Nurses Information Site

http://nursesinfosite.blogspot.com

Nurses Information Site

http://nursesinfosite.blogspot.com

Nurses Information Site

http://nursesinfosite.blogspot.com

Nurses Information Site

http://nursesinfosite.blogspot.com

Nurses Information Site

http://nursesinfosite.blogspot.com

Nurses Information Site

http://nursesinfosite.blogspot.com

Nurses Informations

Monday, June 30, 2008

Screening Test

Screening Test
The Agency for Healthcare Research and Quality (AHRQ) has created a new tool, Stay Healthy at Any Age: Your Checklist for Health to help patients keep track of their health and stay up-to-date on recommended screening tests. There is one checklist for men and one for women. Both include the tests recommended by the U.S. Preventive Services Task Force (USPSTF).

Drug News

The FDA has approved the following generic equivalents:

* risedronate sodium 5, 30, and 35 mg tablets - for the treatment and prevention of postmenopausal and glucocorticoid-induced osteoporosis, and for the treatment of Paget disease. This medication is generically equivalent to Actonel.
* oxcarbazepine 150, 300, and 600 mg tablets - an anticonvulsant for the treatment of partial seizures in adults and children 4 years of age and older. The medication is the generic equivalent of Trileptal. The prescribing information for the generic versions may differ from that of Trileptal, as some sections of the Trileptal label are protected by patents and/or exclusivity.

Woman and Heart Disease

Woman and Heart Disease
Modifiable risk factors for heart disease endanger both men and women, however, they may contribute to a poorer prognosis for women. Educate women about the following risk factors over which they have some control:

* Diabetes
* Hypertension
* Smoking
* Dyslipidemia
* Obesity
* Sedentary life style
* Stress

Methicillin-resistant Staphylococcus aureus (CA-MRSA)

Methicillin-resistant Staphylococcus aureus (CA-MRSA)
The incidence of community-associated Methicillin-resistant Staphylococcus aureus (CA-MRSA) is on the rise. Recent media coverage has brought this health problem to the attention of public.

Be aware that in the community, MRSA infections are infections of the skin that may appear as pustules or boils. They are often red, swollen, painful, or have pus or other drainage, and occur at sites of visible skin trauma and areas of the body covered by hair. Most MRSA skin infections can be treated effectively by draining the site; sometimes antibiotics are administered as well.

Drug Updates - Medication Errors

Unsafe medication-use practice habits place patients in danger of an infection. To protect patients, remember the following:

* Place a sterile cap on the end of a reusable I.V. administration set that has been removed from a primary administration set, saline lock, or I.V. catheter hub that will be used again.
* Properly disinfect the port when accessing needle-free valves on I.V. sets.
* Always follow aseptic technique.
* Avoid "looping" - attaching the exposed end of the I.V. tubing to a port on the same tubing.
* Prohibit unlicensed staff from connecting/disconnecting any medical tubing.
* Establish policies and assess compliance.

Pain Scales

Pain Scales
Understanding another person's pain is not easy. Pain scales have been developed to aid in our understanding, but they must be used correctly and they should be part of a complete pain assessment.

One-dimensional scales, such as the numeric 0 to 10 scale, are appropriate for the acute care setting. A more comprehensive approach should be used for patients with chronic or persistent pain. This often consists of a one-dimensional scale and a body diagram; the use of color can be used to represent pain intensity. Behavioral pain scales are used to assess pain in nonverbal, cognitively impaired, or critically ill patients.

Drug News

* Revised labeling has been approved for the following:
carbamazepine-containing drugs (eg, Carbatrol, Epitol, Equetro, and Tegretol) - to include a recommendation that before starting drug therapy, patients of Asian ancestry get a genetic blood test that identifies a significantly increased risk of developing a rare, but serious, skin reaction. These life-threatening skin reactions include toxic epidermal necrolysis and Stevens-Johnson syndrome.

* Merck has initiated a voluntary recall of 11 lots of PedvaxHIB (Haemophilus b conjugate [meningococcal protein conjugate]) and 2 lots of Comvax (Haemophilus b conjugate (meningococcal protein conjugate]) vaccines because the sterility of these lots is uncertain.

Discharge Summaries

Discharge Summaries
If you must write a narrative discharge summary, be sure to include the following information to comply with JCAHO requirements:
· patient's status at admission and discharge
· any significant information about the patient's stay, including resolved and unresolved problems
· instructions regarding medications, treatments, activity, diet, referrals, follow-up appointments, and any other special instructions.

Drug Updates - Medication Errors

When errors occur with anticoagulant use, fatal bleeding or thrombosis can occur, which is why these medications are considered "high-alert" drugs. Review the following common risks and recommended safeguards associated with heparin, low-molecular weight heparin, and warfarin.

Common risks
- Duplicate or concurrent therapy
- Accidental stoppage of therapy
- Look-alike bags, vials, or syringes
- Look-alike names
- Dosing/infusion errors
- Calculation errors
- Patient monitoring problems
- Drug and food interactions
- Adverse reactions

Recommended safeguards
- Standardization
- Simplification
- Externalize error-prone processes
- Improved access to information
- Differentiation or constraints
- Redundancies
- Patient monitoring
- Failure mode and effects analysis (FMEA)

Providing family support


Providing family support is a big part of our role as nurses. This support comes in many forms, from holding a hand to teaching about an illness, medication, or procedure to providing referrals. Research has shown that the most important needs reported by families are the following:

1. to feel there is hope
2. to feel that hospital staff care about the patient
3. to have the waiting room near the patient
4. to be called at home about the patient's condition
5. to know the prognoses
6. to have questions answered honestly
7. to know specific facts about the patient's prognosis
8. to receive information about the patient once per day
9. to have explanations given in understandable terms
10. to see the patient frequently

Rapid Response Teams


Rapid response teams are composed of clinical experts who are called to the bedside to assess and manage decompensating patients before a code occurs. Members of the team include specially trained nurses, respiratory therapists, and medical personnel. Five key roles of the RRT are:

1. Assessing the patient.
2. Stabilizing the patient either to remain on the unit or for transfer to the ICU.
3. Assisting with communication with the attending physician or other consultants.
4. Educating and supporting the patient's assigned nurse.
5. Assisting with transfer.

Drug Updates - Medication Errors

Variability of dosing methods contributes to the risk of pump programming errors. Reduce the risk of IV infusion dosing errors by considering the following:

* Work with a multidisciplinary team to standardize dosing methods for certain medications.
* Use smart pumps with functional dosage error-reduction software.
* Display drug information on the drug label and medication administration record the same way it is needed to program the pump.
* Verify dosing methods and pump settings.
* Consider the possibility of an error if the appropriate physiologic response to a medication doesn't occur.

Drug Updates - Medication Errors


In 2006, an overdose of fluorouracil had fatal consequences in an oncology patient. To safeguard chemotherapy use, remember the following recommendations from the ISMP:

* Standardize labeling
* Update certification of nurses administering chemotherapeutic agents
* Safeguard pump use
* Enhance double-checks (use charts when possible)
* Use checklists to standardize sequencing and workflow
* Include the patient
* Establish overdose protocols

Thursday, June 26, 2008

Pericarditis

PERICARDITIS


Pericarditis is an inflammation of the pericardium.


1. Acute pericarditis: may be dry or may cause excessive fluid accumulation in the pericardial space.

2 Chronic pericarditis: fibrous thivkening of the visceral and parietal pericardium; thickening inhibits cardiac filling during systole.


Assessment

  1. Risk factors/iology

    1. Acute.

      1. Infection.

      2. Myocardial Injury.

      3. Hypersensitivity (collagen diseases, systematic lupus erythematosus, drug reactions).

      4. Renal failure.

  2. Clinical Manifestations.

    1. Acute.

      1. Precordial pain.

      2. Pericardial friction rub caused by myocardium rubbing against inflamed pericardium.

      3. Pain increases with respiration; sitting may relieve pain.

    2. Chronic: symptoms are characteristic of gradually occurring CHF; chest pain is not a prominent symptom.

  3. Diagnostics (acute and chronic).

    1. ECG changes.

    2. increased WBCs.

    3. History of precipitating causes.

    4. CT scan.

Complications.

  1. Pericardial effusion resulting in cardiac tamponade.


PA and lateral close-ups show thick pericardial calcification around
apex of heart from patient with history of tuberculous pericarditis

Treatment

  1. Acute episode.

    1. Treat underlying problem.

    2. Bed rest.

    3. Antiinflammatory medications.

    4. If pleural effusion and tamponade occur, then pericardiocentesis (aspiration of fluid from the pericardial sac) is performed.

Nursing Intervention

  • GOAL: To maintain homeostasis and promote comfort.

  1. Assess characteristics of pain; administer appropriate analgesics.

  2. Upright position, with client leaning forward, may relieve the pain.

  3. Decrease anxiety, because client often associates problem with an MI; assist client to distinguish the difference.

  4. Observe for symptoms of cardiac tamponade.
    -Paradoxical blood pressure: precipitous decrease in systolic blood pressure on inspiration.

    -CVP increased; presence of jugular venous distention.

-Heart sounds are muffled or distant.
-Narrowing pulse pressure.
  1. In a client with chronic pericarditis, evaluate for symptoms of CHF and initiate nursing intervention.





Wednesday, June 25, 2008

Pulmonary Edema

PULMONARY EDEMA




  • Pulmonary Edema is caused by an abnormal accumulation of fluid in the lung, in both the interstitial and alveolar spaces.




  1. Origin is most often cardiac: Pulmonary congestion occurs when the pulmonary vascular bed receives more blood from the right side of the heart (venous return) than the left side of the heart (cardiac output) can accommodate.

  2. Pulmonary edema results from severe impairment in the ability of the heart to maintain cardiac output, thereby causing an engorgement of the pulmonary vascular bed.




Assessment


  1. Risk factors/etiology.

    1. Hypertention

    2. Aortic valva problems, CHF.

    3. Cardiac myopathy.

    4. Overhydration.


  1. Clinical manifestations: hypoxia

    1. Problem may occur at night or in clients for whom bed rest has been prescribed. The supine position increases venous return and promotes reabsorption of edema from the legs, thus precipitating an increase in cardiac workload and an increase in circulating volume.

    2. Sudden onset of dyspnea.

    3. Severe anxiety, restlessness, irritability.

    4. Cool, moist skin.

    5. Tachycardia (S3, S4 gallop)’tachypnes.

    6. Jugular vein distention

    7. Severe coughing

    8. Noisy, wet respirations that do not clear with coughing.

    9. Frothy, blood-tinge sputum.


*GERIATRIC PRIOT|RITY: Pulmonary edema can occur very rapidly and become a medical emergency.


  1. Diagnostics.

    1. Clinical manifestations.

    2. Predisposing condition.

    3. BNP (B-type natriuretic peptide) levels measured to assess for CHF (<100 pg/ml rules out CHF).




Treatment


Condition demands immediate attention; medications are administered intravenously.

  1. O2 high in concentration.

  2. Sedation (morphine) to allow controlled ventilation: decreases preload/vasoconstriction, as well as decreasing anxiety and pain.

  3. Diuretics to reduce the myocardial workload.

  4. Dopamine to facilitate myocardial contractility.

  5. Medications to increase cardiac contractility and cardiac output

  6. Vasodilators to decrease afterload.





Nursing Intervention


*GOAL: To assess and decrease hypoxia


*GOAL: To improve ventilation.


  1. Place in high-Fowler’s position with the legs dependent.

  2. Administer high levels of O2.

  3. Evaluate level of hypoxia and dyspnea; may need endotracheal tube intubation and mechanical ventilation.

  4. I.V. sedatives/narcotics.

    1. To decrease anxiety and dyspnea and to decrease pressure in pulmonary capillary bed.

    2. Closely observe for respiratory depression.


*ALERT: Pulmonary edema is one of the few circumstances in which a client with respiratory distress may be given a narcotic. The fear of not being able to breath is so strong that the client cannot cooperate. When a sedative/narcotic is administered, the nurse must be ready to support ventilation if respirations become severely depressed.


  1. Administer bronchodilators and evaluate clieant’esponse and common side effects.


*GOAL: To reduce circulating volume and cardiac workload.

  1. Diuretics.

  2. Medications to decrease afterload and increase cardiac output.

  3. Carefully monitor all I.V. fluids and evaluate overall hydration status.

  4. Do not elevate the client’s legs because this will rapidly increase the venous return and the circulating volume.


*GOAL: To provide psychological support and decrease anxiety.


A. Approach client in a calm manner.

B. Explain procedures.

C. Administer sedatives.

D. Remain with the client in acute respiratory distress.


*GOAL: To prevent recurrence of problem.


  1. Recognize early stages.

  2. Maintain client in semi-Fowler’ position.

  3. Decrease levels of activity.

  4. Use extreme caution in administration of fluids and transfusions.







Tuesday, June 24, 2008

Multiple Myeloma

MULTIPLE MYELOMA

Myeloma PET Scan Multiple Myeloma

* A malignancy of plasma cells, specifically the B lymphocytes. Infiltration occurs in the bones and soft tissues.

Assessment
A. Clinical Manifestations.

1. Back pain, bone pain.

2. Pathological fractures.

3. Hypercalcemia.

4. Renal failure.


B. Diagnostics.

1. Serum and/or protein electrophoresis.

2. Bone marrow biopsy.

3. X-ray film showing typical punched-out appearance of the bones caused by demineralization.

Treatment


A. Chemotherapy.

B. Palliative radiation therapy.

PET-CT-Fusion corona multiple myeloma


Nursing Intervention

GOAL: To maintain physical equilibrium.

A. Careful ambulation to decrease hypercalcemia and improve pulmonary status.

B. Adequate hydration to prevent calcium from precipitating in the kidneys; careful monitoring of hydration status.

C. Comfort measures and analgesics for pain.

D. Safety measures to prevent pathological fractures.

1. Do not lift anything weighing more than 10 pounds.

2. Use proper body mechanics.

E. Braces may be necessary to support the spine.


GOAL: To assist client to understand implications of the disease and measures to maintain health.






Sunday, June 22, 2008

Abdominal Ultrasound



Slideshow transcript

Slide 1: Abdominal Ultrasound

Slide 2: Abdominal Ultrasound  An abdominal ultrasound uses reflected sound waves to produce a picture of the organs and other structures in the upper abdomen. Occasionally a specialized ultrasound is ordered for a detailed evaluation of a specific organ, such as a kidney ultrasound.

Slide 4: Abdominal Ultrasound can evaluate: Abdominal aorta , which is the large blood vessel (artery) that passes down the back of the chest and abdomen. The aorta supplies blood to the lower part of the body and the legs.

Slide 6: The aorta stems from the heart, arches upward, and then extends down behind the heart and through the chest (thorax) and the abdomen areas. The aorta then branches out and becomes the iliac arteries, which provide blood to the pelvis and legs.

Slide 7: Abdominal Ultrasound can evaluate: Liver, which is a large dome- shaped organ that lies under the rib cage on the right side of the abdomen. The liver produces bile (a substance that helps digest fat), stores sugars, and breaks down many of the body's waste products.

Slide 9: Liver  The liver is a large organ in the right upper part of the abdomen. It performs a range of complex and important functions that affect all body systems.  Some of the specific functions of the liver include:  Controlling the amounts of sugar (glucose), protein, and fat entering the bloodstream.

Slide 10: Liver  Removing bilirubin, ammonia, and other toxins from the blood. (Bilirubin is a by- product of the breakdown of hemoglobin from red blood cells.)  Processing most of the nutrients absorbed by the intestines during digestion and converting those nutrients into forms that can be used by the body. The liver also stores some nutrients, such as vitamin A, iron, and other minerals.

Slide 11: Liver  Producing cholesterol, substances that help blood clot, bile, and certain important proteins, such as albumin.  Breaking down (metabolizing) many drugs.

Slide 12: Abdominal Ultrasound can evaluate: Gallbladder, which is a saclike organ beneath the liver. The gallbladder stores bile. When food is eaten, the gallbladder contracts, sending bile into the intestines to help in digesting food and absorbing fat-soluble vitamins.

Slide 14: Gallbladder The gallbladder is a small sac under the liver that stores and concentrates bile, a fluid that helps the body digest fats. After a meal, the gallbladder contracts and releases bile through the common bile duct into the small intestine.

Slide 15: Abdominal Ultrasound can evaluate: Spleen, which is the soft, round organ that helps fight infection and filters old red blood cells. The spleen is located to the left of the stomach, just behind the lower left ribs.

Slide 17: Spleen  The spleen is an organ in the upper left side of the abdomen that filters the blood by removing old or damaged blood cells and platelets and helps the immune system by destroying bacteria and other foreign substances. It also holds extra blood that can be released into the circulatory system, if needed.

Slide 18: Spleen  The spleen is a useful but nonessential organ. It is sometimes removed (splenectomy) in people who have blood disorders, such as thalassemia or hemolytic anemia. If the spleen is removed, a person must get certain immunizations to help prevent infections that the spleen normally fights.

Slide 19: Abdominal Ultrasound can evaluate:  Pancreas, which is the gland located in the upper abdomen that produces enzymes that help digest food. The digestive enzymes are then released into the intestines. The pancreas also releases insulin into the bloodstream; insulin helps the body utilize sugars for energy.

Slide 21: Pancreas  The pancreas is an organ in the upper abdomen, behind the stomach and close to the spine, that produces substances (digestive enzymes) needed to break down and use food. The pancreas also produces insulin, the hormone that regulates sugar (glucose) in the blood.

Slide 22: Enzyme An enzyme is a protein produced by the body to speed up a specific chemical reaction in the body. The body produces many different kinds of enzymes for many different body processes, such as digestion and blood clotting.

Slide 23: Enzyme Some inherited diseases are caused by problems with the production of certain enzymes. Health professionals may measure the levels of certain enzymes in a person's blood to help diagnose certain types of disease, such as liver problems.

Slide 24: Insulin  Insulin is a hormone produced in the pancreas that allows sugar (glucose) to enter body cells, where it is used for energy. It also helps the body store extra sugar in muscle, fat, and liver cells where it can be released and used for energy when needed.  Diabetes develops if the body does not produce enough insulin or does not use insulin properly.

Slide 25: Abdominal Ultrasound can evaluate: Kidneys, which are the pair of bean-shaped organs located behind the upper abdominal cavity. The kidneys remove wastes from the blood and produce urine.

Slide 27: Kidneys The kidneys are organs located on either side of the spine, at the small of the back. Kidneys filter the blood and help balance water, salt, and mineral levels in the blood; they also produce hormones that help regulate blood pressure and blood supply.

Slide 28: Kidneys  Waste from the kidneys is carried out of the body in urine. Urine flows through tubes (ureters) to the bladder, where it is stored until a person is ready to urinate. The waste and urine then leave the bladder to exit the body through a tube called the urethra.

Slide 29: Why It Is Done Determine the cause of abdominal pain.

Slide 30: Why It Is Done Detect, measure, or monitor an aneurysm in the aorta. An aneurysm may cause a large, pulsing lump in the abdomen.

Slide 31: Aneurysm An aneurysm is a bulging section in the wall of a blood vessel that has become stretched out and thin. As the wall of the blood vessel bulges out, it becomes weaker and may burst or rupture, causing bleeding.

Slide 32: Aneurysm If an aneurysm in the brain bursts, it may cause a stroke. An aneurysm in a vessel that carries a lot of blood, such as the aorta, is often fatal if it bursts.

Slide 33: Why It Is Done  Evaluate the size, shape, and position of the liver. An ultrasound may be done to evaluate jaundice and other problems of the liver, including liver masses, cirrhosis, fat deposits in the liver (called fatty liver), or abnormal liver function tests.

Slide 35: Jaundice Jaundice is a condition in which the skin and whites of the eyes appear yellow because of the buildup of a yellow-brown pigment called bilirubin in the blood and skin.

Slide 36: Jaundice Bilirubin is produced by the breakdown of red blood cells. The liver normally gets rid of bilirubin in bile (a fluid that helps the body digest fats).

Slide 37: Jaundice  Excess amounts of bilirubin can build up because of rapid destruction of red blood cells, liver diseases (such as hepatitis), blockage of the bile ducts leading from the gallbladder to the small intestine, or other problems. Bilirubin can be measured in the blood, where it is one indicator of a person's liver function.

Slide 38: Jaundice Other symptoms that may occur as a result of excess bilirubin include dark urine, light-colored or whitish stools, and itching of the skin (pruritis).

Slide 39: Jaundice If successful, treatment for the underlying cause of jaundice will cause the skin, eyes, urine, and stools to return to their normal color.

Slide 42: Cirrhosis  Cirrhosis is a potentially life- threatening condition that occurs when inflammation and scarring damage the liver. Alcohol abuse and chronic viral hepatitis are the most common causes of cirrhosis, but it can also be caused by medicines or by another disease (such as hemochromatosis).

Slide 43: Cirrhosis  Symptoms of cirrhosis include nausea, lack of appetite and weight loss, tiredness, and swelling in the legs and belly. If left untreated, severe cirrhosis can result in internal bleeding, yellowing of the skin and eyes (jaundice), unclear thinking, hand tremors, and coma.

Slide 44: Cirrhosis  Cirrhosis is treated by taking care of the underlying cause of the liver damage and by treating other problems, such as internal bleeding, that result from the liver damage. In some cases, a liver transplant may be possible.

Slide 45: Why It Is Done Detect gallstones, inflammation of the gallbladder (cholecystitis), or blocked bile ducts. See an illustration of a gallstone

Slide 47: Gallstones  Gallstones are deposits like small stones that form in bile, a fluid that helps digestion; bile is stored in the gallbladder, a sac under the liver. Gallstones can develop in the gallbladder or in the bile ducts, which are tubes that carry bile to the small intestine.

Slide 49: Gallstones  Gallstones can be smaller than a grain of sand or as large as a golf ball. They generally do not cause problems unless they block a tube (duct) leading from the gallbladder to other organs. When this happens, abdominal pain and other symptoms develop suddenly.

Slide 51: Gallstones  Gallstones are common. They develop when there is too much cholesterol in the bile for the cholesterol to remain dissolved or when the gallbladder does not empty as quickly as it should. Gallstones are most common in women, people who are obese, older people, people with sickle cell disease, people who have lost weight rapidly, and people who are taking certain medicines.

Slide 53: Gallstones  Most people who have gallstones do not have any symptoms and do not need treatment. If symptoms develop, they usually will include pain in the upper abdomen and are rarely life-threatening. However, pain from gallstones can vary in intensity and may cause vomiting. Gallstones that cause symptoms usually are treated with surgery to remove the gallbladder (cholecystectomy).

Slide 54: Abdominal ultrasound showing the gallbladder  Figure 1 shows a normal gallbladder on ultrasound. Figure 2 shows a large gallstone in the gallbladder.

Slide 55: Why It Is Done Detect kidney stones.

Slide 57: Kidney stones  Kidney stones are made of salts and minerals in the urine that stick together to form small "pebbles." They are usually painless while they remain in the kidney, but they can cause severe pain as they break loose and travel through narrow tubes (ureters) to exit the body during urination.

Slide 59: Kidney stones  Symptoms of a kidney stone include severe pain on one side of the back, just below the rib cage (flank pain). The pain may spread to the lower abdomen, groin, and genital area. Other symptoms include blood in the urine (hematuria), painful or frequent urination (dysuria), and nausea and vomiting.

Slide 61: Kidney stones  A kidney stone is usually treated by increasing fluid intake and taking medications to relieve pain until the stone has passed. This typically occurs within a few days. If the stone seems unlikely to pass on its own or is causing severe pain, treatment options include a shock wave treatment (lithotripsy), which can break up a large stone into smaller pieces that are easier to pass, or very rarely, surgery.

Slide 62: Kidney stones  If a stone is stuck in a ureter, a long, thin microscope (ureteroscope) can be passed through the urethra and bladder to the ureter. The stone may be taken out using a tiny basket on a wire passed through the ureteroscope. The stone can also be broken up using laser and then flushed out of the ureter with fluids inserted through the ureteroscope.

Slide 63: Kidney stones There are four different types of kidney stones, and they can be as small as grains of sand or as large as a golf ball. Kidney stones occur most often in adults and are rare in children.

Slide 64: Why It Is Done Determine the size of an enlarged spleen and look for damage or disease.

Slide 66: Why It Is Done Detect problems with the pancreas, such as pancreatitis or pancreatic cancer.

Slide 68: Pancreatitis Pancreatitis is an inflammation of the pancreas, which is an organ in the upper abdomen that makes insulin and digestive enzymes. Pancreatitis may cause sudden, severe abdominal pain.

Slide 69: Pancreatitis  Pancreatitis is most commonly caused by excessive use of alcohol or by a blockage of the tube (duct) that leads from the pancreas to the beginning of the small intestine (duodenum), usually by a gallstone. Other causes include an infection, an injury, or certain medicines. It may develop suddenly (acute), or it may be a long- term, recurring (chronic) problem.

Slide 70: Pancreatitis  Treatment in the hospital includes pain medicine and fluids given through a vein (IV) until the inflammation goes away. Nutrition is given through a tube to avoid stimulating the pancreas. Although most people recover fully from pancreatitis, complications such as bleeding, infection, or organ failure may develop.

Slide 71: Why It Is Done  Determine the cause of blocked urine flow in a kidney. A kidney ultrasound may also be done to determine the size of the kidneys, detect kidney masses, detect fluid surrounding the kidneys, investigate causes for recurring urinary tract infections, or evaluate the condition of transplanted kidneys.

Slide 73: Urinary tract infection A urinary tract infection (UTI) is an infection in the organs and tubes that process and carry urine out of the body. Most UTIs are either bladder infections (cystitis) or kidney infections (pyelonephritis).

Slide 74: Urinary tract infection  UTIs occur most often when bacteria begin to grow in the kidneys, the bladder, the tubes that carry urine from the kidneys to the bladder (ureters), or the tube that carries urine from the bladder to outside of the body (urethra). Sexual intercourse may introduce bacteria into the urinary tract, especially in women. Catheterization is a common source of bacterial infection in people who are hospitalized or live in long- term care facilities.

Slide 75: Urinary tract infection  An adult or older child with a UTI may have:  Pain or burning during urination.  An urge to urinate frequently but usually passing only small quantities of urine.  Dribbling (inability to control urine release).  Reddish or pinkish urine.  Foul-smelling urine.  Cloudy urine.

Slide 76: Urinary tract infection Urinary tract infections are more common in women than in men. They are also more common in older adults than in younger adults.

Slide 77: Urinary tract infection  Treatment for most urinary tract infections is antibiotic pills and home treatment, such as drinking lots of fluids. If widespread infection (sepsis) develops or if the infection is severe or harms kidney function, hospitalization may be necessary so that antibiotics can be given directly into a vein (intravenous antibiotics).

Slide 78: Why It Is Done Determine whether a mass in any of the abdominal organs (such as the liver) is a solid tumor or a simple fluid-filled cyst.

Slide 80: Cyst A cyst is a saclike structure in the body. Cysts usually are filled with fluid, which may be blood, clear fluid, or pus.

Slide 82: Cyst A cyst can be normal, abnormal, or, in rare cases, cancerous. In some cases, a cyst may be drained either with a needle or by cutting it open, or it may be removed entirely.

Slide 83: Why It Is Done  Determine the condition of the abdominal organs after an accident or abdominal injury and look for blood in the abdominal cavity. However, computed tomography (CT) scanning is more commonly used for this purpose because it is more precise than abdominal ultrasound.

Slide 85: CT or CAT scan A computed tomography (CT) scan uses X-rays to make detailed pictures of structures inside of the body.

Slide 86: CT or CAT scan  During the test, you will lie on a table that is hooked to the CT scanner, which is a large doughnut-shaped machine. The CT scanner sends X-ray pulses through the body. Each pulse lasts less than a second and takes a picture of a thin slice of the organ or area being studied. One part of the scanning machine can tilt to take pictures from different positions. The pictures are saved on a computer.

Slide 87: CT or CAT scan A CT scan can be used to study any body organ, such as the liver, pancreas, intestines, kidneys, adrenal glands, lungs, and heart. It also can study blood vessels, bones, and the spinal cord.

Slide 88: CT or CAT scan  An iodine dye (contrast material) is often used to make structures and organs easier to see on the CT pictures. The dye may be used to check blood flow, find tumors, and look for other problems. Dye can be put in a vein (IV) in your arm, or you may drink the dye for some tests. CT pictures may be taken before and after the dye is used.

Slide 89: Why It Is Done Guide the placement of a needle or other instrument during a biopsy.

Slide 91:  Ultrasound-guided biopsy of necrotic metastasis from colon cancer. Gray-scale image of the liver shows a primarily fluid- filled metastasis from colon cancer. There is a relatively thin rim of viable tumor. With ultrasound, the needle tip (arrow) could be precisely positioned within the rim to biopsy the viable portion of tumor and avoid the adjacent normal hepatocytes or necrotic portions of the lesion. The two solid white lines indicate the anticipated path of the needle using an attachable needle guide. In this case, the needle deflected outside the anticipated path.

Slide 92: Biopsy  A biopsy is a sample of tissue collected from an organ or other part of the body. A biopsy can be done by cutting or scraping a small piece of the tissue or by using a needle and syringe to remove a sample, which is then examined for abnormalities, such as cancer, by a doctor trained to look at tissue samples (pathologist).

Slide 93: Why It Is Done Detect fluid buildup in the abdominal cavity (ascites). An ultrasound also may be done to guide the needle during a procedure to remove fluid from the abdominal cavity ( paracentesis).

Slide 94:  Cirrhosis with marked ascites

Slide 95: Paracentesis  Paracentesis is a procedure in which a needle is inserted through the abdominal wall to remove fluid that has built up in the abdominal cavity (ascites). It may be used as a test (diagnostic paracentesis) or as a treatment (therapeutic paracentesis).

Slide 96: Paracentesis  Paracentesis may be done to:  Collect a fluid sample from the abdominal cavity to help determine the cause of ascites (diagnostic).  Diagnose infection in the ascitic fluid (diagnostic).  Remove a large amount of fluid from the abdominal cavity when the fluid is causing discomfort or affecting the function of the kidneys or intestines (therapeutic).

Slide 97: Preparation Tell your doctor if you have had a barium enema or a series of upper GI (gastrointestinal) tests within the past 2 days. Barium that remains in the intestines can interfere with the ultrasound test.

Slide 98:  You should be able to identify the various components of the bowel on these films. Note the caecum (1), ascending colon (2), transverse colon (3), descending colon (4) and the rectum (5). On the right, the ascending colon turns towards the midline. This is called the right colic flexure (6) (also known as the hepatic flexure - so called as it is adjacent to the liver). On the left, the transverse colon turns downwards, creating the left colic flexure (7) (or splenic flexure - so called as it is adjacent to the spleen).

Slide 99: Barium enema  A barium enema, or lower gastrointestinal (GI) examination, is an X-ray examination of the large intestine (colon and rectum). The test is used to help find problems that affect the large intestine. To make the intestine visible on an X- ray picture, the colon is filled with a white barium contrast material.

Slide 101: Barium enema The contrast material is put through a tube placed in the anus. The barium blocks X-rays, so the barium-filled colon shows up clearly on the X-ray picture.

Slide 102: Barium enema A barium enema may be done to check for the cause of rectal bleeding or blood in the stool. The test may help find diseases such as inflammatory bowel disease and diverticulosis. A barium enema may also be used to look for colon cancer.

Slide 103: Preparation  Other preparations depend on the reason for the abdominal ultrasound test you are having.  For ultrasound of the liver, gallbladder, spleen, and pancreas, you may be asked to eat a fat-free meal on the evening before the test and then to avoid eating for 8 to 12 hours before the test.

Slide 104: Preparation  For ultrasound of the kidneys, you may not need any special preparation. You may be asked to drink 4 to 6 glasses of liquid (usually juice or water) about an hour before the test to fill your bladder. You may be asked to avoid eating for 8 to 12 hours before the test to avoid gas buildup in the intestines. This could interfere with the evaluation of the kidneys, which lay behind the stomach and intestines.

Slide 105: Preparation For ultrasound of the aorta, you may need to avoid eating for 8 to 12 hours before the test.

Slide 106: Procedure  This test is done by a doctor who specializes in performing and interpreting imaging tests ( radiologist) or by an ultrasound technologist (sonographer) who is supervised by a radiologist. It is done in an ultrasound room in a hospital or doctor's office.

Slide 107: Procedure  You will need to remove any jewelry that might interfere with the ultrasound scan. You will need to take off all or most of your clothes, depending on which area is examined (you may be allowed to keep on your underwear if it does not interfere with the test). You will be given a cloth or paper covering to use during the test.

Slide 108: Procedure  You will lie on your back (or on your side) on a padded examination table. Warmed gel will be spread on your abdomen to improve the quality of the sound waves. A small handheld unit, called a transducer, is pressed against your abdomen and moved back and forth over it. A picture of the organs and blood vessels can be seen on a video monitor.

Slide 109: Procedure You may be asked to change positions so additional scans can be made. For a kidney ultrasound, you may be asked to lie on your stomach.

Slide 110: Procedure  You need to lie very still while the ultrasound scan is being done. You may be asked to take a breath and hold it for several seconds during the scanning. This lets the sonographer see organs and structures, such as the bile ducts, more clearly because they are not moving.

Slide 111: Procedure Holding your breath also temporarily pushes the liver and spleen lower into the belly so they are not hidden by the lower ribs which makes it harder for the sonographer to see them clearly.

Slide 112: Procedure Abdominal ultrasound usually takes 30 to 60 minutes. You may be asked to wait until the radiologist has reviewed the information. The radiologist may want to do additional ultrasound views of some areas of your abdomen.

Slide 113: How It Feels  The gel may feel cold when it is applied to your stomach unless it is first warmed to body temperature. You will feel light pressure from the transducer as it passes over your abdomen. The ultrasound usually is not uncomfortable. However, if the test is being done to assess damage from a recent injury, the slight pressure of the transducer may be somewhat painful. You will not hear or feel the sound waves.

Slide 114: Risks There are no known risks from having an abdominal ultrasound test.

Slide 115: Results An abdominal ultrasound uses reflected sound waves to produce a picture of the organs and other structures in the abdomen.

Slide 116: Normal: The size and shape of the abdominal organs appear normal. The liver, spleen, and pancreas appear normal in size and texture. No abnormal growths are seen. No fluid is found in the abdomen.

Slide 117:  Ultrasound images of liver in normal weight (left) and obese (right) patients. The latter image quality is limited by body habitus

Slide 118: Normal: The diameter of the aorta is normal and no aneurysms are seen.

Slide 119: Normal: The thickness of the gallbladder wall is normal. The size of the bile ducts between the gallbladder and the small intestine is normal. No gallstones are seen.

Slide 121: Normal: The kidneys appear as sharply outlined bean-shaped organs. No kidney stones are seen. No blockage to the system draining the kidneys is present.

Slide 123: Abnormal:  An organ may appear abnormal because of inflammation, infection, or other diseases. An organ may be smaller than normal because of an old injury or past inflammation. An organ may be pushed out of its normal location because of an abnormal growth pressing against it. An abnormal growth (such as a tumor) may be seen in an organ. Fluid in the abdominal cavity (ascites) may be seen.

Slide 124: Abnormal: The aorta is enlarged, or an aneurysm is seen.

Slide 125:  Normal Aorta

Slide 126:  Enlarged aorta (abdominal aortic aneurysm)

Slide 127: Abnormal: The liver may appear abnormal, which may indicate liver disease (such as cirrhosis or cancer).

Slide 129: Cirrhosis  Cirrhosis is a potentially life- threatening condition that occurs when inflammation and scarring damage the liver. Alcohol abuse and chronic viral hepatitis are the most common causes of cirrhosis, but it can also be caused by medicines or by another disease (such as hemochromatosis).

Slide 130: Cirrhosis  Symptoms of cirrhosis include nausea, lack of appetite and weight loss, tiredness, and swelling in the legs and belly. If left untreated, severe cirrhosis can result in internal bleeding, yellowing of the skin and eyes (jaundice), unclear thinking, hand tremors, and coma.

Slide 131: Cirrhosis  Cirrhosis is treated by taking care of the underlying cause of the liver damage and by treating other problems, such as internal bleeding, that result from the liver damage. In some cases, a liver transplant may be possible.

Slide 132: Abnormal:  The walls of the gallbladder may be thickened, or fluid may be present around the gallbladder, which may indicate inflammation. The bile ducts may be enlarged because of blockage (from a gallstone or an abnormal growth in the pancreas). Gallstones may be seen inside the gallbladder.

Slide 133:  Tubular echogenic structure in the gall bladder lumen

Slide 134: Abnormal: The kidneys may be enlarged because of urine that is not draining properly through the ureters. Kidney stones are seen within the kidneys (not all stones can be seen with ultrasound).

Slide 135:  Enlarged Kidney

Slide 136: Ureters The ureters are small tubes, each about 25cm long, that carry urine from the kidneys to the bladder.

Slide 137: Abnormal: An area of infection (abscess) or a fluid-filled cyst may appear as a round, hollow structure inside an organ. The spleen may be ruptured (if an injury to the abdomen has occurred).

Slide 138: Cyst  A cyst is a saclike structure in the body. Cysts usually are filled with fluid, which may be blood, clear fluid, or pus.  A cyst can be normal, abnormal, or, in rare cases, cancerous. In some cases, a cyst may be drained either with a needle or by cutting it open, or it may be removed entirely.

Slide 139: Contraindications  Factors that can interfere with your test and the accuracy of the results include:  Stool, air (or other gas), or contrast material (such as barium) in the stomach or intestines.  The inability to remain still during the test.  Extreme obesity.  Having an open wound in the area being viewed.

Slide 140: Contrast material  Contrast material, or contrast dye, is a substance used to make specific organs, blood vessels, or types of tissue (such as tumors) more visible on X-rays. Contrast material may also be used during a CT scan, an ultrasound, or an MRI scan.  Common contrast material substances include iodine, barium, and gadolinium.

Slide 141: Obesity Obesity is a complex disease in which having too much body fat increases a person's risk for developing other health problems. Obesity generally is measured by body mass index (BMI), a calculation that shows weight in relation to height.

Slide 142: Obesity  As BMI increases, the risk of some diseases increases. A BMI of 30 or above is considered obese in adults, which means a person is at a higher risk for certain diseases, including heart disease, high blood pressure, and coronary artery disease (CAD). If you are Asian, your health may be at risk with a lower BMI. But BMI is only one of many factors used to predict the risk of developing a disease.

Slide 143: Obesity To fit the medical definition of obesity, the excess weight must come from having too much body fat. Athletes may have a BMI over 30, but because their weight is due to muscle, not fat, they are not considered obese.

Slide 144: Obesity  The location of body fat is important. If fat accumulates mostly around the abdomen (central obesity, sometimes called apple-shaped), a person is at greater risk for type 2 diabetes, high blood pressure, high cholesterol, and CAD than people who are lean or people who have fat around the hips (peripheral obesity, sometimes called pear-shaped).

Slide 145: What To Think About Additional tests, such as a computed tomography (CT) scan , may be needed to investigate abnormal ultrasound results. For more information, see the medical test Computed Tomography (CT) Scan .

Slide 146: What To Think About  X-rays are not recommended during pregnancy because of the risk of damage to the developing baby (fetus). Because ultrasound is safe during pregnancy, it generally is used instead of an abdominal X- ray if a pregnant woman's abdomen needs to be evaluated.

Slide 147: What To Think About  On rare occasions, gallstones may not be detected by ultrasound. Other imaging tests may be done if gallstones are suspected but not seen on the ultrasound. For more information, see the medical tests Gallbladder Scan, Endoscopic Retrograde Cholangiopancreatogram (ERCP), and Abdominal X-ray.

Slide 148: What To Think About  Using abdominal ultrasound, a doctor can usually distinguish among a simple fluid-filled cyst, a solid tumor, or another type of mass that needs further evaluation. If a solid tumor is found, abdominal ultrasound cannot determine whether it is cancerous (malignant) or noncancerous (benign). A biopsy may be needed if a tumor is found. Ultrasound may be used during the biopsy to help guide the placement of the needle.

Slide 149: What To Think About  Ultrasound is less expensive than other tests, such as a CT scan or magnetic resonance imaging (MRI) scan, that also can provide a picture of the abdominal organs. However, for some problems, such as abdominal masses or an injury, a CT scan or MRI may be a more appropriate test. Also, these tests may be done if the abdominal ultrasound is normal but abdominal pain persists. For more information, see the medical tests Computed Tomography (CT) Scan and Magnetic Resonance Imaging (MRI) of the Abdome .

Slide 150: What To Think About A pelvic ultrasound will be used to produce a picture of the lower abdominal (pelvic) organs and other structures inside the pelvis. For more information, see the medical test Pelvic Ultrasound.

Slide 151: “Nurses Informations” http://nursesinformations.blogspot.com

Thursday, June 19, 2008

Coffee Drinkers Have Slightly Lower Death Rates, Study Finds

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Coffee Drinkers Have Slightly Lower Death Rates, Study Finds

A new study has found that both caffeinated and decaffeinated coffee consumption (up to 6 cups per day) is associated with a somewhat smaller rate of death from heart disease. (Credit: iStockphoto)


A new study has good news for coffee drinkers: Regular coffee drinking (up to 6 cups per day) is not associated with increased deaths in either men or women. In fact, both caffeinated and decaffeinated coffee consumption is associated with a somewhat smaller rate of death from heart disease.

"Coffee consumption has been linked to various beneficial and detrimental health effects, but data on its relation with death were lacking," says Esther Lopez-Garcia, PhD, the study's lead author. "Coffee consumption was not associated with a higher risk of mortality in middle-aged men and women. The possibility of a modest benefit of coffee consumption on heart disease, cancer, and other causes of death needs to be further investigated."

Women consuming two to three cups of caffeinated coffee per day had a 25 percent lower risk of death from heart disease during the follow-up period (which lasted from 1980 to 2004 and involved 84,214 women) as compared with non-consumers, and an 18 percent lower risk of death caused by something other than cancer or heart disease as compared with non-consumers during follow-up. For men, this level of consumption was associated with neither a higher nor a lower risk of death during the follow-up period (which lasted from 1986 to 2004 and involved 41,736 men).

The researchers analyzed data of 84,214 women who had participated in the Nurses' Health Study and 41,736 men who had participated in the Health Professionals Follow-up Study. To be in the current study, participants had to have been free of cancer and heart disease at the start of those larger studies.

The study participants completed questionnaires every two to four years that included questions about how frequently they drank coffee, other diet habits, smoking, and health conditions. The researchers then compared the frequency of death from any cause, death due to heart disease, and death due to cancer among people with different coffee-drinking habits.

Among women, 2,368 deaths were due to heart disease, 5,011 were due to cancer, and 3,716 were due to another cause. Among men, 2,049 deaths were due to heart disease, 2,491 were due to cancer, and 2,348 were due to another cause.

While accounting for other risk factors, such as body size, smoking, diet, and specific diseases, the researchers found that people who drank more coffee were less likely to die during the follow-up period. This was mainly because of lower risk for heart disease deaths among coffee drinkers.

The researchers found no association between coffee drinking and cancer deaths. These relationships did not seem to be related to caffeine because people who drank decaffeinated coffee also had lower death rates than people who did not drink coffee.

The editors of Annals of Internal Medicine caution that the design of the study does not make it certain that coffee decreases the chances of dying sooner than expected. Something else about coffee drinkers might be protecting them. And some measurement error in the assessment of coffee consumption is inevitable because estimated consumption came from self-reports.

This study was supported by National Institutes of Health research grants.

Tuesday, June 10, 2008

Blood Transfusion




Slideshow transcript

Slide 1: Blood Transfusion Nursing Procedure

Slide 2: *Whole blood transfusion replenishes the circulatories:  Volume  Oxygen-carrying capacity *Packed Red Blood Cells (RBCs) restores:  Oxygen-carrying capacity Both treat decreased hemoglobin and hematocrit.

Slide 3: Two nurses must identify the: 1. Patient 2. Blood products before administering a transfusion (to prevent errors & potentially fatal reaction)

Slide 4: If a patient is a Jehova’s Witness, a transfusion requires special written permission.

Slide 5: Equipments needed 1. Blood recipient set (filter & tubing with drip chamber for blood, or combined set)

Slide 6: Equipments needed 2. I.V. pole 3. Gloves 4. Gown 5. Face Shield

Slide 7: Equipments needed 6. Multi-lead tubing

Slide 8: Equipments needed 7. Whole blood or packed RBC’s

Slide 9: Equipments needed 8. 250 ml of Normal Saline Solution

Slide 10: Equipments needed 9. Venipuncture equipment, if necessary (should include 20G or larger catheter)

Slide 11: Equipments needed 10. optional: ice bag, warm compresses

Slide 12: Getting Ready Avoid obtaining either whole blood or packed RBC’s until you’re ready to begin the transfusion Prepare the equipment when you’re ready to start the infusion.

Slide 13: The Procedure Explain the procedure to the patient Make sure an informed consent has been signed Record baseline vital signs

Slide 14: The Procedure Obtain whole blood or packed RBCs from the blood bank within 30 minutes of the transfusion start time.

Slide 15: The Procedure Check the expiration date on the blood bag, & observe for abnormal color, RBC clumping, gas bubbles, & extraneous material. Return outdated or abnormal blood to the blood bank.

Slide 16: The Procedure Compare the name & number on the patient’s wristband with those on the blood bag label.

Slide 17: The Procedure Check the blood bag identification number, ABO blood group, and Rh compatibility. Also, compare the patient’s blood bank identification number, if present, with the number on the blood bag.

Slide 18: The Procedure Identification of blood & blood products is performed at the patient’s bedside by two licensed profesionals, according to the facility’s policy.

Slide 20: The Procedure Wash your hands. Put on gloves, a gown, & a face shield.

Slide 21: Remove IV administration set and fluid from packaging

Slide 22: Remove the cover from the selected spike and the cover from the bottle/bag of fluid.

Slide 23: The Procedure Then insert the spike of the line you’re using for the normal saline solution into the bag of saline solution aseptically.

Slide 24: When fluid drips out of the end of the distal tubing turn off the infusion rate clamp.

Slide 25: The Procedure Using a Y-type set, close all the clamps on the set.

Slide 26: The Procedure Next, open the port on the blood bag & insert the other spike.

Slide 27: The Procedure Hang the bags on the I.V. pole,

Slide 28: The Procedure open the clamp on the line of saline solution,

Slide 29: The Procedure squeeze the drip chamber until it’s half full.

Slide 30: The Procedure If the patient doesn’t have an I.V. line in place, perform venipuncture, using a 20G or larger-diameter catheter.

Slide 31: The Procedure Avoid using an existing line if the needle or catheter lumen is smaller than 20G. Ventral venous access devices also may be used for transfusion therapy.

Slide 32: The Procedure If you’re administering whole blood, gently invert the bag several times to mix the cells.

Slide 33: The Procedure Attach the prepared blood administration set to the venipuncture device, & flush it with normal saline solution.

Slide 34: The Procedure Then close the clamp to the saline solution, & open the clamp between the blood bag & the patient.

Slide 35: The Procedure Adjust the flow clamp closest to the patient to deliver the blood at the calculated drip rate.

Slide 36: The Procedure Remain with the patient, & watch for the signs of a tranfusion reaction, such as fever, chills, & wheezing.

Slide 37: The Procedure If such sign develop, record vital signs and stop the transfusion.

Slide 38: The Procedure Infuse saline solution at a moderately slow infusion rate, & notify the doctor at once.

Slide 39: The Procedure If no signs of a reaction appear within 15 minutes, you’ll need to adjust the flow clamp to the ordered infusion rate.

Slide 40: The Procedure A unit of RBCs may be given over 1-4 hours as ordered.

Slide 41: The Procedure After completing the transfusion, you’ll need to put on gloves & remove & discard the used transfusion equipment.

Slide 42: The Procedure Then remember to reconnect the original I.V. fluid, if necessary, or disconnect the I.V. infusion.

Slide 43: The Procedure Return the empty blood bag to the blood bank, & discard the tubing & filter.

Slide 44: The Procedure Record the patient’s vital signs.

Slide 45: Practice Pointers Although some microaggregate filters can be used for up to 10 units of blood, always replace the filter & tubing if more than 1 hour elapses between transfusions.

Slide 46: Practice Pointers When administering multiple units of blood, use blood warmer to avoid hypothermia.

Slide 47: Practice Pointers For rapid blood replacement, know that you may need to use a pressure bag.

Slide 48: Practice Pointers If you’re administering packed RBCs with Y-type set, you can add saline solution to the bag to dilute the cells by closing the clamp between the patient & the drip chamber & opening the clamp from the blood

Slide 49: Practice Pointers Then lower the blood bag below the saline solution container & let 30-50ml of saline solution flow into the packed cells.

Slide 50: Practice Pointers Finally, close the clamp to the blood bag, rehang the bag, rotate it gently to mix the cells & saline container

Slide 51: Documenting Blood Transfusion In your notes, record: Date & time of the transfusion. Type & amount of transfusion product. Patient’s vital signs. Your check of all identification data. Transfusion reaction & nursing actions taken.

Slide 52: “Nurses Informations” http://nursesinformations.blogspot.com

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