Wednesday, July 11, 2012
At 101, Patient Is Nation's Oldest Transcatheter Heart Valve Replacement
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(D) PRC December 2007 Nursing Licensure (Board) Examination (NLE) Results
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Tuesday, July 10, 2012
Monday, July 9, 2012
SAGES Top 14 Video: Part 9 -- Laparoscopic Splenectomy
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The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) prepared their top 14 procedures. Each video will be presented here. I hope you find this video informative.
Part 9 -- Lap Splenectomy:
Part 1 -- Flexible Endoscopy
Part 2 -- Diagnostic Laparoscopy
Part 3 -- Laparoscopic Cholecystectomy
Part 4 -- Laparoscopic Common Bile Duct Exploration
Part 5 -- Laparoscopic Appendectomy
Part 6 -- Laparoscopic Nissen
Part 7 -- Laparoscopic Inguinal Hernia Repair
Part 8 -- Laparoscopic Ventral Hernia Repair
Part 9 -- Lap Splenectomy:
Part 1 -- Flexible Endoscopy
Part 2 -- Diagnostic Laparoscopy
Part 3 -- Laparoscopic Cholecystectomy
Part 4 -- Laparoscopic Common Bile Duct Exploration
Part 5 -- Laparoscopic Appendectomy
Part 6 -- Laparoscopic Nissen
Part 7 -- Laparoscopic Inguinal Hernia Repair
Part 8 -- Laparoscopic Ventral Hernia Repair
Activity after Major Surgery
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It's time to get out of bed.
Exercise after a major surgery is important. It decreases the risk of deep vein thrombosis and pneumonia. It also helps minimize deconditioning that results for the stress of an operation.
Day 0: Get to a chair. At least dangle and stand at the side of the bed, of course, with the help of the nurse.
Day 1: Out of bed as much as possible. Maybe to a chair for an 1 hour and walking four times.
Day 2 to discharge: Walking in halls four to six times. Spend more of the daylight hours in the chair rather than the bed.
At discharge: Clarify your restrictions with your surgeon and discharging nurse. Typically, you will need to limit heavy lifting for 4 to 6 weeks.
Before you arrive home, make sure that it is a safe environment. Loose mats and carpets can be a tripping hazard. How many steps into your house? Try stairs at the hospital (with the help of the nurse) before getting home and realizing you can't get to your bedroom.
1st Week Home: Walk, walk, walk. Get outside, you are no longer in the hospital. Enjoy the fresh air.
2nd Week and on wards: Aerobic exercise is good. If it hurts, wait 1 or 2 weeks and try it again.
Major abdominal operations can trigger significant back pain due to an imbalance of core muscles. Therefore, stretching exercises and frequent re-positioning can minimize back discomfort. If you have a significant history of back pain before the abdominal operation, consider arranging physical therapy before discharge.
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| (c) Mike Baird bairdphotos.com |
Exercise after a major surgery is important. It decreases the risk of deep vein thrombosis and pneumonia. It also helps minimize deconditioning that results for the stress of an operation.
Day 0: Get to a chair. At least dangle and stand at the side of the bed, of course, with the help of the nurse.
Day 1: Out of bed as much as possible. Maybe to a chair for an 1 hour and walking four times.
Day 2 to discharge: Walking in halls four to six times. Spend more of the daylight hours in the chair rather than the bed.
At discharge: Clarify your restrictions with your surgeon and discharging nurse. Typically, you will need to limit heavy lifting for 4 to 6 weeks.
Before you arrive home, make sure that it is a safe environment. Loose mats and carpets can be a tripping hazard. How many steps into your house? Try stairs at the hospital (with the help of the nurse) before getting home and realizing you can't get to your bedroom.
1st Week Home: Walk, walk, walk. Get outside, you are no longer in the hospital. Enjoy the fresh air.
2nd Week and on wards: Aerobic exercise is good. If it hurts, wait 1 or 2 weeks and try it again.
Major abdominal operations can trigger significant back pain due to an imbalance of core muscles. Therefore, stretching exercises and frequent re-positioning can minimize back discomfort. If you have a significant history of back pain before the abdominal operation, consider arranging physical therapy before discharge.
SAGES Top 14 Video: Part 10 -- Laparoscopic Adrenalectomy
To contact us Click HERE
The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) prepared their top 14 procedures. Each video will be presented here. I hope you find this video informative.
Part 10 -- Lap Adrenalectomy:
Part 1 -- Flexible Endoscopy
Part 2 -- Diagnostic Laparoscopy
Part 3 -- Laparoscopic Cholecystectomy
Part 4 -- Laparoscopic Common Bile Duct Exploration
Part 5 -- Laparoscopic Appendectomy
Part 6 -- Laparoscopic Nissen
Part 7 -- Laparoscopic Inguinal Hernia Repair
Part 8 -- Laparoscopic Ventral Hernia Repair
Part 9 -- Laparoscopic Splenectomy
Part 10 -- Lap Adrenalectomy:
Part 1 -- Flexible Endoscopy
Part 2 -- Diagnostic Laparoscopy
Part 3 -- Laparoscopic Cholecystectomy
Part 4 -- Laparoscopic Common Bile Duct Exploration
Part 5 -- Laparoscopic Appendectomy
Part 6 -- Laparoscopic Nissen
Part 7 -- Laparoscopic Inguinal Hernia Repair
Part 8 -- Laparoscopic Ventral Hernia Repair
Part 9 -- Laparoscopic Splenectomy
At 101, Patient Is Nation's Oldest Transcatheter Heart Valve Replacement
To contact us Click HERE
When Doris Snyder celebrated her 102nd birthday on August 10, she was that much closer to the expected birth of her first great-granddaughter who's due to arrive early September. She is very excited about the milestone, which might not have been possible were it not for a cutting-edge, experimental procedure that replaced one of Doris' heart valves weeks earlier when she was 101. The valve had been rendered useless by aortic valve stenosis hardening from calcium deposits that restrict the flow of blood from the heart.
"This procedure could be a major breakthrough for these patients, as they're generally told that nothing can be done for them," said Patrick M. McCarthy, MD, chief of the division of cardiothoracic surgery for Northwestern Memorial Hospital and director of the hospital's Bluhm Cardiovascular Institute and the Heller-Sacks professor of Surgery at Northwestern University's Feinberg School of Medicine.
McCarthy is a co-principal investigator for the clinical trial that provided Doris' new heart valve, which is formally referred to as the Placement of AoRtic TraNscathetER Valve, or PARTNER. The Bluhm Institute is among the trial's pioneering sites. The technique is being evaluated as a course of therapy for patients who are considered too weak to undergo conventional open-heart surgery. It uses expandable-stenting technology to insert a prosthetic valve while the heart continues beating, eliminating the need for cardiopulmonary bypass and its associated risks.
"Patients who are too weak to be surgically treated have very limited options for valve replacement," said Charles J. Davidson, who is also a co-principal investigator for the trial and a professor of Medicine at Northwestern University's Feinberg School of Medicine. Davidson says the procedure builds upon the balloon aortic valvuloplasty, but is a "more durable treatment."
Spry and amazingly keen, Doris had never encountered any major health issues. Moreover, the avid reader who's kept a diary for more than 60 years is usually game to tackle most things that come her way but open-heart surgery was not one of them. S. Chris Malaisrie, MD, a Northwestern Memorial cardiac surgeon and member of the site team evaluating this new procedure, said she wouldn't survive it.
"Doris exemplifies the fact that your state of health is not necessarily defined by your age," said Malaisrie. "She's healthier than a lot of people much younger than her."
Drs. McCarthy and Malaisrie are paid consultants of Edwards LifeSciences, makers of the experimental prosthetic valve.
"This procedure could be a major breakthrough for these patients, as they're generally told that nothing can be done for them," said Patrick M. McCarthy, MD, chief of the division of cardiothoracic surgery for Northwestern Memorial Hospital and director of the hospital's Bluhm Cardiovascular Institute and the Heller-Sacks professor of Surgery at Northwestern University's Feinberg School of Medicine.
McCarthy is a co-principal investigator for the clinical trial that provided Doris' new heart valve, which is formally referred to as the Placement of AoRtic TraNscathetER Valve, or PARTNER. The Bluhm Institute is among the trial's pioneering sites. The technique is being evaluated as a course of therapy for patients who are considered too weak to undergo conventional open-heart surgery. It uses expandable-stenting technology to insert a prosthetic valve while the heart continues beating, eliminating the need for cardiopulmonary bypass and its associated risks.
"Patients who are too weak to be surgically treated have very limited options for valve replacement," said Charles J. Davidson, who is also a co-principal investigator for the trial and a professor of Medicine at Northwestern University's Feinberg School of Medicine. Davidson says the procedure builds upon the balloon aortic valvuloplasty, but is a "more durable treatment."
Spry and amazingly keen, Doris had never encountered any major health issues. Moreover, the avid reader who's kept a diary for more than 60 years is usually game to tackle most things that come her way but open-heart surgery was not one of them. S. Chris Malaisrie, MD, a Northwestern Memorial cardiac surgeon and member of the site team evaluating this new procedure, said she wouldn't survive it.
"Doris exemplifies the fact that your state of health is not necessarily defined by your age," said Malaisrie. "She's healthier than a lot of people much younger than her."
Drs. McCarthy and Malaisrie are paid consultants of Edwards LifeSciences, makers of the experimental prosthetic valve.
Sunday, July 8, 2012
Going home -- a guide to hospital discharge after major surgery
To contact us Click HERE
So, you are ready for discharge. Glad to be going home. Everything has gone well with no sign of complication. What happens next?
The surgeon, nurses, physician assistants, discharge planners, and social workers are always thinking about the transition from inpatient to outpatient. The process of discharging a patient begins the day of the operation. Everyone wants this process to be smooth and result in the best outcome for the patient.
The first step is a communication between the surgeon and patient. You are going home today? Next, the surgeon will prepare discharge materials. Nursing will provide discharge education, such as drain care or dressing change instructions. Necessary supplies and prescriptions are filled.
Just before discharge, all IVs are removed and the nurse provides discharge materials.
You should receive the following:
1) Summary of hospital course
2) Updated list of medications
3) New prescriptions
4) Follow-up plan with appointments
5) Nursing or care instructions
6) Contact information
7) Record of operation
8) Record of pathology
9) Activity restrictions
10) Instructions on when to call the surgeon.
Double check that you receive all these materials. I'll explain why they are important.
Summary of Hospital Course: Hopefully your post-operative recovery was uncomplicated. Even if your stay in the hospital was boring, the events of the hospital stay should be documented. This documentation can be given to your primary care doctor or other providers. It is very insightful. Keep this summary in your records.
List of medications: Medications frequently start and stop after major surgery. You need to know what you should and should not be taking. Stop and ask. Get clarification from the nurse. Do new medications have side effects? Can you stop taking any medications? Are there redundant/duplicate medications? Do you need a refill on a medication? Keep this list and take it your primary care doctor so that everyone has an up-to-date medication list.
New prescriptions: When you are discharged on the weekend, filling new prescriptions can sometimes be difficult. Can or should they be filled before discharge? When should you take the next dose? How long will you be taking the new medication(s)? All of these questions can be answered by the discharging nurse.
Follow-up plan: Ideally, the follow-up plan is established before discharge. Sometimes, because of office hours, appointment times can't be arranged. If the plan is not clearly outlined in the discharge paperwork or conflicts with your understanding of the follow-up plan, ask for clarification. Every operation and every patient is unique and follow-up plans require customization. Before agreeing to specific appointment times, make sure you factor in transportation and if your driver needs to take time off work.
Nursing or care instructions: This documentation depends on the operation. Just ask the nurse, "Do you have any post-operative care instructions for this operation?" Make sure supplies are provided if you need to flush drains or change dressings.
Contact information: Make sure you receive a physician on-call number, surgeon's office number, medical records contact number (if you need to have records forwarded), and main hospital number.
Record of operation: This is not routinely included in the discharge materials. However, request the operative note for your records. Since the final version of the operation note does take several days before it is available, you might have to request the operation note as an outpatient.
Record of pathology: Similar to operation notes, pathology reports are not always included in the discharge materials. The detailed pathology report can be very technical and difficult to understand but is a very important document especially for patients with cancer. This document describes the size, stage, and lymph node status of a tumor. Pathology reports are not typically available until 3 - 5 days after an operation so you might have to request a copy as an outpatient.
Activity restrictions: The discharge paperwork should outline activity restrictions. This includes comments on lifting, sexual activity, driving, bathing, and swimming.
Instructions on when to call the surgeon: Typically, the discharge paperwork will state that you should call your surgeon when you have fever, chills, nausea, vomiting, or redness at the incision. Beyond these common instructions, make sure to ask your surgeon or nurse what to look out for after surgery.
So, you have your discharge paperwork in hand. IV is removed. Are you ready to go? Yes and no. Ask the nurse before you walk out the door since many hospitals provide or require that you take a wheel chair to the lobby.
So, you are ready for discharge. Glad to be going home. Everything has gone well with no sign of complication. What happens next?The surgeon, nurses, physician assistants, discharge planners, and social workers are always thinking about the transition from inpatient to outpatient. The process of discharging a patient begins the day of the operation. Everyone wants this process to be smooth and result in the best outcome for the patient.
The first step is a communication between the surgeon and patient. You are going home today? Next, the surgeon will prepare discharge materials. Nursing will provide discharge education, such as drain care or dressing change instructions. Necessary supplies and prescriptions are filled.
Just before discharge, all IVs are removed and the nurse provides discharge materials.
You should receive the following:
1) Summary of hospital course
2) Updated list of medications
3) New prescriptions
4) Follow-up plan with appointments
5) Nursing or care instructions
6) Contact information
7) Record of operation
8) Record of pathology
9) Activity restrictions
10) Instructions on when to call the surgeon.
Double check that you receive all these materials. I'll explain why they are important.
Summary of Hospital Course: Hopefully your post-operative recovery was uncomplicated. Even if your stay in the hospital was boring, the events of the hospital stay should be documented. This documentation can be given to your primary care doctor or other providers. It is very insightful. Keep this summary in your records.
List of medications: Medications frequently start and stop after major surgery. You need to know what you should and should not be taking. Stop and ask. Get clarification from the nurse. Do new medications have side effects? Can you stop taking any medications? Are there redundant/duplicate medications? Do you need a refill on a medication? Keep this list and take it your primary care doctor so that everyone has an up-to-date medication list.
New prescriptions: When you are discharged on the weekend, filling new prescriptions can sometimes be difficult. Can or should they be filled before discharge? When should you take the next dose? How long will you be taking the new medication(s)? All of these questions can be answered by the discharging nurse.
Follow-up plan: Ideally, the follow-up plan is established before discharge. Sometimes, because of office hours, appointment times can't be arranged. If the plan is not clearly outlined in the discharge paperwork or conflicts with your understanding of the follow-up plan, ask for clarification. Every operation and every patient is unique and follow-up plans require customization. Before agreeing to specific appointment times, make sure you factor in transportation and if your driver needs to take time off work.
Nursing or care instructions: This documentation depends on the operation. Just ask the nurse, "Do you have any post-operative care instructions for this operation?" Make sure supplies are provided if you need to flush drains or change dressings.
Contact information: Make sure you receive a physician on-call number, surgeon's office number, medical records contact number (if you need to have records forwarded), and main hospital number.
Record of operation: This is not routinely included in the discharge materials. However, request the operative note for your records. Since the final version of the operation note does take several days before it is available, you might have to request the operation note as an outpatient.
Record of pathology: Similar to operation notes, pathology reports are not always included in the discharge materials. The detailed pathology report can be very technical and difficult to understand but is a very important document especially for patients with cancer. This document describes the size, stage, and lymph node status of a tumor. Pathology reports are not typically available until 3 - 5 days after an operation so you might have to request a copy as an outpatient.
Activity restrictions: The discharge paperwork should outline activity restrictions. This includes comments on lifting, sexual activity, driving, bathing, and swimming.
Instructions on when to call the surgeon: Typically, the discharge paperwork will state that you should call your surgeon when you have fever, chills, nausea, vomiting, or redness at the incision. Beyond these common instructions, make sure to ask your surgeon or nurse what to look out for after surgery.
So, you have your discharge paperwork in hand. IV is removed. Are you ready to go? Yes and no. Ask the nurse before you walk out the door since many hospitals provide or require that you take a wheel chair to the lobby.
Grey Turner' s Sign
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Ecchymosis or bruising on the abdomen is rarely a good sign on physical exam. Grey Turner's sign is bilateral flank bruising or ecchymosis and is a classic finding of bleeding into the retroperitoneum around the kidneys and pancreas. It is associated with severe acute pancreatitis but may occur following cardiac catheterization with bleeding into the retroperitoneum.
Unfortunately, abdominal wall bruising is common and not always Grey Turner's sign. Location of the bruising really matters. In blunt trauma (e.g. high speed motor vehicle accident), the classic "seat belt sign" is an indicator of potential intra-abdominal injury. Physicians can easily be mislead by subcutaneous injection of insulin or blood thinning medications (e.g. low-molecular weight heparin). These medications can result in impressive abdominal wall bruising that is usually self-limited.
Dr. George Grey Turner was born September 8, 1887 in North Shields, England. As a young surgeon, he traveled extensively throughout America, Canada, and Africa. He was a pioneer in cancer surgery of the esophagus. In 1920, Dr. Grey Turner reported his experience with two patients that died after abdominal exploration for acute pancreatitis. From his experience, he noted periumbilical discoloration (Cullen's sign) and bilateral flank discoloration. He hypothesized that the discoloration was "direct action of pancreatic juice."
Reference:
White H. An Outstanding ISS/SIC Surgeon: George Grey Turner. World Journal of Surgery. 2003. 27:511-513.
Turner G. Local Discoloration of the Abdominal Wall as a Sign of Acute Pancreatitis. British Journal of Surgery. 1920. 7:394-395.
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| Figure 1. Grey Turner's Sign. |
Unfortunately, abdominal wall bruising is common and not always Grey Turner's sign. Location of the bruising really matters. In blunt trauma (e.g. high speed motor vehicle accident), the classic "seat belt sign" is an indicator of potential intra-abdominal injury. Physicians can easily be mislead by subcutaneous injection of insulin or blood thinning medications (e.g. low-molecular weight heparin). These medications can result in impressive abdominal wall bruising that is usually self-limited.
Dr. George Grey Turner was born September 8, 1887 in North Shields, England. As a young surgeon, he traveled extensively throughout America, Canada, and Africa. He was a pioneer in cancer surgery of the esophagus. In 1920, Dr. Grey Turner reported his experience with two patients that died after abdominal exploration for acute pancreatitis. From his experience, he noted periumbilical discoloration (Cullen's sign) and bilateral flank discoloration. He hypothesized that the discoloration was "direct action of pancreatic juice."
 |
| Figure 2. Image from original report by Dr. Grey Turner. |
Reference:
White H. An Outstanding ISS/SIC Surgeon: George Grey Turner. World Journal of Surgery. 2003. 27:511-513.
Turner G. Local Discoloration of the Abdominal Wall as a Sign of Acute Pancreatitis. British Journal of Surgery. 1920. 7:394-395.
Humanities
To contact us Click HERE
* Canvas print and canvas photo
* canvas prints
* Photo canvas prints
* Canvas photo prints
* How to hang a canvas print
* The Human Investor Part IX
* Canvas photos
* Canvas photo print
* Close Up Of A Modern Time Legend
* Why?
* Tiwanaku Alien and the Nostradamus Prophecies – Part 1
* Birthday ceremony party tips for 1 to 10 Ages kids only
* Did the ancient Chinese have a Caucasian ancestry?
* Did the ancient Chinese have a Caucasian ancestry?
* Did the ancient Chinese have a Caucasian ancestry?
* Did the ancient Chinese have a Caucasian ancestry?
* Did the ancient Chinese have a Caucasian ancestry?
* "Hooks To Hits: The Key to Writing Songs That Promote"
* Performing - The Casting Course of
* Acting - On The Job
* Appearing - Have you received what it takes?
* Performing - Getting Began
* Acrylic Painting Lesson - Mistakes To Avoid In Your Acrylic Paintings
* Correct Psychic Readings
* Summary Artwork As Remedy
* Summary Artwork and I
* About Tattoo
* A Look on "Trainspotting
* A Clean Canvas: A short consideration of Trendy Design
* Did the ancient Chinese have a Caucasian ancestry?
* canvas prints
* Photo canvas prints
* Canvas photo prints
* How to hang a canvas print
* The Human Investor Part IX
* Canvas photos
* Canvas photo print
* Close Up Of A Modern Time Legend
* Why?
* Tiwanaku Alien and the Nostradamus Prophecies – Part 1
* Birthday ceremony party tips for 1 to 10 Ages kids only
* Did the ancient Chinese have a Caucasian ancestry?
* Did the ancient Chinese have a Caucasian ancestry?
* Did the ancient Chinese have a Caucasian ancestry?
* Did the ancient Chinese have a Caucasian ancestry?
* Did the ancient Chinese have a Caucasian ancestry?
* "Hooks To Hits: The Key to Writing Songs That Promote"
* Performing - The Casting Course of
* Acting - On The Job
* Appearing - Have you received what it takes?
* Performing - Getting Began
* Acrylic Painting Lesson - Mistakes To Avoid In Your Acrylic Paintings
* Correct Psychic Readings
* Summary Artwork As Remedy
* Summary Artwork and I
* About Tattoo
* A Look on "Trainspotting
* A Clean Canvas: A short consideration of Trendy Design
* Did the ancient Chinese have a Caucasian ancestry?
Baby Shower Card
To contact us Click HERE
I made this really cute baby shower card for my friend Kim's daughter who is having a baby. Supplies Used: Simply Charmed Cricut cartridge, cricut expression, cuttlebug baby embossing folder, sizzix's big kick, bazzill cardstock, SU! cardstock, My Pink Stamper stamps, Peachy Keen face stamps, gel pen, SU! Ink, silver gems, chunky pearls, sizzix's traditional tag die, Tim Holtz safety pin, ribbon, atg gun...and SU! foam dots.
I made this really cute baby shower card for my friend Kim's daughter who is having a baby. Supplies Used: Simply Charmed Cricut cartridge, cricut expression, cuttlebug baby embossing folder, sizzix's big kick, bazzill cardstock, SU! cardstock, My Pink Stamper stamps, Peachy Keen face stamps, gel pen, SU! Ink, silver gems, chunky pearls, sizzix's traditional tag die, Tim Holtz safety pin, ribbon, atg gun...and SU! foam dots.
Tea pot shaped Mother's Day card
To contact us Click HERE
I created this tea pot shaped card for my Mom for Mother's Day. I dowloaded this cut file http://www.letteringdelights.com/clipart:tea_time_party-10903.html and uploaded it to my SCAL program. I then cut it out with my Silhouette Cameo and paper pieced it together. The tea cup is an svg file I found on google images. I also used an action wobble behind the flower to give it some fun action. I just loved how it turned out. Thanks letteringdelights!
Supples Used: Silhouette Cameo Lettering Delights tea time cut file Bazzill Cardstock Action Wobble Tim Holtz Button My Pink Stamper Stampin Up! Ink Stickles Hero Arts Lace ATG Gun Gel Pen Sizzix Tag die Hot glue gun
I created this tea pot shaped card for my Mom for Mother's Day. I dowloaded this cut file http://www.letteringdelights.com/clipart:tea_time_party-10903.html and uploaded it to my SCAL program. I then cut it out with my Silhouette Cameo and paper pieced it together. The tea cup is an svg file I found on google images. I also used an action wobble behind the flower to give it some fun action. I just loved how it turned out. Thanks letteringdelights!
Supples Used: Silhouette Cameo Lettering Delights tea time cut file Bazzill Cardstock Action Wobble Tim Holtz Button My Pink Stamper Stampin Up! Ink Stickles Hero Arts Lace ATG Gun Gel Pen Sizzix Tag die Hot glue gun
Saturday, July 7, 2012
Tea pot shaped Mother's Day card
To contact us Click HERE
I created this tea pot shaped card for my Mom for Mother's Day. I dowloaded this cut file http://www.letteringdelights.com/clipart:tea_time_party-10903.html and uploaded it to my SCAL program. I then cut it out with my Silhouette Cameo and paper pieced it together. The tea cup is an svg file I found on google images. I also used an action wobble behind the flower to give it some fun action. I just loved how it turned out. Thanks letteringdelights!
Supples Used: Silhouette Cameo Lettering Delights tea time cut file Bazzill Cardstock Action Wobble Tim Holtz Button My Pink Stamper Stampin Up! Ink Stickles Hero Arts Lace ATG Gun Gel Pen Sizzix Tag die Hot glue gun
I created this tea pot shaped card for my Mom for Mother's Day. I dowloaded this cut file http://www.letteringdelights.com/clipart:tea_time_party-10903.html and uploaded it to my SCAL program. I then cut it out with my Silhouette Cameo and paper pieced it together. The tea cup is an svg file I found on google images. I also used an action wobble behind the flower to give it some fun action. I just loved how it turned out. Thanks letteringdelights!
Supples Used: Silhouette Cameo Lettering Delights tea time cut file Bazzill Cardstock Action Wobble Tim Holtz Button My Pink Stamper Stampin Up! Ink Stickles Hero Arts Lace ATG Gun Gel Pen Sizzix Tag die Hot glue gun
(I) PRC December 2007 Nursing Licensure (Board) Examination (NLE) Results
To contact us Click HERE
Roll of Successful Examinees in theNURSE LICENSURE EXAMINATIONHeld on JUNE 1 & 2, 2008Released on JULY 23, 2008 13259 IBABAO, LIEZL CEBRERO13260 IBADLIT, LHYN MAR ISMAEL13261 IBALLA, CHRISTIAN LASS ALMAIZ13262 IBARBIA, ROSA ANGELICA LIBRANDO13263 IBARRA, ERIKA KRYZTA OVIEDO13264 IBARRA, HOLLY CHRISTY BETONIO13265 IBARRA, JAMEELA VILLA13266 IBARRA, JHOANNA ROSE LAGANDAON13267 IBARRA, ROGELIO JR
Nursing Informations, Study and Review Guides, Latest News and Updates, Health, all about nursing...
Nursing Informations, Study and Review Guides, Latest News and Updates, Health, all about nursing...
(K) PRC December 2007 Nursing Licensure (Board) Examination (NLE) Results
To contact us Click HERE
Roll of Successful Examinees in theNURSE LICENSURE EXAMINATIONHeld on JUNE 1 & 2, 2008Released on JULY 23, 2008 13994 KABIGTING, JOANNE CHRISTINE BANTING13995 KABIGTING, MAY ANN DAYRIT13996 KABIGTING, PRINCESS GERALDINE LIMLAO13997 KADIL, ABDURAFFI RAGAY13998 KADIL, LYDIA HIPONIA13999 KADIL, MOHAMAD ERSHAD ABAS14000 KAGAHASTIAN, ERIKA ANNE REYESRoll of Successful Examinees in theNURSE LICENSURE
Nursing Informations, Study and Review Guides, Latest News and Updates, Health, all about nursing... 
Nursing Informations, Study and Review Guides, Latest News and Updates, Health, all about nursing...
(L) PRC December 2007 Nursing Licensure (Board) Examination (NLE) Results
To contact us Click HERE
Roll of Successful Examinees in theNURSE LICENSURE EXAMINATIONHeld on JUNE 1 & 2, 2008Released on JULY 23, 2008 14088 LA GUARDIA, JONATHAN RED14089 LA ROSA, DEBBIE SARDIDO14090 LAAG, LAARNI CAANGAY14091 LABACLADO, DARLENE CLARICE VALLES14092 LABADAN, LEO JR LUGO14093 LABADO, ROY ALDNER CALIPES14094 LABAGALA, REGINA MAE CAPA14095 LABAJO, LHENDY ABELLANA14096 LABAJO, MA EINA MADRIGAL14097 LABAJO,
Nursing Informations, Study and Review Guides, Latest News and Updates, Health, all about nursing... 
Nursing Informations, Study and Review Guides, Latest News and Updates, Health, all about nursing...
(M) PRC December 2007 Nursing Licensure (Board) Examination (NLE) Results
To contact us Click HERE
Roll of Successful Examinees in theNURSE LICENSURE EXAMINATIONHeld on JUNE 1 & 2, 2008Released on JULY 23, 2008 15574 MAABA, KRISTIAN LEANDRO BAUTISTA15575 MAADIL, MENAHEM CHIONG15576 MAADIL, MYRLEN CHIONG15577 MAAGAD, EISEL TUÑACAO15578 MAAGAD, KHRYSTEL MAULAS15579 MAALA, ATHENA MAHREE DEVENA15580 MAALA, IRA KIM UDARBE15581 MAALA, JOANNA ROXAS15582 MAALA, JORAY ABRIL DINGAYAN15583 MAALIHAN,
Nursing Informations, Study and Review Guides, Latest News and Updates, Health, all about nursing... 
Nursing Informations, Study and Review Guides, Latest News and Updates, Health, all about nursing...
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