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Jumat, 02 Oktober 2009
Kamis, 03 September 2009
Nursing Intervention
What is Nursing Intervention? Nursing intervention means is an action of Nurse that carried out in handling some patient's health problems based on nursing care plan in accordance with the nurse's diagnosis that was determined beforehand by comprehensive system of nursing's standard method.
Nursing interventions are different between one patient to the other patient depend on case or disease, general practice to all specialty areas. Nursing intervention has clinical tool standardizes and defines the knowledge base for nursing curricula and practice, communicates the nature of nursing, and facilitates the appropriate selection of nursing interventions for nurses, including practicing nurses, nursing students, nursing administrators, and faculty.
To provide standardization of expected nursing interventions, better for the nurses if they have a handbook of Nursing Diagnosis, Nursing Care Plans and Nursing interventions classification.
Many handbook are release to help the nurses as pocket guide to determinant of Nursing Diagnosis, Nursing Care Plans and Nursing interventions.
Nursing interventions are different between one patient to the other patient depend on case or disease, general practice to all specialty areas. Nursing intervention has clinical tool standardizes and defines the knowledge base for nursing curricula and practice, communicates the nature of nursing, and facilitates the appropriate selection of nursing interventions for nurses, including practicing nurses, nursing students, nursing administrators, and faculty.
To provide standardization of expected nursing interventions, better for the nurses if they have a handbook of Nursing Diagnosis, Nursing Care Plans and Nursing interventions classification.
Many handbook are release to help the nurses as pocket guide to determinant of Nursing Diagnosis, Nursing Care Plans and Nursing interventions.
Rabu, 02 September 2009
International Council of Nurses Bookshop
New from ICN and Blackwell Publishing | |
 Click on image for full size. |
International Council of Nurses: Nursing Leadership by Sally Shaw (former director of the ICN Leadership for Change programme) Paperback: 232 pages, 1 illustrations. Publisher: Blackwell Publishing Language English ISBN: 9781405135238 |
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Nursing Leadership focuses on principles of effective leadership and leadership development in nursing, and is equally applicable for other professional groups. It explores the importance of balancing leadership theory and knowledge with the development of leadership skills based on action-learning, and using a framework of three integrated components: the person who is the leader, the setting of leadership, and the followers. It also highlights the importance of preparing nurses for leadership in a global context in light of the challenge of changing health services and nursing roles. Nursing Leadership is brought to life with examples from the International Council of Nurses' experience with its 'Leadership for Change™' programme (LFC™ ) implemented in over fifty countries and in a variety of socio-political and cultural contexts. The book addresses principles of effective leadership that promote successful and sustainable outcomes across many different settings, including within resource-limited health systems.
Can be ordered from Blackwell Publishing: or Amazon UK site: or US site: | |
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Nurses (RN) Job In Al Salam Hospital - Kuwait
Nurses (RN) Job In Al Salam Hospital - Kuwait
Al Salam International Hospital (S.I.H.) is a private hospital in Dasma Area - Kuwait which provided 2002 beds for the in-patient. Al Salam International Hospital hosts a multitude of medical and surgical specialties and services staffed (professional doctors and nurses) with highly qualified and trained clinical and non-clinical workforce stemming from different origins.Al Salam International Hospital is first private hospital or medical facilities in Kuwait which provided services such as: Cardiology and Cardiac Surgery, Neurology and Neurosurgery, as well as Oncology and Radiation Therapy.
In order to increase their services to the patient, recently Al Salam International Hospital looking for energetic, intelligent and talented Staff Nurses(RNs - all areas and specially critical care areas, operating rooms). Working with Al Salam International Hospital (S.I.H.) the Nurses will be amply rewarded in terms of salary, conditions, working environment, career opportunities and other benefits.
The Nurses who interest to join and work as Staff Nurse in Al Salam International Hospital should have Bachelors Degree or Diploma in Nursing with 2-3 years experience.
To apply for Nurses Job position, you can send your resume to the following address :
Al Salam International Hospital
Human Resources Department
Email: hr@sih-kw.com
Fax No. (00965) 22540167 or (00965) 22512351
Nurses and Paramedic Job in Dubai
Looking for Job in Dubai? Recently, The Canadian Specialist Hospital (CSH) open position in career opportunity for the Nurses and Paramedic Staff to join with them as healthcare provider in Dubai. To improve their service to the patient, The Canadian Specialist Hospital has many expert and professional worker including Nurses, Paramedic, physicians, social workers, dietitians, physiotherapist, occupational therapist and also respiratory therapists.The Canadian Specialist Hospital is one of big private hospital in Dubai. They has a World Class medical facility that will cater to the tertiary health care needs of the Middle East. There are about 25 department in the Canadian Specialist Hospital ;
Rehabilitation, Ear, Nose and Throat, Anesthesiology, Audiology, Cardiology (Interventional cathlab), Nephrology / Kidney dialysis, Neuro surgery / Brain & Spinal surgery, Dental Surgery Department, Dermatology, Dietary Counseling Clinic, Emergency Medicine, Endocrinology / Diabetes, Gastroenterology, General surgery, Laboratory & Blood bank, Obstetrics & Gynecology, Ophthalmology, Orthopedic, Pediatrics, Pharmacy & Medicines, Plastic Surgery, Preventive Health Services, Pulmonology, Radio Diagnostic and Urology.
Job Position for Nurses and Paramedic :
- Registered Nurse : ICU / CCU, O/R : Recovery Nurse, Endoscopy, Midwife
- Registered Nurse Medical Surgical (Orthopedic Experience required).
- Nursing Supervisor, midwife (Part time/Full time)
- Dental Nurse
- Dental Assistant
- Paramedic
Working as nurses and paramedic staff at Canadian Specialist Hospital you will get facility such as housing and transportation. The hospital also offering attractive salary to the nurses.
Only those candidate who qualified and in short list will get contact from them. The nurses and paramedic who interest for this job position they can send their CV to the e-mail : HR@CSH.AE.
Pneumococcal's Vaccine (Prevnar)
Pneumococcal disease are infections caused by the bacteria Streptococcus pneumoniae, which also known as pneumococcus. The most common types of infections caused by this bacteria are include middle ear infections, pneumonia, blood stream infections (bacteremia), sinus infections, and meningitis. Pneumococcal diseases is a very serious illness in young children which can cause brain damage. In rare cases, Pneumococcal diseases can cause of death.
Young children are much more likely than older children and adults to get pneumococcal disease. Children under 2, children in group child care, and children who have certain illnesses (for example sickle cell disease, HIV infection, chronic heart or lung conditions) are at higher risk than other children to get pneumococcal disease.
US Food and Drug Administration (FDA) as an agency of the United States Department of Health and Human Services, on February 17, 2000 approved the first vaccine to prevent invasive pneumococcal diseases (IPD) in infants and toddlers. This vaccine is Pneumococcal 7-valent Conjugate Vaccine (Diphtheria CRM197Protein) and marketed as Prevnar by a unit of Wyeth-Ayerst Laboratories, a Division of American Home Products Corporation in Philadelphia, Pennsylvania.
Prevnar is the first multivalent conjugate pneumococcal vaccine for children under the age of two. The vaccine has composition (Ingredients) such as Streptococcus pneumoniae, diphtheria CRM protein, casamino acids, yeast extract, ammonium sulphate, aluminium.
The vaccine should be given to all infants <> At 2, 4, and 6 months of age, followed by a booster dose at 12-15 months of age ;
Children who are unvaccinated and are 7 to 11 months of age should be given a total of 3 doses (2 months apart)
Children age 12 to 23 months should be given a total of 2 doses at least two months apart
Most children who are 24 months of age or older only need one dose of the vaccine
The Advisory Committee on Immunization Practices (ACIP) also recommends this vaccine be given to children age 24 to 59 months at highest risk of infection, including those with certain illness (sickle cell anemia, HIV infection, chronic lung or heart disease).
Important Safety Information
In clinical trials (n=18,168), the most frequently reported adverse events included injection site reactions, fever (>=38ْ C/100.4ْ F), irritability, drowsiness, restless sleep, decreased appetite, vomiting, diarrhea and rash.
Risks are associated with all vaccines, including PREVNAR. Hypersensitivity to any vaccine component including diphtheria toxoid, Thrombocytopenia or any coagulation disorder, Adults - especially pregnant and lactating women , are a contraindication to its use. PREVNAR does not provide 100% protection against vaccine serotypes or protect against nonvaccine serotypes.
Young children are much more likely than older children and adults to get pneumococcal disease. Children under 2, children in group child care, and children who have certain illnesses (for example sickle cell disease, HIV infection, chronic heart or lung conditions) are at higher risk than other children to get pneumococcal disease.
US Food and Drug Administration (FDA) as an agency of the United States Department of Health and Human Services, on February 17, 2000 approved the first vaccine to prevent invasive pneumococcal diseases (IPD) in infants and toddlers. This vaccine is Pneumococcal 7-valent Conjugate Vaccine (Diphtheria CRM197Protein) and marketed as Prevnar by a unit of Wyeth-Ayerst Laboratories, a Division of American Home Products Corporation in Philadelphia, Pennsylvania.
Prevnar is the first multivalent conjugate pneumococcal vaccine for children under the age of two. The vaccine has composition (Ingredients) such as Streptococcus pneumoniae, diphtheria CRM protein, casamino acids, yeast extract, ammonium sulphate, aluminium.
The vaccine should be given to all infants <> At 2, 4, and 6 months of age, followed by a booster dose at 12-15 months of age ;
The Advisory Committee on Immunization Practices (ACIP) also recommends this vaccine be given to children age 24 to 59 months at highest risk of infection, including those with certain illness (sickle cell anemia, HIV infection, chronic lung or heart disease).
Important Safety Information
In clinical trials (n=18,168), the most frequently reported adverse events included injection site reactions, fever (>=38ْ C/100.4ْ F), irritability, drowsiness, restless sleep, decreased appetite, vomiting, diarrhea and rash.
Risks are associated with all vaccines, including PREVNAR. Hypersensitivity to any vaccine component including diphtheria toxoid, Thrombocytopenia or any coagulation disorder, Adults - especially pregnant and lactating women , are a contraindication to its use. PREVNAR does not provide 100% protection against vaccine serotypes or protect against nonvaccine serotypes.
Breast Cancer Disease
Breast cancer is a malignant tumor that has developed from cells of the breast. Breast cancer is fairly common. In men, breast cancer is very rare. Breast cancer is not exclusively a disease of women, however. Breast cancer is the most lethal form of cancer for women in the world. Breast cancer is the leading cause of death for women between the ages of 35 and 55. In Arizona and Canada, breast cancer is the leading form of cancer among women. The highest recorded incidence of male breast cancer is in parts of Brazil, Colombia, Hungary, and Singapore, though it is not clear why. The Breast cancer is the most frequently diagnosed cancer (other than skin cancer) in women.
Cause of Breast Cancer
The cause of breast cancer is unknown. The most deadly feature of breast cancer is when it disperses from the breast, causing tumours to develop in other parts of the body. Breast cancer is life-threatening because it spreads to vital organs. A family history of breast cancer is one of the few identified and most consistent determinants of breast cancer risk. The relationship between alcohol consumption and the risk of breast cancer is currently the focus of much research (Alcohol can cause breast cancer by increasing levels of the hormone oestrogen). The relationship between race, ethnicity, and breast cancer is complex. Many rumor and suggest that the leading cause of breast cancer is the use of deodorants and antiperspirants. Radiation as a cause of breast cancer. Postmenopausal Hormone Therapy Cause Breast Cancer.
Bumping, bruising, pinching, or touching the breast does not cause breast cancer. While it is questionable that additional awareness of breast cancer is useful, in the case of domestic violence, more coverage would be helpful. In fact, breast cancer is still a rare occurrence in young women. Breast cancer is also far more common in post-menopausal women and the risk continues to increase with rising age.
Researchers now understand that breast cancer is not one disease, but many different diseases. Many people with Paget's disease of the nipple also have a breast cancer somewhere else in the same breast. Proliferative breast disease (PBD) is a significant risk factor for the development of breast cancer and appears to be a precursor lesion. Current use of hormone-replacement therapy (HRT) increases the incidence of breast cancer.
Type of Breast Cancer
There are 3 types of breast cancer;
Sign and Symptom of Breast Cancer
Symptoms may not always be severe, but can cause a lot of discomfort. If a woman has any breast symptoms it is very important that she consult her doctor so that the cause of these symptoms can be found. Bellow are some sign and symptom that you may put attention to check your self to the dokter :
- A new lump in the breast
- A lump that has changed
- change in the size or shape of the breast
- Pain in the breast or nipple that does not go away
- Skin anywhere on the breast that is flaky, red, or swollen
- A nipple that is very tender or that suddenly turns inward
- Fluid coming from the nipple when not nursing a baby
Treatment for Breast Cancer
In th Breast cancer is identified by type, and the type will be a determining factor in treatment. When breast cancer is diagnosed, tests will be done to find out if the cancer has spread from the breast to other parts of the body. Calcium deficiency may cause breast cancer spread, David Douglas said on his Book which released 10/19/2007. Drug for Advanced Breast Cancer Is Also Found Effective in Early Treatment.
Research new approach, chemotherapy would be mostly for the 30 percent of women whose not fueled by estrogen. Women with a fibrocystic disease should continue to do breast self-examination. Until now, the adjuvant therapy for breast cancer is a complex one. Aromatase inhibitors as adjuvant endocrine therapy for post-menopausal women with hormone receptor-positive early breast cancer. Adjuvant therapy after surgery for breast cancer has provided significant benefits to patients at risk of relapse.
Post Breast Therapy Pain Syndrome (PBTPS) remains an underreported-yet often debilitating-consequence of breast cancer therapy. Treatments are improving all the time, and new drugs are on the horizon waiting to be implemented into the adjuvant therapy of breast cancer.
The cause of breast cancer is unknown. The most deadly feature of breast cancer is when it disperses from the breast, causing tumours to develop in other parts of the body. Breast cancer is life-threatening because it spreads to vital organs. A family history of breast cancer is one of the few identified and most consistent determinants of breast cancer risk. The relationship between alcohol consumption and the risk of breast cancer is currently the focus of much research (Alcohol can cause breast cancer by increasing levels of the hormone oestrogen). The relationship between race, ethnicity, and breast cancer is complex. Many rumor and suggest that the leading cause of breast cancer is the use of deodorants and antiperspirants. Radiation as a cause of breast cancer. Postmenopausal Hormone Therapy Cause Breast Cancer.
Bumping, bruising, pinching, or touching the breast does not cause breast cancer. While it is questionable that additional awareness of breast cancer is useful, in the case of domestic violence, more coverage would be helpful. In fact, breast cancer is still a rare occurrence in young women. Breast cancer is also far more common in post-menopausal women and the risk continues to increase with rising age.
Researchers now understand that breast cancer is not one disease, but many different diseases. Many people with Paget's disease of the nipple also have a breast cancer somewhere else in the same breast. Proliferative breast disease (PBD) is a significant risk factor for the development of breast cancer and appears to be a precursor lesion. Current use of hormone-replacement therapy (HRT) increases the incidence of breast cancer.
There are 3 types of breast cancer;
- Ductal carcinoma in situ, is an early breast cancer in the milk ducts. It can be detected by mammograms and is normally easy to cure.
- Lobular carcinoma in situ, this is not considered to be breast cancer but a pre-cancerous condition. They just have an increased risk of breast cancer, so they are given frequent checkups.
- Invasive lobular carcinoma, is a breast cancer that starts in the lobules and has spread. It's may difficult to diagnose because they do not always form a lump or show up on mammograms.
Symptoms may not always be severe, but can cause a lot of discomfort. If a woman has any breast symptoms it is very important that she consult her doctor so that the cause of these symptoms can be found. Bellow are some sign and symptom that you may put attention to check your self to the dokter :
- A new lump in the breast
- A lump that has changed
- change in the size or shape of the breast
- Pain in the breast or nipple that does not go away
- Skin anywhere on the breast that is flaky, red, or swollen
- A nipple that is very tender or that suddenly turns inward
- Fluid coming from the nipple when not nursing a baby
In th Breast cancer is identified by type, and the type will be a determining factor in treatment. When breast cancer is diagnosed, tests will be done to find out if the cancer has spread from the breast to other parts of the body. Calcium deficiency may cause breast cancer spread, David Douglas said on his Book which released 10/19/2007. Drug for Advanced Breast Cancer Is Also Found Effective in Early Treatment.
Research new approach, chemotherapy would be mostly for the 30 percent of women whose not fueled by estrogen. Women with a fibrocystic disease should continue to do breast self-examination. Until now, the adjuvant therapy for breast cancer is a complex one. Aromatase inhibitors as adjuvant endocrine therapy for post-menopausal women with hormone receptor-positive early breast cancer. Adjuvant therapy after surgery for breast cancer has provided significant benefits to patients at risk of relapse.
Post Breast Therapy Pain Syndrome (PBTPS) remains an underreported-yet often debilitating-consequence of breast cancer therapy. Treatments are improving all the time, and new drugs are on the horizon waiting to be implemented into the adjuvant therapy of breast cancer.
Drugs as Medicine to Treatment of Disease
Antihistamines: Antihistamines are used for symptomatic relief from allergic rhinitis (hay fever) including runny nose, sneezing, itching of the nose or throat, and itchy and watery eyes. The anticholinergic effects of antihistamines may cause a thickening of bronchial secretions; therefore, these agents may be counterproductive in respiratory conditions characterized by congestion. Antihistamines may cause drowsiness.Xanthines: Xanthines, primarily theophylline, relieve bronchial spasm by direct action on the bronchial smooth muscle in bronchospastic conditions such as asthma and chronic bronchitis. Some xanthine-containing combination products are available over-the-counter, but asthmatic patients should use them only under physician supervision.
Sympathomimetics: Sympathomimetics are used for their vasoconstrictor/decongestant or bronchodilator effects.
Decongestants: Decongestants are used for temporary relief of nasal congestion due to colds or allergy. Given orally, they are less effective than topical nasal decongestants and have a potential for systemic side effects. Frequent or prolonged topical use may lead to local irritation and rebound congestion.
Bronchodilators: Ephedrine is common in these combinations; however, it stimulates cardiac (b1) receptors. Bronchodilation is weaker than with the catecholamines: a-adrenergic effects may decrease congestion of mucous membranes. Other b-active agents are effective bronchodilators, but pseudoephedrine is not.
Analgesics: Analgesics (eg, acetaminophen, aspirin, ibuprofen, sodium salicylate) are frequently included for symptoms of headache, fever, muscle aches, and pain.
Anticholinergics: Anticholinergics are included for their drying effects on mucous secretions. This action may be beneficial in acute rhinorrhea; however, drying of respiratory secretions may lead to obstruction. Traditionally, anticholinergics have been avoided in patients with asthma or chronic obstructive pulmonary disease (COPD); however, some patients respond well to these agents. Caution is still advised in this group. An anticholinergic for oral inhalation is available as a bronchodilator for maintenance of bronchospasm associated with COPD, including chronic bronchitis and emphysema.
Papaverine HCl: Papaverine HCl relaxes the smooth muscle of the bronchial tree and tractus duodenum, this drug mostly use for the diarrhea patients.
Barbiturates: Barbiturates are included for their sedative effects as “correctives” in combination with xanthines or sympathomimetics, which may cause CNS stimulation. The sedative efficacy of low doses (eg, 8 mg phenobarbital) is questionable.
Caffeine: Caffeine is included in some combinations for CNS stimulation to counteract antihistamine depression and to enhance concomitant analgesics.
Barbiturates, prochlorperazine, hydroxyzine, meprobamate, chlordiazepoxide: These components are used as sedatives and antianxiety agents.
Ergotamine tartrate: Ergotamine tartrate provides inhibition of the sympathetic nervous system.
Kaolin: Kaolin is used for its adsorbent properties.
Narcotic analgesics: Codeine, hydrocodone bitartrate, dihydrocodeine bitartrate, opium, oxycodone HCl, oxycodone terephthalate, meperidine HCl, propoxyphene HCl, propoxyphene napsylate.
Nonnarcotic analgesics: Acetaminophen, salicylates, salicylamide. Caffeine, a traditional component of many analgesic formulations, may be beneficial to certain vascular headaches.
Magnesium-aluminum hydroxides and calcium carbonate: Magnesium-aluminum hydroxides and calcium carbonate are used as buffers.
Barbiturates, acetylcarbromal, carbromal, and bromisovalum: Barbiturates, acetylcarbromal, carbromal, and bromisovalum are used for their sedative effects.
Promethazine HCl: Promethazine HCl (a phenothiazine derivative with antihistamine properties) is used for its sedative effect.
Belladonna alkaloids: Belladonna alkaloids are used as an antispasmodic.
Barbiturates, meprobamate, and antihistamines: Barbiturates, meprobamate, and antihistamines are used for their sedative effects.
Antacids: Antacids are used to minimize gastric upset from salicylates.
Caffeine: Caffeine, a traditional component of many analgesic formulations, may be beneficial in treating certain vascular headaches.
Belladonna: Belladonna alkaloids are used as antispasmodics, the medicine which popular for the colic abdominal patients.
Pamabrom: Pamabrom is used as a diuretic.
Cinnamedrine: Cinnamedrine, a sympathomimetic amine claimed to have a relaxant effect in the uterus, is used in products for premenstrual syndrome. Its real value has not been established.
Loss, Grief and End-of-Life Care
People are complex, biopsychosocial beings. When they become ill, undergo diagnosis for altered health states, experience a loss, or progress into the end stage of life, their responses are the result of the complex interaction of biopsychosocial changes that occur. Because we live in a culture marked by dramatically different responses to the experiences of loss and grief, nurses often feel inadequate in planning interventions to facilitate grief management and the healing process.A. Loss
The concept of loss can be defined in several ways. The following definitions have been selected to familiarize the student with the concept of loss:
- Change in status of a significant object
- Any change in an individual's situation that reduces the probability of achieving implicit or explicit goals
- An actual or potential situation in which a valued object, person, or other aspect is inaccessible or changed so that it is no longer perceived as valuable
- A condition whereby an individual experiences deprivation of, or complete lack of, something that was previously present
Everyone has experienced some type of major loss at one time or another. Clients with psychiatric disorders, such as depression or anxiety, commonly describe the loss of a spouse, relative, friend, job, pet, home, or personal item.
A loss may occur suddenly (eg, death of a child due to an auto accident) or gradually (eg, loss of a leg due to the progression of peripheral vascular disease). It may be predictable or occur unexpectedly. Loss has been referred to as actual (the loss has occurred or is occurring), perceived (the loss is recognized only by the client and usually involves an ideal or fantasy), anticipatory (the client is aware that a loss will occur), temporary, or permanent.
For example, a 65-year-old married woman with the history of end stage renal disease is told by her physician that she has approximately 12 months to live. She may experience several losses that affect not only her, but also her husband and family members, as her illness gradually progresses. The losses may include a predictable decline in her physical condition, a perceived alteration in her relationship with her husband and family, and a permanent role change within the family unit as she anticipates the progression of her illness and actual loss of life.
Whether the loss is traumatic or temperate to the client and her family depends on their past experience with loss; the value the family members place on the loss of their mother/wife; and the cultural, psychosocial, economic, and family supports that are available to each of them. Box 6-1 describes losses identified by student nurses during their clinical experiences.
- Loss of spouse, friend, and companion. The client was a 67-year-old woman admitted to the psychiatric hospital for treatment of depression following the death of her husband. During a group discussion that focused on losses, the client stated that she had been married for 47 years and had never been alone. She described her deceased husband as her best friend and constant companion. The client told the student and group that she felt better after expressing her feelings about her losses.
- Loss of physiologic function, social role, and independence because of kidney failure. A 49-year-old woman was admitted to the hospital for improper functioning of a shunt in her left forearm. She was depressed and asked that no visitors be permitted in her private room. She shared feelings of loneliness, helplessness, and hopelessness with the student nurse as she described the impact of kidney failure and frequent dialysis treatment on her lifestyle. Once an outgoing, independent person, she was housebound because of her physical condition and presented what her kidneys were doing to her.
B. Grief
Grief is a normal, appropriate emotional response to an external and consciously recognized loss. It is usually time-limited and subsides gradually. Staudacher (1987, p. 4) refers to grief as a “stranger who has come to stay in both the heart and mind.†Mourning is a term used to describe an individual's outward expression of grief regarding the loss of a love object or person.
The individual experiences emotional detachment from the object or person, eventually allowing the individual to find other interests and enjoyments. Some individuals experience a process of grief known as bereavement (eg, feelings of sadness, insomnia, poor appetite, deprivation, and desolation). The grieving person may seek professional help for relief of symptoms if they interfere with activities of daily living and do not subside within a few months of the loss.
The grief process is all-consuming, having a physical, social, spiritual, and psychological impact on an individual that may impair daily functioning. Feelings vary in intensity, tasks do not necessarily follow a particular pattern, and the time spent in the grieving process varies considerably from weeks to years (Schultz & Videbeck, 2002).
- Denial: During this stage the person displays a disbelief in the prognosis of inevitable death. This stage serves as a temporary escape from reality. Fewer than 1% of all dying clients remain in this stage. Typical responses include: No, it can't be true, It isn't possible, and No, not me. Denial usually subsides when the client realizes that someone will help him or her to express feelings while facing reality.
- Anger: Why me? Why now? and it's not fair! are a few of the comments commonly expressed during this stage. The client may appear difficult, demanding, and ungrateful during this stage.
- Bargaining: Statements such as; If I promise to take my medication, will I get better? or If I get better, I'II never miss church again? are examples of attempts at bargaining to prolong one's life. The dying client acknowledges his or her fate but is not quite ready to die at this time. The client is ready to take care of unfinished business, such as writing a will, deeding a house over to a spouse or child, or making funeral arrangements as he or she begins to anticipate various losses, including death.
- Depression: This stage is also a very difficult period for the family and physician because they feel helpless watching the depressed client mourn present and future losses. The dying patient is about to lose not just one loved person but everyone he has ever loved and everything that has been meaningful to him. (Kubler-Ross, 1971, p. 58).
- Acceptance: At this stage the client has achieved an inner and outer peace due to a personal victory over fear: “I'm ready to die. I have said all the goodbyes and have completed unfinished business. During this stage, the client may want only one or two significant people to sit quietly by the client's side, touching and comforting him or her.
Several authors have described grief as a process that includes various stages, characteristic feelings, experiences, and tasks. Staudacher (1987) states there are three major stages of grief: shock, disorganization, and reorganization.
Westberg (1979) describes ten stages of grief work, beginning with the stage of shock and progressing through the stages of expressing emotion, depression and loneliness, physical symptoms of distress, panic, guilt feelings, anger and resentment, resistance, hope, and concluding with the stage of affirming reality.
Kubler-Ross (1969) identifies five stages of the grieving process including denial, anger, bargaining, depression, and acceptance; however, progression through these stages does not necessarily occur in any specific order. Her basic premise has evolved as a result of her work with dying persons.
C. End-of-Life Care
End-of-life care refers to the nursing care given during the final weeks of life when death is imminent. The American culture is marked by dramatically different responses to the experience of death. On one hand, death is denied or compartmentalized with the use of medical technology that prolongs the dying process and isolates the dying person from loved ones.
On the other hand, death is embraced as a frantic escape from apparently meaningless suffering through means such as physician-assisted suicide. Both require compassionate responses rooted in good medical practice and personal religious beliefs.
The Patient Self-Determination Act (PSDA), passed in 1990, states that every competent individual has the right to make decisions about his or her health care and is encouraged to make known in advance directives (AD; legal documents specifying care) end-of-life preferences, in case the individual is unable to speak on his or her own behalf (Allen, 2002; Robinson & Kennedy-Schwarz, 2001).
Rheumatic Heart Disease
Rheumatic heart disease (RHD) is a condition in which permanent damage to heart valves is caused by rheumatic fever. Rheumatic fever begins with a strep throat from streptococcal (STREP'to-KOK'al) infection. As many as 39% of patients with acute rheumatic fever may develop varying degrees of pancarditis with associated valve insufficiency, heart failure, pericarditis, and even death.
With chronic rheumatic heart disease, patients develop valve stenosis with varying degrees of regurgitation, atrial dilation, arrhythmias, and ventricular dysfunction. Chronic rheumatic heart disease remains the leading cause of mitral valve stenosis and valve replacement in adults in many countries including in Indonesia.
What are the symptoms of rheumatic heart disease?
The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. When symptoms do appear, they may depend on the extent and location of the heart damage. The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. When symptoms do appear, they may depend on the extent and location of the heart damage.
How to treat of rheumatic heart disease :
Medical therapy is directed toward eliminating the group A streptococcal pharyngitis (if still present), suppressing inflammation from the autoimmune response, and providing supportive treatment for congestive heart failure. But the specific treatment for rheumatic heart disease will be determined by your physician based on:
Since rheumatic fever is the cause of rheumatic heart disease, the best treatment is to prevent rheumatic fever from occurring. Oral penicillin V remains the drug of choice for treatment of group A streptococcal pharyngitis. When oral penicillin is not feasible or dependable, a single dose of intramuscular benzathine penicillin G is therapeutic. For patients who are allergic to penicillin, administer erythromycin or a first-generation cephalosporin.
Other options include clarithromycin for 10 days, azithromycin for 5 days, or a narrow-spectrum (first-generation) cephalosporin for 10 days. To reduce inflammation, aspirin, steroids, or non-steroidal medications may be given. Surgery may be necessary to repair or replace the damaged valve.
Can Rheumatic Heart Disease be Prevented?
The best way to prevent rheumatic heart disease is to seek immediate medical attention to a strep throat and not let it progress to rheumatic fever. The Nurses also have a role in prevention, primarily in screening school-aged children for sore throats that may be caused by Group A streptococci(especially Group A β Hemolytic Streptococcus pyogenes).
Persons who have previously contracted rheumatic fever are often given continuous (daily or monthly) antibiotic treatments, possibly for life, to prevent future attacks of rheumatic fever and lower the risk of heart damage.
With chronic rheumatic heart disease, patients develop valve stenosis with varying degrees of regurgitation, atrial dilation, arrhythmias, and ventricular dysfunction. Chronic rheumatic heart disease remains the leading cause of mitral valve stenosis and valve replacement in adults in many countries including in Indonesia.
The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. When symptoms do appear, they may depend on the extent and location of the heart damage. The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. When symptoms do appear, they may depend on the extent and location of the heart damage.
- Fever.
- Weight loss.
- Fatigue.
- Stomach pains.
- Joint inflammation - including swelling, tenderness, and redness over multiple joints. The joints affected are usually the larger joints in the knees or ankles. The inflammation "moves" from one joint to another over several days.
- Small nodules or hard, round bumps under the skin.
- A change in your child's neuromuscular movements (this is usually noted by a change in your child's handwriting and may also include jerky movements).
- Rash (a pink rash with odd edges that is usually seen on the trunk of the body or arms and legs).
Medical therapy is directed toward eliminating the group A streptococcal pharyngitis (if still present), suppressing inflammation from the autoimmune response, and providing supportive treatment for congestive heart failure. But the specific treatment for rheumatic heart disease will be determined by your physician based on:
- your overall health and medical history
- extent of the disease
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
Since rheumatic fever is the cause of rheumatic heart disease, the best treatment is to prevent rheumatic fever from occurring. Oral penicillin V remains the drug of choice for treatment of group A streptococcal pharyngitis. When oral penicillin is not feasible or dependable, a single dose of intramuscular benzathine penicillin G is therapeutic. For patients who are allergic to penicillin, administer erythromycin or a first-generation cephalosporin.
Other options include clarithromycin for 10 days, azithromycin for 5 days, or a narrow-spectrum (first-generation) cephalosporin for 10 days. To reduce inflammation, aspirin, steroids, or non-steroidal medications may be given. Surgery may be necessary to repair or replace the damaged valve.
The best way to prevent rheumatic heart disease is to seek immediate medical attention to a strep throat and not let it progress to rheumatic fever. The Nurses also have a role in prevention, primarily in screening school-aged children for sore throats that may be caused by Group A streptococci(especially Group A β Hemolytic Streptococcus pyogenes).
Persons who have previously contracted rheumatic fever are often given continuous (daily or monthly) antibiotic treatments, possibly for life, to prevent future attacks of rheumatic fever and lower the risk of heart damage.
Management of Acute Hypersensitivity Reactions
Friday, September 26, 2008
Management of Acute Hypersensitivity Reactions
Type I Hypersensitivity reactions are immunologic responses to a foreign antigen to which a patient has been previously sensitized (immediate hypersensitivity or anaphylaxis). Anaphylactoid reactions are not immunologically mediated; however, symptoms and treatment are similar.
Acute hypersensitivity reactions typically begin within 1 to 30 minutes of exposure to the offending antigen. Tingling sensations and a generalized flush may proceed to a fullness in the throat, chest tightness, or a “feeling of impending doom.” Urticaria and sweating are most common sign and symtomp of acute hypersensitivity reactions. Severe reactions include life-threatening involvement of the airway and cardiovascular system.
When this case is happened , an appropriate and immediate treatment is imperative. The following general measures are commonly employed to the patient who has acute hypersensitivity reactions :
- Administered of Epinephrine.
Epinephrine Sub Cutaneouse (SC) Injection : 1:1000, 0.2 to 0.5 mg (0.2 to 0.5 ml) is primary treatment. In children, administer 0.01 mg/kg or 0.1 mg. Doses may be repeated every 5 to 15 minutes if needed. A succession of small doses is more effective and less dangerous than a single large dose. Additionally, 0.1 mg may be introduced into an injection site where the offending drug was administered. If appropriate, the use of a tourniquet above the site of injection of the causative agent may slow its absorption and distribution. However, remove or loosen the tourniquet every 10 to 15 minutes to maintain circulation.
Epinephrine Intravenouse (IV) Injection as general indicated in the presence of hypotension is often recommended in a 1:10,000 dilution, 0.3 to 0.5 mg over 5 minutes; repeat every 15 minutes, if necessary. In children, inject 0.1 to 0.2 mg or 0.01 mg/kg/dose over 5 minutes; repeat every 30 minutes.
A conservative IV epinephrine protocol includes 0.1 mg of a 1:100,000 dilution (0.1 mg of a 1:1000 dilution mixed in 10 ml normal saline) given over 5 to 10 minutes. If an IV infusion is necessary, administer at a rate of 1 to 4 mcg/min. In children, infuse 0.1 to 1.5 (maximum) mcg/kg/min.
Giving epinephrine 1:10,000 through an endotracheal tube is a possible way, if no other parenteral access is available, directly into the bronchial tree. It is rapidly absorbed there from the capillary bed of the lung. - Check for Airway.
Ensure a patent airway via endotracheal intubation or cricothyrotomy (ie, inferior laryngotomy, used prior to tracheotomy) and administer oxygen. Severe respiratory difficulty may respond to IV aminophylline or to other bronchodilators. - Check for Blood Pressure.
Hypotension in acute hypersensitivity reactions is should be recumbent with feet elevated. Depending upon the severity, consider the following measures :
- Establish a patent IV catheter in a suitable vein.
- Administer IV fluids (eg, Normal Saline, Lactated Ringer's).
- Administer plasma expanders.
- Administer cardioactive agents (see group and individual monographs). Commonly recommended agents include dopamine, dobutamine, norepinephrine, and phenylephrine. - Adjunctive therapy.
Adjunctive therapy does not alter acute reactions, but may modify an ongoing or slow-onset process and shorten the course of the reaction.
- Antihistamines : Diphenhydramine 50 to 100 mg IM or IV, continued orally at 5 mg/kg/day or 50 mg every 6 hours for 1 to 2 days. For children, give 5 mg/kg/day, maximum 300 mg/day. Chlorpheniramine Adults, 10 to 20 mg; children, 5 to 10 mg IM or slowly IV. Hydroxyzine 10 to 25 mg orally or 25 to 50 mg IM 3 to 4 times daily.
- Corticosteroids : Eg, hydrocortisone IV 100 to 1000 mg or equivalent, followed by 7 mg/kg/day IV or oral for 1 to 2 days. The role of corticosteroids is controversial.
- H2 antagonists : Cimetidine Children, 25 to 30 mg/kg/day IV in 6 divided doses; Adults, 300 mg every 6 hours. Ranitidine 50 mg IV over 3 to 5 minutes. May be of value in addition to H1 antihistamines, although this opinion is not universally shared.
External Radiation Therapy
Friday, November 28, 2008
External Radiation Therapy
All cancer patients, About 60% are treated with some form of external radiation therapy (radiotherapy). This treatment delivers X-rays or gamma-rays directly to the cancer place. Radiotherapy effects are local because only the area being treated experiences direct effects.
Radiation doses are based on the type, stage, and location of the tumor as well as on the patient's size, condition and overall treatment goals. Radiation doses are given in increments, usually three to five times a week, until the total dose is reached. The goals of radiation therapy include cure, in which the cancer is completely destroyed and not expected to recur; control, in which the cancer doesn't progress or regress but is expected to progress at some later time; or palliation, in which radiation is given to relieve symptoms caused by the cancer (such as bone pain, bleeding, and headache).
External beam radiation therapy is delivered by machines that aim a concentrated beam of high-energy particles (photons and gamma rays) at the target site. There are two types of radiotherapy machines; units containing cobalt or cesium as radioactive sources for gamma rays, and linear accelerators that use electricity to produce X-rays.
Linear accelerators produce high energy with great penetrating ability. Some (known as orthovoltage machines) produce less powerful electron beams that may be used for superficial tumors.
Radiation therapy may be augmented by chemotherapy, brachytherapy (radiation implant therapy), or surgery, as needed.
Equipment for Radiotherapy Procedure
Radiation therapy machine need for film badge or pocket dosimeter.
Implementation of Radiotherapy Procedure
1. Explain the treatment to the patient and his family.
Review the treatment goals, and discuss the range of potential adverse effects as well as interventions to minimize them. Also discuss possible long-term complications and treatment issues. Educate the patient and his family about local cancer services.
2. Make sure the radiation oncology department has obtained informed consent.
3. Review the patient's clinical record for recent laboratory and imaging results, and alert the radiation oncology staff to any abnormalities or other pertinent results (such as myelosuppression, paraneoplastic syndromes, oncologic emergencies, and tumor progression).
4. Transport the patient to the radiation oncology department.
5. The patient begins by undergoing simulation (treatment planning), in which the target area is mapped out on his body using a machine similar to the radiation therapy machine. Then the target area is tattooed or marked in ink on his body to ensure accurate treatments.
6. The physician and radiation oncologist determine the duration and frequency of treatments, depending on the patient's body size, size of portal, extent and location of cancer, and treatment goals.
7. The patient is positioned on the treatment table beneath the machine. Treatments last from a few seconds to a few minutes. Reassure the patient that he won't feel anything and won't be radioactive. After treatment is complete, the patient may return home or to his room.
Special considerations
1. Explain to the patient that the full benefit of radiation treatments may not occur until several weeks or months after treatments begin. Instruct him to report long-term adverse effects.
2. Emphasize the importance of keeping follow-up appointments with the physician.
3. Refer the patient to a support group, such as a local chapter of the American Cancer Society.
Home care after Radiotherapy done
Instruct the patient and his family about proper skin care and management of possible adverse effects.
Complications of Radiotherapy
Adverse effects arise gradually and diminish gradually after treatments. They may be acute, subacute (accumulating as treatment progresses), chronic (following treatment), or long-term (arising months to years after treatment). Adverse effects are localized to the area of treatment, and their severity depends on the total radiation dose, underlying organ sensitivity, and the patient's overall condition.
Common acute and subacute adverse effects can include altered skin integrity, altered GI and genitourinary function, altered fertility and sexual function, altered bone marrow production, fatigue, and alopecia.
Chronic and long-term complications or adverse effects may include radiation pneumonitis, neuropathy, skin and muscle atrophy, telangiectasia, fistulas, altered endocrine function, and secondary cancers.
Other complications of treatment include headache, alopecia, xerostomia, dysphagia, stomatitis, altered skin integrity (wet or dry desquamation), nausea, vomiting, heartburn, diarrhea, cystitis, and fatigue.
Documentation of Radiotherapy Procedure
Record radiation precautions taken during treatment; interventions used and their effectiveness; grading of adverse effects; teaching given to the patient and his family and their responses to it; the patient's tolerance of isolation procedures and the family's compliance with procedures; discharge plans and teaching; and referrals to local cancer services, if any.
Radiation doses are based on the type, stage, and location of the tumor as well as on the patient's size, condition and overall treatment goals. Radiation doses are given in increments, usually three to five times a week, until the total dose is reached. The goals of radiation therapy include cure, in which the cancer is completely destroyed and not expected to recur; control, in which the cancer doesn't progress or regress but is expected to progress at some later time; or palliation, in which radiation is given to relieve symptoms caused by the cancer (such as bone pain, bleeding, and headache).
External beam radiation therapy is delivered by machines that aim a concentrated beam of high-energy particles (photons and gamma rays) at the target site. There are two types of radiotherapy machines; units containing cobalt or cesium as radioactive sources for gamma rays, and linear accelerators that use electricity to produce X-rays.
Linear accelerators produce high energy with great penetrating ability. Some (known as orthovoltage machines) produce less powerful electron beams that may be used for superficial tumors.
Radiation therapy may be augmented by chemotherapy, brachytherapy (radiation implant therapy), or surgery, as needed.
Radiation therapy machine need for film badge or pocket dosimeter.
1. Explain the treatment to the patient and his family.
Review the treatment goals, and discuss the range of potential adverse effects as well as interventions to minimize them. Also discuss possible long-term complications and treatment issues. Educate the patient and his family about local cancer services.
2. Make sure the radiation oncology department has obtained informed consent.
3. Review the patient's clinical record for recent laboratory and imaging results, and alert the radiation oncology staff to any abnormalities or other pertinent results (such as myelosuppression, paraneoplastic syndromes, oncologic emergencies, and tumor progression).
4. Transport the patient to the radiation oncology department.
5. The patient begins by undergoing simulation (treatment planning), in which the target area is mapped out on his body using a machine similar to the radiation therapy machine. Then the target area is tattooed or marked in ink on his body to ensure accurate treatments.
6. The physician and radiation oncologist determine the duration and frequency of treatments, depending on the patient's body size, size of portal, extent and location of cancer, and treatment goals.
7. The patient is positioned on the treatment table beneath the machine. Treatments last from a few seconds to a few minutes. Reassure the patient that he won't feel anything and won't be radioactive. After treatment is complete, the patient may return home or to his room.
1. Explain to the patient that the full benefit of radiation treatments may not occur until several weeks or months after treatments begin. Instruct him to report long-term adverse effects.
2. Emphasize the importance of keeping follow-up appointments with the physician.
3. Refer the patient to a support group, such as a local chapter of the American Cancer Society.
Instruct the patient and his family about proper skin care and management of possible adverse effects.
Adverse effects arise gradually and diminish gradually after treatments. They may be acute, subacute (accumulating as treatment progresses), chronic (following treatment), or long-term (arising months to years after treatment). Adverse effects are localized to the area of treatment, and their severity depends on the total radiation dose, underlying organ sensitivity, and the patient's overall condition.
Common acute and subacute adverse effects can include altered skin integrity, altered GI and genitourinary function, altered fertility and sexual function, altered bone marrow production, fatigue, and alopecia.
Chronic and long-term complications or adverse effects may include radiation pneumonitis, neuropathy, skin and muscle atrophy, telangiectasia, fistulas, altered endocrine function, and secondary cancers.
Other complications of treatment include headache, alopecia, xerostomia, dysphagia, stomatitis, altered skin integrity (wet or dry desquamation), nausea, vomiting, heartburn, diarrhea, cystitis, and fatigue.
Record radiation precautions taken during treatment; interventions used and their effectiveness; grading of adverse effects; teaching given to the patient and his family and their responses to it; the patient's tolerance of isolation procedures and the family's compliance with procedures; discharge plans and teaching; and referrals to local cancer services, if any.
What is Spina bifida?
Spina bifida is a birth defect in central nervous system. It occurs as a result from neural tube failure to close during embryonic development. The term spina bifida comes from Latin and literally means "split" or "open" spine.
Spina bifida commonly occurs at the end of the first month of pregnancy when the two sides of the embryo's spine fail to join together, leaving an open area. In some cases, the spinal cord or other membranes may push through this opening in the back. The condition usually is detected before a baby is born and treated right away.
Type of Spina Bifida :
1. Spina Bifida Occulta :
Posterior vertebral arches fail to close in the lumbosacral area. Spinal cord remains intact and usually is not visible. Meninges are not exposed on the skin surface and neurological deficit are not usually present. In other word, Most children with this type of defect never have any health problems, and the spinal cord is often unaffected.
2. Spina Bifida Cystica/Manifesta:
The vertebra and neural tube close incomplete resulting in a saclike protrusion in the lumbar or sacral area. The defect includes meningocele, myelomeningocele, lipomeningocel, and lipomeningomyelocele.
Spina Bifida Cystica - Meningocele
The protrusion involves meninges and a saclike cyst that contains CSF in the midline of the back. Spinal cord is not involved and neurological deficits are usually not present.
Spina Bifida Cystica - Myelomeningocel
The protrusion involves meninges, CSF, nerve roots, and spinal cord. The sac is covered by a thin membrane that is prone to leakage or rupture. Neurological deficit are evident.
Signs and Symptoms of Spina Bifida :
Those patients were diagnosed as Spina Bifida, mostly they have sign and symptom bellow :
Nursing Intervention of Spina Bifida :
Treatment of Spina Bifida :
Currently, there is no cure for spina bifida, but there are a number of treatments available to help manage the disease and prevent complications. Initial goals of treatment include reducing neurological damage to your child, minimizing complications such as infections and helping your family learn about and cope with the disorder.
Children with the mildest form of the disease, spina bifida occulta, usually do not require treatment (and often not for meningocele.). The key priorities in the treatment of myelomeningocele are to prevent infection from developing through the exposed nerves and tissue of the defect on the spine and to protect the exposed nerves and structures from additional trauma.
Treatment of the severe form of spina bifida myelomeningocele depends on the specific problems caused by the spinal defect and may include surgery, physical therapy, and the use of braces and other aids.
Spina bifida commonly occurs at the end of the first month of pregnancy when the two sides of the embryo's spine fail to join together, leaving an open area. In some cases, the spinal cord or other membranes may push through this opening in the back. The condition usually is detected before a baby is born and treated right away.
Type of Spina Bifida :
1. Spina Bifida Occulta :
Posterior vertebral arches fail to close in the lumbosacral area. Spinal cord remains intact and usually is not visible. Meninges are not exposed on the skin surface and neurological deficit are not usually present. In other word, Most children with this type of defect never have any health problems, and the spinal cord is often unaffected.
2. Spina Bifida Cystica/Manifesta:
The vertebra and neural tube close incomplete resulting in a saclike protrusion in the lumbar or sacral area. The defect includes meningocele, myelomeningocele, lipomeningocel, and lipomeningomyelocele.
The protrusion involves meninges and a saclike cyst that contains CSF in the midline of the back. Spinal cord is not involved and neurological deficits are usually not present.
The protrusion involves meninges, CSF, nerve roots, and spinal cord. The sac is covered by a thin membrane that is prone to leakage or rupture. Neurological deficit are evident.
Signs and Symptoms of Spina Bifida :
Those patients were diagnosed as Spina Bifida, mostly they have sign and symptom bellow :
- Visible spinal defect
- Flaccid paralysis of the legs
- Hip and joint deformities
- Altered bladder and bowel function
- Specific signs and symptoms depend on the spinal cord involvement
Nursing Intervention of Spina Bifida :
- Assess the sac and measure the lesion
- Assess neurological system
- Assess and monitor for increasing ICP
- Measure head circumferences
- Protect the sac, cover with a sterile, moist (normal saline), nonadherent dressing and change the dressing every 2-4 hours
- Place patient in prone position and head to one side
- Use antiseptic technique
- Assess and monitor the sac for redness, clear or purulent drainage, abrasions, irritation, and signs of infection
- Assess for hip and joint deformities
- Administer medication: antibiotics, anticholinergics, and laxatives as prescribed
Treatment of Spina Bifida :
Currently, there is no cure for spina bifida, but there are a number of treatments available to help manage the disease and prevent complications. Initial goals of treatment include reducing neurological damage to your child, minimizing complications such as infections and helping your family learn about and cope with the disorder.
Children with the mildest form of the disease, spina bifida occulta, usually do not require treatment (and often not for meningocele.). The key priorities in the treatment of myelomeningocele are to prevent infection from developing through the exposed nerves and tissue of the defect on the spine and to protect the exposed nerves and structures from additional trauma.
Treatment of the severe form of spina bifida myelomeningocele depends on the specific problems caused by the spinal defect and may include surgery, physical therapy, and the use of braces and other aids.
Epistaxis (Nosebleeds)
Epistaxis is the relatively common occurrence of bleeding (hemorrhage) from the nose, usually noticed when the blood drains out through the nostrils.
A. Type of Epistaxis
There are two types ; Anterior from the nasal septum (Kiesselbach’s plexus) as most common cases. Anterior bleeding may also originate anterior to the inferior turbinate. Posterior from the nasal septum as less common cases. Posterior hemorrhage originates from branches of the sphenopalatine artery in the posterior nasal cavity or nasopharynx.
Sometimes in more severe cases, the blood can come up the nasolacrimal duct and out from the eye. Fresh blood and clotted blood can also flow down into the stomach and cause nausea and vomiting.
B. Sign and Symptoms
A common sign, epistaxis can be spontaneous or induced from the front or back of the nose. Bleeding usually occurs from only one nostril. If the bleeding is heavy enough, the blood can fill up the affected nostril and overflow into the nasopharynx (the area inside the nose where the two nostrils converge), causing simultaneous bleeding from the other nostril as well.
Blood can also drip into the back of the throat or down into the stomach, causing a person to spit up or even vomit blood. Signs of excessive blood loss include dizziness, weakness, confusion and fainting. Excessive blood loss from nosebleeds does not often occur.
C. Causes Of Epistaxis
D. Pathophysiology Of Epistaxis
Nosebleeds are due to the rupture of a blood vessel within the richly perfused nasal mucosa. Rupture may be spontaneous or initiated by trauma. Nosebleeds are reported in up to 60% of the population with peak incidences in those under the age of ten and over the age of 50 and appears to occur in males more than females.
An increase in blood pressure (e.g. due to general hypertension) or local blood flow (for example following a cold or infection) will increase the likelihood of a spontaneous nosebleed. Anticoagulant medication and disorders of blood clotting can promote and prolong bleeding. Spontaneous epistaxis is more common in the elderly as the nasal mucosa (lining) becomes dry and thin and blood pressure tends to be higher. The elderly are also more prone to prolonged nose bleeds as their blood vessels are less able to constrict and control the bleeding.
E. Nursing Measures in Epistaxis Cases
Image of Netcell Epistaxis Pack and Epistaxis Catheter
F. Nursing Diagnoses
Nursing dianoses on the patient with Epistaxis :
In case bleeding does not stop after 20 minutes, Medical team will think about suspect posterior nasal epistaxis. A relatively serious condition that may require intervention by an otolaryngologist. Treatment may include placement of a double-lumen posterior epistaxis balloon catheter and packing.
Nose bleeding occurs after an injury to the head, this may suggest a skull fracture and x-rays should be taken, the nose may be broken (for example, it is misshapen after a blow or injury).
A. Type of Epistaxis
There are two types ; Anterior from the nasal septum (Kiesselbach’s plexus) as most common cases. Anterior bleeding may also originate anterior to the inferior turbinate. Posterior from the nasal septum as less common cases. Posterior hemorrhage originates from branches of the sphenopalatine artery in the posterior nasal cavity or nasopharynx.
Sometimes in more severe cases, the blood can come up the nasolacrimal duct and out from the eye. Fresh blood and clotted blood can also flow down into the stomach and cause nausea and vomiting.
B. Sign and Symptoms
A common sign, epistaxis can be spontaneous or induced from the front or back of the nose. Bleeding usually occurs from only one nostril. If the bleeding is heavy enough, the blood can fill up the affected nostril and overflow into the nasopharynx (the area inside the nose where the two nostrils converge), causing simultaneous bleeding from the other nostril as well.
Blood can also drip into the back of the throat or down into the stomach, causing a person to spit up or even vomit blood. Signs of excessive blood loss include dizziness, weakness, confusion and fainting. Excessive blood loss from nosebleeds does not often occur.
C. Causes Of Epistaxis
- Most cases of epistaxis do not have an easily identifiable cause.
- Local trauma (ie, nose picking) is the most common cause, followed by facial trauma, foreign bodies, nasal or sinus infections, and prolonged inhalation of dry air. A disturbance of normal nasal airflow, as occurs in a deviated nasal septum, may also be a cause of epistaxis.
- Latrogenic causes include nasogastric and nasotracheal intubation.
- Children usually present with epistaxis due to local irritation or recent upper respiratory infection (URI).
- Oral anticoagulants and coagulopathy due to splenomegaly, thrombocytopenia, platelet disorders, or AIDS-related conditions predispose to epistaxis.
- The relationship between hypertension and epistaxis is implicated. Epistaxis is more common in hypertensive patients, and patients are more likely to be acutely hypertensive during an episode of epistaxis. Hypertension, however, is rarely a direct cause of epistaxis, and therapy should be focused on controlling hemorrhage before blood pressure reduction.
- Epistaxis is more prevalent in dry climates and during cold weather.
- Sclerotic vessels
- Hereditary hemorrhagic telangiectasia
- Arteriovenous malformation
- Neoplasm
- Septal perforation, deviation
- Endometriosis
D. Pathophysiology Of Epistaxis
Nosebleeds are due to the rupture of a blood vessel within the richly perfused nasal mucosa. Rupture may be spontaneous or initiated by trauma. Nosebleeds are reported in up to 60% of the population with peak incidences in those under the age of ten and over the age of 50 and appears to occur in males more than females.
An increase in blood pressure (e.g. due to general hypertension) or local blood flow (for example following a cold or infection) will increase the likelihood of a spontaneous nosebleed. Anticoagulant medication and disorders of blood clotting can promote and prolong bleeding. Spontaneous epistaxis is more common in the elderly as the nasal mucosa (lining) becomes dry and thin and blood pressure tends to be higher. The elderly are also more prone to prolonged nose bleeds as their blood vessels are less able to constrict and control the bleeding.
E. Nursing Measures in Epistaxis Cases
- Place patient in an upright position, leaning forward to reduce venous pressure
- Avoiding the patient to talk and let to breathe through his mouth
- Tell the Patient to firmly grasp and pinch his entire nose between the thumb and fingers for at least 10 minutes
- Compress the soft outer portion of the nose against the midline septum for about 5-10 minutes continuously
- Keep the head of the bed elevated 30 to 45 degrees for the next 4 hours.
- Tell to the patient not to blow his/her nose for several hours and to avoid lifting objects or bending at the waist for the next 24 hours.
- If symptoms persist assist the physician, They will do or order some of following treatments: application of topical anesthetic vasoconstrictor solution, such as a 4% lidocaine and topical epinephrine; topical chemical cauterization with silver nitrate; nasal tampon insertion; or insertion of up to 36 to 72 inches (90 to 180 cm) of ½ inch petroleum gauze packing into the nostril.
- Care of the gauze packing pack inside the nose and be remove after 24 hours
- Psychological support to the patient specially if packing is applied as he feels uncomfortable
F. Nursing Diagnoses
Nursing dianoses on the patient with Epistaxis :
- Risk for Deficient Fluid Volume (If excessive blood loss happened)
- Risk for Ineffective Breathing Pattern or Ineffective Airway Clearance (especially in children, they are going to be scared, so Fear is also another nursing diagnosis to consider).
In case bleeding does not stop after 20 minutes, Medical team will think about suspect posterior nasal epistaxis. A relatively serious condition that may require intervention by an otolaryngologist. Treatment may include placement of a double-lumen posterior epistaxis balloon catheter and packing.
Nose bleeding occurs after an injury to the head, this may suggest a skull fracture and x-rays should be taken, the nose may be broken (for example, it is misshapen after a blow or injury).
Management of Shock
Shock is a serious medical condition where the tissue perfusion is insufficient to meet demand for oxygen and nutrients because the body is not getting enough blood flow. This can damage multiple organs and can get worse very rapidly. This hypoperfusional state is a life-threatening medical emergency and one of the leading causes of death for critically ill people.
Major classes of shock include :
1. Hypovolemic Shock (caused by inadequate blood volume)
Hypovolemic shock is an emergency condition in which severe blood and fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.
Blood loss can be due to bleeding from cuts or other injury or internal bleeding such as gastrointestinal tract bleeding. The amount of blood in your body may drop when you lose too many other body fluids, which can happen with diarrhea, vomiting, burns, and other conditions.
Management of Shock
Symptom are :
Therapy are include :
2. Cardiogenic shock (associated with heart problems)
Cardiogenic shock is a disease state where the heart is damaged enough that it is unable to supply sufficient blood to the body. Most common causes are :
a). acute myocardial infarction
b). dilated cardiomyopathy, This is a serious disease in which the heart muscle becomes inflamed (enlarged and stretched) and doesn't work as well as it should.
c). acute myocarditis
d). arrhythmias
Symptoms are :
similar to hypovolaemic shock but in addition:
Therapy are include :
The main goals of the treatment of cardiogenic shock are the re-establishment of circulation to the myocardium, minimising heart muscle damage and improving the heart's effectiveness as a pump.
3. Septic shock (associated with infections)
Septic shock is a serious condition that occurs when an overwhelming infection leads to low blood pressure and low blood flow. The brain, heart, kidneys, and liver may not work properly or may fail.
Most common of this case may it’s happened to the patients with Meningococcemia, Waterhouse-Friderichsen syndrome, DIC (disseminated intravascular coagulation), Multiple organ dysfunction syndrome (MODS), Acute Respiratory Distress Syndrome (ARDS).
Symtomps are :
similar to hypovolaemic shock except in the first stages:
4. Neurogenic shock (caused by damage to the nervous system)
Neurogenic shock is shock caused by the sudden loss of the sympathetic nervous system signals to the smooth muscle in vessel walls. This can result from severe central nervous system (brain and spinal cord) damage. With the sudden loss of background sympathetic stimulation, the vessels suddenly relax resulting in a sudden decrease in peripheral vascular resistance and decreased blood pressure.
Signs and symptoms:
similar to hypovolaemic shock except in the skin's characteristics. In neurogenic shock, the skin is warm and dry.
Therapy are include :
5. Anaphylactic Shock (caused by allergic reaction)
Anaphylaxis is an severe, whole-body allergic reaction. After an initial exposure to a substance like bee sting toxin, the person's immune system becomes sensitized to that allergen. On a subsequent exposure, an allergic reaction occurs. This reaction is sudden, severe, and involves the whole body.
Common causes include insect bites/stings, horse serum (used in some vaccines), food allergies, and drug allergies.
Symptoms of anaphylaxis are related to the action of Immunoglobulin E and other anaphylatoxins, which act to release histamine and other mediator substances from mast cells (degranulation). In addition to other effects, histamine induces vasodilation of arterioles and constriction of bronchioles in the lungs, also known as bronchospasm (constriction of the airways).
Symptoms can include the following :
Polyuria, respiratory distress, hypotension (low blood pressure), encephalitis, fainting, unconsciousness, urticaria (hives), flushed appearance, angioedema (swelling of the lips, face, neck and throat), tears (due to angioedema and stress), vomiting, itching, diarrhea, abdominal pain, anxiety, impending sense of doom.
Therapy are include :
Major classes of shock include :
1. Hypovolemic Shock (caused by inadequate blood volume)
Hypovolemic shock is an emergency condition in which severe blood and fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.
Blood loss can be due to bleeding from cuts or other injury or internal bleeding such as gastrointestinal tract bleeding. The amount of blood in your body may drop when you lose too many other body fluids, which can happen with diarrhea, vomiting, burns, and other conditions.
Symptom are :
- Anxiety, restlessness, altered mental state due to decreased cerebral perfusion and subsequent hypoxia.
- Hypotension due to decrease in circulatory volume.
- A rapid, weak, thready pulse due to decreased blood flow combined with tachycardia.
- Cool, clammy skin due to vasoconstriction and stimulation of vasoconstriction.
- Rapid and deep respirations due to sympathetic nervous system stimulation and acidosis.
- Hypothermia due to decreased perfusion and evaporation of sweat.
- Thirst and dry mouth, due to fluid depletion.
- Fatigue due to inadequate oxygenation.
- Cold and mottled skin (cutis marmorata), especially extremities, due to insufficient perfusion of the skin.
Therapy are include :
- Maintain or increase intravascular volume, In hypovolaemic shock, caused by bleeding, it is necessary to immediately control the bleeding and restore the victim's blood volume by giving infusions of balanced salt solutions. Blood transfusions are necessary for loss of large amounts of blood (e.g. greater than 20% of blood volume), but can be avoided in smaller and slower losses. Hypovolaemia due to burns, diarrhoea, vomiting, etc. is treated with infusions of electrolyte solutions that balance the nature of the fluid lost.
- Decrease any future fluid loss via I.V fluid regimen
- Give supplementary O2 therapy to commence replacement of fluids via the intravenous route.
2. Cardiogenic shock (associated with heart problems)
Cardiogenic shock is a disease state where the heart is damaged enough that it is unable to supply sufficient blood to the body. Most common causes are :
a). acute myocardial infarction
b). dilated cardiomyopathy, This is a serious disease in which the heart muscle becomes inflamed (enlarged and stretched) and doesn't work as well as it should.
c). acute myocarditis
d). arrhythmias
Symptoms are :
similar to hypovolaemic shock but in addition:
- Distended jugular veins due to increased jugular venous pressure.
- Absent pulse due to tachyarrhythmia.
Therapy are include :
The main goals of the treatment of cardiogenic shock are the re-establishment of circulation to the myocardium, minimising heart muscle damage and improving the heart's effectiveness as a pump.
- Oxygen (O2) therapy to reduces the workload of the heart by reducing tissue demands for blood flow.
- Administration of cardiac drugs
- Increase heart’s pumping action through medication such as Dopamine, dobutamine, epinephrine, norepinephrine, amrinone
3. Septic shock (associated with infections)
Septic shock is a serious condition that occurs when an overwhelming infection leads to low blood pressure and low blood flow. The brain, heart, kidneys, and liver may not work properly or may fail.
Most common of this case may it’s happened to the patients with Meningococcemia, Waterhouse-Friderichsen syndrome, DIC (disseminated intravascular coagulation), Multiple organ dysfunction syndrome (MODS), Acute Respiratory Distress Syndrome (ARDS).
Symtomps are :
similar to hypovolaemic shock except in the first stages:
- Pyrexia and fever, or hyperthermia, due to overwhelming bacterial infection.
- Vasodilation and increased cardiac output due to sepsis.
- Restore intravascular volume via I.V fluid
- Give supplemental O2 therapy
- Identify and control source of infection
- Administer antibiotic
- Remove risk factor for infection
Therapy are include :
4. Neurogenic shock (caused by damage to the nervous system)
Neurogenic shock is shock caused by the sudden loss of the sympathetic nervous system signals to the smooth muscle in vessel walls. This can result from severe central nervous system (brain and spinal cord) damage. With the sudden loss of background sympathetic stimulation, the vessels suddenly relax resulting in a sudden decrease in peripheral vascular resistance and decreased blood pressure.
Signs and symptoms:
similar to hypovolaemic shock except in the skin's characteristics. In neurogenic shock, the skin is warm and dry.
Therapy are include :
- Large volumes of fluid may be needed to restore normal hemodynamics
- Vasopressors (Norepinephrine)
- Atropine (speeds up heart rate and Cardiac Output)
5. Anaphylactic Shock (caused by allergic reaction)
Anaphylaxis is an severe, whole-body allergic reaction. After an initial exposure to a substance like bee sting toxin, the person's immune system becomes sensitized to that allergen. On a subsequent exposure, an allergic reaction occurs. This reaction is sudden, severe, and involves the whole body.
Common causes include insect bites/stings, horse serum (used in some vaccines), food allergies, and drug allergies.
Symptoms of anaphylaxis are related to the action of Immunoglobulin E and other anaphylatoxins, which act to release histamine and other mediator substances from mast cells (degranulation). In addition to other effects, histamine induces vasodilation of arterioles and constriction of bronchioles in the lungs, also known as bronchospasm (constriction of the airways).
Symptoms can include the following :
Polyuria, respiratory distress, hypotension (low blood pressure), encephalitis, fainting, unconsciousness, urticaria (hives), flushed appearance, angioedema (swelling of the lips, face, neck and throat), tears (due to angioedema and stress), vomiting, itching, diarrhea, abdominal pain, anxiety, impending sense of doom.
Therapy are include :
- Identify and remove causative antigen
- Administer counter-mediators such as anti-histamine
- Oxygen therapy and I.V fluid replacement
Professionalism in Nursing
Dr. Nora Ahmad PhD is Assistant Professor College of Nursing PAAET - Kuwait. In the celebrate of Nursing Day 2009, Indonesian National Nurses Association in Kuwait (INNA-K) made a seminar for their members in the Indonesian Embassy with topic Professionalism in Nursing.
What is Professionalism? Professionalism is a calling which requires specialized knowledge and often long and extensive academic preparation.
Sunday, May 10, 2009
Professionalism in Nursing
Dr. Nora Ahmad PhD is Assistant Professor College of Nursing PAAET - Kuwait. In the celebrate of Nursing Day 2009, Indonesian National Nurses Association in Kuwait (INNA-K) made a seminar for their members in the Indonesian Embassy with topic Professionalism in Nursing.What is Professionalism? Professionalism is a calling which requires specialized knowledge and often long and extensive academic preparation.
Professional Nursing is "the process in which substantial specialized knowledge derived from the biological, physical, and behavioral sciences is applied to: the care, diagnosis, treatment, counsel and health teaching of persons who are experiencing changes in the normal health processes or who require assistance in the maintenance of health or the prevention or management of illness, injury or infirmity…” (ksbn, 2003).
What is Professional Responsibility? There are two big point they have to mention on their job regarding to the their profession :
- They should be responsible to the area of legal practice that encompasses the duties of an attorney to act in a professional manner, obey the law, avoid conflicts of interest, and put the interests of clients ahead of their own interests.
- All professionals in every field are expected to act in this legally binding manner in all their relationships with the client
As a Nurse, you should understand about responsibility of the Nursing Professional Body :
- Participates in determining individual members and group responsibilities and conduct
- Regulation of its members adherence to its own professional standards
What makes nursing a profession? There are many criteria which can makes the nursing become a profession :
- There is an educational background required to ensure safe and effective practice. A practitioners must complete Board certified educational programs or meet minimum criteria to be eligible for licensure.
- Members are accountable for continuing education and competency.
- Members of the profession adhere to a code of ethics.
- Members participate in professional organizations.
- members publish and communicate their knowledge and advances in the profession.
- Members of the profession are autonomous and self- regulating
- Members of the profession are involved in research They are involved in community service
- The profession develops, evaluates and uses theory as a basis for practice
So, the question is.... Do we meet the criteria(s) above?
Do we have the criteria of professional nursing values and behaviors?
- Professional Values ; Altruism (humanity), Equality, Aesthetic, Freedom/Autonomy, Human, dignity, Justice and Truth.
- Professional Behaviors ; Dependability, Professional presentation, Initiative, Empathy, Cooperation, Organization, Clinical reasoning, Supervisory process, Verbal and written Communication (Kasar, et al, 1996).
- Membership
- Communication
- Changes in Nursing practice
- Diversity in the population
- Lack of autonomy
- Lack of leadership skills
- Nature of the job : long hours, health care risks, emotional load and undervalue by society.
- Shortage of the nurses
- Limited opportunities
Ok, Now we talk about Professionalism and Competency.
A. Professional Competencies
Professional competency is defined as the values, attitudes and practices that competent nurses embody and may share with members of other professions. Nursing care competency is defined as relationship capabilities that nurses need to work with clients and colleagues. the knowledge and skills of practicing the discipline and competencies that encompass understanding of the broader health care system.
B. Core Values of Nursing Competency
A competent nurse’s personal and professional actions are based on a set of shared core nursing values through the understanding that nursing is a humanitarian profession based on a set of core nursing values, including Social justice, Caring, Advocacy, Respect for self and others, Collegiality, and Ethical behaviour.
C. Foundations of Nursing Competency
Develops insight through reflection, self-analysis, and self-care through the understanding that by using ongoing reflection, critical examination and evaluation of one’s professional and personal life improves nursing practice.
Nurse engages in ongoing self-directed learning with the understanding that knowledge and skills are dynamic and evolving; in order to maintain competency one must continuously update the knowledge.
Demonstrates leadership in nursing and health care through the understanding that an effective nurse is able to take a leadership role to meet client needs, improve the health care system and facilitate community problem solving.
Collaborates as part of a health care team through the understanding that successful health care depends on a team effort, and collaboration with others in a collegial team is essential for success in serving clients.
Practices within, utilizes, and contributes to the broader health care system through the understanding that professional nursing has a legally defined standard of practice .
Each nurse has the responsibility and Accountability for effective and efficient management and utilization of health care resources.
Practices relationship-centered care through the understanding that the effectiveness of nursing interventions and treatment plans depends, in part, on the attitudes, beliefs and values of clients and these are influenced both by how professionals interact with clients and by the intervention.
Communicates effectively through the understanding that effective use of therapeutic communication, to establish a caring relationship, to create a positive environment, to inform clients, and to advocate is an essential part of all interventions
Makes sound clinical judgments through the understanding that effective nursing judgment is not a single event, but concurrent and recurrent processes that include assessment (data collection, analysis and diagnosis), community and client participation in planning, implementation, treatment, ongoing evaluation, and reflection
In making practice decisions, locates, evaluates and uses the best available evidence, coupled with a deep understanding of client experience and preferences, through the understanding that there are many sources of knowledge, including research evidence, standards of care, community perspectives, practical wisdom gained from experience, which are legitimate sources of evidence for decision-making
What we can do to promote Professionalism?
- Provide strategic directions and programs that enhance the competencies of nurses to be globally competitive.
- Passionately sustain the quality work life and collegial interactions with and among nurses.
- Encourage staff to develop their knowledge and skills by participating in a wide variety of both formal and informal activities.
- Enthusiastically explore possibilities of collaboration.
- Maintain nursing educational standards
- Promote professional behaviour in the professional nurse
- Practice evidence-based care delivery
Jumat, 07 Agustus 2009
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