIRATORY FAILURE AND ACUTE RESPIRATORY
DISTRESS SYNDROME
1. Respiratory Failure
a. Etiology and Pathophysiology
b. Clinical Manifestations
c. Diagnostic Studies
d. Nursing and Collaborative Care
- Nursing Assessment
- Nursing Diagnoses
- Planning:
- Prevention
- Restoration
Respiratory Therapy Oxygen
Therapy; mobilization of secretion;
positive pressure ventilator
- Drug Therapy
- Medical supportive therapy
- Nutritional therapy
e. Evaluation
2. Acute Respiratory Distress Syndrome
a. Etiology and Pathophysiology
b. Clinical Progression and Manifestation
c. Complications
d. Nursing and Collaborative Management
- Nursing Assessment
- Nursing Diagnoses
- Planning
-Respiratory Therapy
- Medical Supportive Therapy
Critical Care
A. Hemodynamic Monitoring
1. Terminology
- Cardiac Output and cardiac Index
- Preload

3. Coresponsibility
4. Respect for
Human Dignity
5.Commitment to
Vincentian
Excellence

4 hours

2 hours

6 hours

the care of clients to


achieve outcomes.

- Afterload
- Vascular Resistance
- Contractility
2. Principles
- Referencing
- Zeroing
3. Types
- Invasive Pressure Monitoring
a. Arterial Blood Pressure
b. Pulmonary Artery
- Flow-Directed Catheter
- Non-invasive Oxygenation
Monitoring
4. Nursing Management in Hemodynamic

4 hours

Monitoring
B. Circulatory Assist Devices
1. Intraaortic Balloon Pump
2. Ventricular Assist Devices (VAD)
3. Implantable Artificial Heart
4. Nursing Management in Circulatory Assist
Devices
C. Artificial Airways
1. Endotracheal Tubes
2. E.T. Intubation Procedures
3. Nursing Management Artificial Airway
D. Mechanical Ventilation
1. Types
2. Settings of Mechanical Ventilation
3. Modes of Volume Ventilation
4. Modes of Pressure Ventilation
5. Other Ventilatory Maneuvers
6. Complications of Positive Pressure
Ventilation
7. Weaning from Positive Pressure
Ventilation and
Extubation

8 hours

8. Chronic Mechanical Ventilation

INTERMEDIATE
COMPETENCIES

CONTENT

After each 3-hour session,


the students should be able
to:

HEALTH PERCEPTIONHEALTH MANAGEMENT


PATTERN

1. enumerate the
components of the immune
system and define each
type.

A. Care of Clients with


Infection

2. define cytokines, the


functions and the immune
response process.

1. Overview of the Immune


System

3. distinguish the types of


immunity.

a. Immune System
Components

4. identify the different


factors that affect the
immune system.
5. differentiate the immune
system of individuals across
the lifespan.

TEACHINGLEARNING
ACTIVITIES

INTEGRATED
VALUES

NO. OF
HRS.

Facilitated
Discussion on the
Use of Braden Scale
for Predicting
pressure sore risks

The following
values shall be
incorporated:

1. Self
awareness
Lecture/Discussion

- Antigens

*Monocytes, Macrophages
and Dendritic cells
*B lymphocytes

*Natural killer cells

1. Prioritize according to
which patient the
nursing student should
see first

Ethical Dilemmas:
-

Genetic
3. Respect for
Testing
Individual vs. Patients Rights
Public Health
Protection

Viewing of a short
video clip on the
immune system

4. Value for
family support

5. Culture and
gender
sensitivity

*Immunoglobulins
* T lymphocytes

Paper and pencil tests


using the following
strategies:

2. Value for life

- Immune cells
* Major Histocompatibility
Complex

EVALUATION

6. Respect for
all religions and
cultures

2. Check all that apply

3. Multiple-choice
questions

- The Lymphoid Organs


- Cytokines and the Immune
Response

7.
Professionalism

b. Nonspecific Inflammatory
Response

8. Genuine
nursing care

c. Specific Immune Response


d. Natural or Acquired
Immunity

9. Selfdiscipline

e. Immune Response in the


Elderly

10. Being
sensitive to the
feelings of
others

2. Normal Immune
Responses
a. Tissue Inflammation
- Acute Inflammation
*Vascular response
*Cellular response
*Acute phase response

Lecture-discussion

*Inflammatory mediators
*Inflammatory exudates
After each 3-hour session,
the students should be able
to:

- Chronic Inflammation
b. Infection

B. Care of Clients with

Pantomime for the


distinct signs and
symptoms

Paper and pen quiz

1. define immunodeficiency.

Altered Immunity

2. trace the pathophysiologic


process of each disorder
through diagram
representation.

1. Altered Immune
Responses

3. define each immunologic


disorder.
4. enumerate the different
signs and symptoms of each
disorder.
5. enumerate the possible
complications of each
disorder.
6. formulate appropriate
nursing diagnoses for each
disorder.
7. enumerate appropriate
nursing interventions for
each disorder.

a. Immunodeficiency Disease
Humoral (B-cell)
Immunodeficiency
-Transient
Hypogammaglobulinemia of
Infancy
-Primary B-cell
immunodeficiencies
-Secondary B-cell
immunodeficiencies
Cellular (T-cell)
Immunodeficiencies
-Primary T-cell
immunodeficiencies
-Secondary T-cell
immunodeficiencies
Combined T-cell and B-cell
Immunodeficiencies
-Severe Combined
Immunodeficiency
-Ataxia-Telangiectasia
-Wiskott-Aldrich Syndrome

b. Hypersensitivity Reactions
Type 1
Immediate/Anaphylactic
Reactions
*Time of onset
*Common signs and
symptoms
*Role of IgE
*Specific conditions: Asthma
and other allergies, Atopic
Disorders
Type 2 Cytotoxic, antibody
dependent
*Time of onset
*Common signs and
symptoms
*Specific conditions: Blood
transfusion reactions, Rh
incompatibilities
Type 3 Immune-Complex
Mediated
*Antigen-antibody
mechanism
*Its effect on the kidneys
*Arthrus Reaction
*Serum sickness

Type 4 Cell Mediated


*Cellular changes
*Hypersensitivity disorders
*Allergic contact dermatitis
*Hypersensitivity
pneumonitis

LATEX ALLERGY
c. Autoimmune Disorder
-Immunologic Tolerance
-Mechanism of Autoimmune
Disease
*Heredity and Gender
*Failure of T-cell mediated
suppression
*Molecular mimicry
*Superantigens
-Rheumatoid Arthritis
-Systemic Lupus
Erythematosus
-Idiopathic
Thrombocytopenia Purpura
-Autoimmune hemolytic
anemia

-Graves disease
-Hashimotos thyroiditis
-Myasthenia Gravis
-Celiac disease
-Pemphigous
d. Tissue Transplant
-Transplantation
Immunopathology
*Host-Versus-Graft Disease
*Graft-Versus-Host Disease
-Stem cell transplantation
e. Disorders of Phagocytosis
-Primary disorders of
phagocytosis
After each 3-hour session,
the students should be able
to:

1. describe the mechanisms


of HIV transmission and
relate them to the need for
public awareness and
concern regarding the
spread of AIDS.
2. list the 3 stages of HIV
infection and describe the

*Job Syndrome
*Chediak-Higashi Syndrome
-Secondary disorders of
phagocytosis

2. Impaired Immune
Response
a. HIV infection
-Transmission of HIV infection

Paper and pen quiz

symptoms, psychosocial
issues and management
concerns for each stage.
3. discuss the vertical
transmission of HIV from
mother to child and
recommended prevention
measures.
4. cite problems with
diagnosis of HIV infection in
the infant.
5. compare the progress of
HIV infection in infants and
children with HIV infection in
adults.
6. briefly trace the history of
the AIDS epidemic.
7. state the virus responsible
for AIDS and explain how it
differs from other viruses.
8. describe the diagnosis of
AIDS.
9. describe the alterations in
immune function that occur
in persons with AIDS.

Given specific client


condition, the students
utilize the nursing process

- Diagnosis of HIV infection


-Classification of HIV
infection
-Phases of HIV infection
-Clinical Course
*Opportunistic Infections
*Respiratory Manifestations
*Gastrointestinal
Manifestations
*Nervous System
Manifestations
*Cancer and Malignancies
*Wasting Syndrome
*Metabolic Manifestations
-Early Management
-Treatment
-Psychosocial Issues
-Prevention of HIV Infection
-HIV Infection in pregnancy
and in infants and children
b. Acquired Immunodeficiency
Syndrome
-The AIDS Epidemic

to:

-Pathophysiology of AIDS

1. identify significant data


that should be obtained
necessary to be used as the
basis of rendering patient
care and management.

2. define each type of


physical examination
technique.

Interactive Role Play

C. Nursing Process of
Clients with Infection
/Altered Immune Response

1. Health History
-Significant subjective data
from the client
*family history
*chief complaints
*functional patterns
3. distinguish each type of
lesion in terms of
appearance and other
characteristics.

*psychosocial and behavioral


assessment
Photo presentation
of each
2. Physical Assessment

Principles and techniques of


physical examination in all
age groups, deviations from
normal
-Inspection
*Types of Skin Lesions

Primary Lesions
1. MACULE
2. PAPULE
3. NODULE
4. TUMOR
5. PLAQUE
6. VESICLE
7. BULLAE
8. PUSTULE
9. WHEAL
10.BURROW
11. TELANGIECTASIA

Secondary Lesions
1. SCALE

Paper and pen moving


quiz

2. CRUST
3. ATROPHY
4. LICHENIFICATION
4. demonstrate proper
palpation and inspection
techniques.

5. EROSION
6. EXCORIATION
7. FISSURE
8. ULCERATION
9. SCAR
10.ESCHAR

5. define each diagnostic


test.
6. identify the indications for
each test.
7. identify the possible
complications for each test.
8. identify the appropriate
nursing responsibilities for
each test.

11. KELOIDS
12. PETECHIAE, PURPURA AND
ECCHYMOSES

Lecture-discussion

-Palpation
*Turgor
*Tenderness

Paper and pen quiz

*Masses
*Body temperature

3. Diagnoses
a. Diagnostic Tests and
Nursing Responsibilities

Simulation (Lumbar
tap)

NON-INVASIVE
-Urinalysis
-C and S
-X-ray

INVASIVE
9. formulate appropriate
nursing diagnoses for each
disorder.

-CBC

10. formulate SMART


objectives and outcome
criteria.

-Biopsy

11. enumerate appropriate


nursing interventions for
each disorder.

-Antistreptolysin titer

-Blood Chemistry
-Lumbar tap
-ELISA
-Western blot
-Immunoelectrophoresis

12. define each principle of


modalities of management.
13. cite examples of each
principle.

Group formulation of
Nursing Care Plan

b. Nursing Diagnoses
Taxonomy/Development of
Outcome Criteria
-Impaired skin integrity
-Activity Intolerance
-Potential for Infection
-Disturbances in SelfConcept

Individual NCP making


with the 5 BEST nursing
interventions

-Ineffective Family Coping


-Social Isolation

14. identify the


pharmacologic management
for immunologic disorders.
15. identify the mechanism
of action, indication,
contraindication, adverse
effects and side effects of
each drug.
16. enumerate the nursing
responsibilities appropriate
for each pharmacologic
management

c. Principles of Various
Modalities of Management
-health promotion
-disease prevention

1 versus 45 (from 1
versus 1 million
game)

-curative
-restorative

Paper and pen quiz


4. Intervention
a. Pharmacologic Actions
-Therapeutic use, side
effects, indications,
contraindication, nursing
responsibilities

17. define each type of


surgical and special
procedure.

*Antibiotics
*Antifungal agents
*Anticholinergic agents
*Adrenergic agents

18. enumerate appropriate


nursing responsibilities
perioperatively.

*Anti-inflammatory agents
*Corticosteroids

Photo presentation
of nursing
procedures

*Immunologic agents

Simulation

*Vaccines
Paper and pen quiz
b. Nursing Responsibilities for
specific surgical and special
procedures

Return demonstration

-Thyroidectomy
-Incision and Drainage, etc.
- Safe and comprehensive
perioperative nursing care
*Assessment and care during
the perioperative period
*Techniques in assisting the
surgical team during the
operation
19. define the following:
a. Universal Precaution
b. Reverse Isolation
c. Medical Asepsis

*Principles of safety, comfort


and privacy during the
perioperative period
*Nursing responsibilities
during the perioperative
period

d. Surgical Asepsis
Surgical Procedures
20. demonstrate the proper
technique of each
procedure.

-debridement, incision and


drainage, excision
Special Procedures

Lecture
demonstration

-Universal Precaution
-Reverse Isolation
-Medical Asepsis
-Surgical Asepsis

21. identify the different


ethical concerns in patient
care.
5. Steps/pointers in
decision making and
prioritization with client/s
having problems in
inflammatory
and
immunologic reaction

6. Client, family,
community education
a. Bioethics: Principles and
application of bioethics in the
care of the clients
22. formulate a discharge
plan specific for each
disorder.

-Patients rights
-Confidentiality
-The Informed Consent
-Advance Directive

23. identify the guidelines in


accurate recording and
documentation.

-Issues in patients with AIDS

Role-play

b. Appropriate discharge plan


including health education

c. Accurate recording and


documentation

REFERENCES

Contemporary Medical-Surgical Nursing by Rick Daniels, Laurel Nosek and Leslie Nicol 2007
Medical-Surgical Nursing Critical Thinking in Client Care by Priscilla LeMone and Karen Burke 4th edition 2008
Medical-Surgical Nursing Assessment and Management of Clinical Problems
Medical-Surgical Nursing by Brunner and Suddarth 2008
Medical-Surgical Nursing Critical Thinking for Collaborative Care by Ignatavicius and Workman

Prepared by:

Ma. Ethel B. Bergantinos, RN


Rob Ryan T. Duag, RN
Hazel Roda A. Estorque, RN
Jimmellee Ellen P. Olilang, RN
Edrelyn A. Venturanza, RN
CLINICAL INSTRUCTORS

Received and Approved by:


Sr. Editha A. Bagayaua, DC, RN, MAN
Dean, College of Nursing