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Having trouble sleeping? Light may be the issue….

November 24th, 2010 · Nursing

You may want to get rid of the normal night lights in your kids rooms, and to light your hallways and exchange them for red lights!  Recent studies have shown that even the smallest amount of light can be transmitted through your eyelids and cause disturbances in your sleep.  I know that I’ve talked about sleep aids for sleep, but there is a lot of new research supporting the effects of light on the circadian rhythm (the bodies natural sleep/wake cycle).

How does this happen?
Well, there are light sensitive cells in our retinas and they send signals to the brain letting us know whether it is day or night and if we should be awake or sleeping.  These cells can get pretty confused due to jet lag or off shift work.  So, exposure of these cells to bright white light (from TV’s, lamps, etc) at night can cause the cells to overwork and become confused, which can lead to sleeping disorders.  As well, people who work inside with exposure to dull light all day, like from overhead lights and from computer screens, can cause confusion to the cells.

http://healthysleep.med.harvard.edu/healthy/science/how/external-factors

The signals from the cells in the retina push for a drive to be awake, no matter ow tired you are.  After extensive sleep deprivation, that drive wears off and the sleep cycle begins because of a build up of adenosine in the brain, but no one likes to go through the day exhausted and barely getting through, so we drink caffeine which blocks the adenosine and keeps you awake.

So what can I do?
Decrease all light in the bedroom. If you sleep during the day, get black out shades and limit caffeine before bed.  Keep TV’s off, and if you do need a nightlight, you can change it to a low red bulb OR get a very, very dim white bulb that is not in your direct vision or area of your eyes.  Also, try to decrease the amount of light stimulation right before bed; so don’t read in bed with a bed side light, so that the retinal cells are not directly stimulated right before bed. Also, you may want to make your bedroom temperature a little lower, REM sleep is better attained when temperatures in the room are cool, so you can cozy up and get some good sleep!

Also, not to be overlooked but whether you have a sleep partner that is human, or not (i.e. dog, cat, etc), you need to work with any problems they might have.  So, if there are any snoring problems, or sleeping disorders that they might have, it can affect you!  Sleep studies are covered by most insurances, so it is worth going to your HCP for you or your partner if you have extensive sleep problems that are effecting either of you to get adequate sleep, because long term sleep deprivation can cause obesity, depression, and other issues.  But, try to keep down bright lights, and give yourself time to get to sleep (i.e. turn in about 30 minutes before you “need” to get to sleep so that you decrease light stimulation and give your body time to wind down.)

Yours in Good Health
B



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Peptic Ulcer Treatment

November 23rd, 2010 · Nursing

Treatment of peptic ulcers

Self-help

There are lifestyle changes that you can make to help your ulcers heal and prevent them coming back. These include:

  • not having food and drink that give you more severe symptoms, such as spicy foods and alcohol
  • stopping smoking
  • not taking painkillers that are likely to cause ulcers in the future – your GP or pharmacist can give you advice on other medicines you can take instead

Medicines

There are two main groups of medicines available to treat peptic ulcers. These are:

  • proton pump inhibitors, such as omeprazole and lansoprazole
  • H2-blockers – examples include ranitidine and cimetidine

Both types of medicine reduce acid production in the stomach, allowing your ulcer to heal. They can both be used long-term to prevent your ulcer coming back.

These medicines will relieve your symptoms and within a few weeks your ulcer will heal. However, once you stop taking the medicine, your ulcer may come back unless the H. pylori has been treated and removed.

Treating H. pylori infection

If tests confirm that you have H. pylori, you will be prescribed medicines to treat it. This is usually a combination of a proton pump inhibitor and two antibiotics. Treating the H. pylori infection should allow your ulcer to heal and prevent it from coming back. Your GP will do the tests again after treatment to make sure it has been successful in getting rid of H. pylori.

Source : hcd2.bupa.co.uk



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Looking For Free NCLEX Questions For Practice ?

November 23rd, 2010 · Nursing Care Plans

Looking For Free NCLEX Questions For Practice?

By John C Duncan

NCLEX-RN exam is the licensing exam for the USA-RN. If you wanted to be a US-RN you would need to pass the NCLEX exam. Need Free NCLEX Questions for practice?

NCLEX-RN exams have been developed by NCSBN and it is a computer based testing system. The exams are currently handled by Pearson VUE. If you would like to take the NCLEX-RN exam you would then need to make sure you have registered with the appropriate state board of Nursing first.

Pearson Vue is just a testing center and is not in any way connected with NCSBN or NCLEX-RN. They are just the testing center that facilitates the exam.

It is important to know that different state boards of nursing have different requirements. Make sure before taking the NCLEX-RN application, you are eligible. The first step upon determining that you are eligible is to send the state board of nursing of the territory where you would like to practice. Although the NCLEX-RN exam is nationwide, the eligibility to take the NCLEX exam is individual and unique per each state.

After being eligible, you would then need to register to pearson vue, and pay the appropriate fees. For international test takers, an additional $150 may be required.

The next step would be to register for the testing center where you would like to take the exam. There are nationwide and worldwide testing centers for Pearson VUE. It would be great if you could have your schedule weeks before starting the test to have ample time for your review.

Then after getting the Authorization to test you would then need to get started reviewing for the test.

Remember preparation is the key to success!

Click here -> Nclex Practice Test

If you would like to know where to get free nclex questions visit our site below.

** Disclaimer : The site below is not associated with NCLEX-RN, NCSBN or with any other organization. It is provided for educational purposes only and DOES NOT contain the real NCLEX questions.

Have you ever wanted to take practice for free nclex questions? Get Free Nclex Questions and help pass your tests!

Article Source: http://EzineArticles.com/?expert=John_C_Duncan

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Looking For Free NCLEX Questions For Practice ?

November 23rd, 2010 · Nursing Care Plans

Looking For Free NCLEX Questions For Practice?

By John C Duncan

NCLEX-RN exam is the licensing exam for the USA-RN. If you wanted to be a US-RN you would need to pass the NCLEX exam. Need Free NCLEX Questions for practice?

NCLEX-RN exams have been developed by NCSBN and it is a computer based testing system. The exams are currently handled by Pearson VUE. If you would like to take the NCLEX-RN exam you would then need to make sure you have registered with the appropriate state board of Nursing first.

Pearson Vue is just a testing center and is not in any way connected with NCSBN or NCLEX-RN. They are just the testing center that facilitates the exam.

It is important to know that different state boards of nursing have different requirements. Make sure before taking the NCLEX-RN application, you are eligible. The first step upon determining that you are eligible is to send the state board of nursing of the territory where you would like to practice. Although the NCLEX-RN exam is nationwide, the eligibility to take the NCLEX exam is individual and unique per each state.

After being eligible, you would then need to register to pearson vue, and pay the appropriate fees. For international test takers, an additional $150 may be required.

The next step would be to register for the testing center where you would like to take the exam. There are nationwide and worldwide testing centers for Pearson VUE. It would be great if you could have your schedule weeks before starting the test to have ample time for your review.

Then after getting the Authorization to test you would then need to get started reviewing for the test.

Remember preparation is the key to success!

Click here -> Nclex Practice Test

If you would like to know where to get free nclex questions visit our site below.

** Disclaimer : The site below is not associated with NCLEX-RN, NCSBN or with any other organization. It is provided for educational purposes only and DOES NOT contain the real NCLEX questions.

Have you ever wanted to take practice for free nclex questions? Get Free Nclex Questions and help pass your tests!

Article Source: http://EzineArticles.com/?expert=John_C_Duncan

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Antidepressant Use and Miscarriage

November 23rd, 2010 · Nursing

 A large study out of Canada, that was performed over a 5 year time period came out with some surprising statistics related to the use of SSRI’s (selective serotonin reuptake inhibitors) and miscarriage rates.  The specific drugs that were found to have a higher rate of miscarriage, 68% higher risk (than those who have never used antidepressants ever), were Prozac, Paxil, and Effexor.  Paxil actually has a 75% higher risk of miscarriage, specifically. It was originally found that in pregnant rats, there were high numbers of miscarriages, thus the study moved to humans because a few years ago, the medical community, for the most part, advocated for the use of antidepressants in pregnant women because the benefit to the mother outweighed the risk to the fetus.

The study, from the Canadian Journal of Medicine, looked at just shy of 70,000 Canadian women from ages 15 to 45, of which some took antidepressants, some just had a history of depression, and some had none of the risk factors.  To make things a little clearer, the risk of miscarriage compared to those on Antidepressants versus women who have never used them is 68%, the risk for women who have a history of SSRI use versus those on them during pregnancy is 61%, and the risk factor of having a history of depression is 19%. But, in the US out of the roughly 2 million pregnancies per year, there are approximately 600,000 miscarriages within the first trimester (20 weeks), so the baseline risk of miscarriage in the US is about 20-31% anyway.

Now, this is not to say, that if you are pregnant, you should stop taking antidepressants because the risk factor is there, based on this large study, but it is unknown why exactly the rate of miscarriage is higher.  It is theorized that the change in serotonin levels can put pressure on the uterus in an early stage of pregnancy, and possibly cause the miscarriage.  But, despite this study being rather large and appear to be non-biased, it doesn’t take into effect some of the risk factors that are associated with depression in pregnancy, such as smoking, obesity, and older age.  It is also theorized that the stress related to depression itself on your body, may be the cause of the increased rate of miscarriage; much more research needs to be done in this area.

Thus, you need to speak with your HCP about your specifics needs related to depression and the health of your baby.  It wouldn’t be healthy for you to stop taking the medications, go into withdrawal and a severe depression because of it, so there may be behavior modifications that you can do, or switch to a different medication, that may have a decreased risk.  Plus, if you are more in tune to the fact that you are at a higher risk for miscarriage, you may be more likely to notice different changes in your body, perhaps take it easy the first few months of your pregnancy, and follow-up with your OB/GYN more closely at first.

What are some non-medication treatments for depression used in Pregnancy?
Most of these have not been well studied, but are used by some HCP’s with positive responses from their patients, so again, talk to your HCP and don’t start any of these therapies without their approval!
-Addition of Omega-3 fatty acids to your diet
-Bright light therapy which can help with Seasonal Affective Disorder (30-40 minutes of bright light per day either out in the sun OR using specific light bulbs)
-Exercise can keep endorphins up and make you feel better about yourself
-Psychotherapy; talking to a licensed therapist can alleviate stress and depression symptoms
-And behavioral cognitive therapy can reduce symptoms of depression (a type of psychotherapy that emphasizes the role of thinking in what we do and how we feel- so you think and make active choices in your life)

If you have depression, and whether or not you are being treated for it, you should talk to your Primary Care Provider (PCP) and OB/GYN (and possibly Psychiatrist) before getting pregnant about the risks, possibly change medications or decrease doses, and your other options for treatment during pregnancy.  And if you get pregnant and it was unplanned, go to your HCP ASAP and discuss your options and risks. DO NOT take yourself off of your medications based on these few studies!  There are many different options, and you will just need to be watched closer, and try to de-stress any way you can, such as go out with friends for a walk, go to the spa for a facial, get your nails done, spend time with your significant other…whatever helps you to relieve stress, do it!  Make time for yourself and pay attention to your body.  And, don’t feel horrible if you call your HCP every time you are worried…it is YOUR body and your baby, and you know how your body feels.

Yours in Good Health
B



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Treatment Chart for Peptic Ulcer

November 22nd, 2010 · Nursing

TREATMENT CHART FOR PEPTIC ULCER

A – DIET

I. Milk and banana diet for three to five days.

II. Thereafter, the following diet may be adopted:-

1. Upon arising: 25 black raisins soaked overnight in water along with the water in which they are soaked and also water kept overnight in copper vessel.

2. Breakfast: Fruits such as bananas, mangoes, musk melon, custard apple, papaya and figs and a glass of milk. Avoid sour fruits .

3. Mid-morning: Carrot juice or coconut water.

4. Lunch: Steamed vegetables, whole wheat chappatis or rice.

5. Mid-afternoon: Few dates and milk.

6. Dinner: Lightly cooked vegetables, whole wheat Chappatis and fruits.

NOTE: Introduce gradually raw vegetables and sprouted green gram .

7. Before retiring: A glass of milk.

AVOID: Tobacco, alcohol, flesh foods, coffee, tea, condiments, all chillies, white sugar, white flour and their products, fried and greasy foods.

IMPORTANT: Take low salt diet, small and frequent meals, avoid too hot or too cold foods and drink eight glasses of water everyday.

B – OTHER MEASURES

1. We packs for one hour in the morning and evening on an empty stomach, hot packs in case of abdominal pain.
2. Yogasanas like uttanpadasan, pavanmuktasan, bhujan¬gasan and shavasan.
3. Avoid stress, nervous strain, and worries.
4. Adequate rest and relaxation.

Source : www.diethealthclub.com



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Nursing Care Plan for COPD (Chronic Obstructive Pulmonary Disease)

November 22nd, 2010 · Nursing Care Plans

NCP – Nursing Care Plan for COPD (Chronic Obstructive Pulmonary Disease)

Nursing Care Plan for COPD Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is estimated to affect 32 million persons in the United States and is the fourth leading cause of death in this country. Patients typically have symptoms of both chronic bronchitis and emphysema, but the classic triad also includes asthma. Most of the time COPD is secondary to tobacco abuse, although cystic fibrosis, alpha-1 antitrypsin deficiency, bronchiectasis, and some rare forms of bullous lung diseases may be causes as well.

Causes

In general, the vast majority of chronic obstructive pulmonary disease (COPD) cases are the direct result of tobacco abuse. While other causes are known, such as alpha-1 antitrypsin deficiency, cystic fibrosis, air pollution, occupational exposure (eg, firefighters), and bronchiectasis, this is a disease process that is somewhat unique in its direct correlation to a human activity.

Signs and Symptoms

Essentials of diagnosis include:

  • History of cigarette smoking.
  • Chronic cough and sputum production (in chronic bronchitis)
  • Dyspnea (in emphysema)
  • Rhonchi, decreased intensity of breath sounds, and prolonged expiration on physical examination
  • Airflow limitation on pulmonary function testing that is not fully reversible and most often progressive

One of the most common symptoms of COPD is shortness of breath (dyspnea). People with COPD commonly describe this as: “My breathing requires effort,” “I feel out of breath,” or “I can’t get enough air in”. People with COPD typically first notice dyspnea during vigorous exercise when the demands on the lungs are greatest. Over the years, dyspnea tends to get gradually worse so that it can occur during milder, everyday activities such as housework. In the advanced stages of COPD, dyspnea can become so bad that it occurs during rest and is constantly present.

Other symptoms of COPD are a persistent cough, sputum or mucus production, wheezing, chest tightness, and tiredness.

People with advanced (very severe) COPD sometimes develop respiratory failure. When this happens, cyanosis, a bluish discoloration of the lips caused by a lack of oxygen in the blood, can occur. An excess of carbon dioxide in the blood can cause headaches, drowsiness or twitching (asterixis). A complication of advanced COPD is cor pulmonale, a strain on the heart due to the extra work required by the heart to pump blood through the affected lungs. Symptoms of cor pulmonale are peripheral edema, seen as swelling of the ankles, and dyspnea.

There are a few signs of COPD that a healthcare worker may detect although they can be seen in other diseases. Some people have COPD and have none of these signs. Common signs are :

  • tachypnea, a rapid breathing rate
  • wheezing sounds or crackles in the lungs heard through a stethoscope
  • breathing out taking a longer time than breathing in
  • enlargement of the chest, particularly the front-to-back distance (hyperaeration)
  • active use of muscles in the neck to help with breathing
  • breathing through pursed lips
  • increased anteroposterior to lateral ratio of the chest (i.e. barrel chest).
Nursing Care Plan for Chronic Obstructive Pulmonary Disease (COPD)

Assessment

  1. The identity of the client
    Name, place of birth date, age, gender, religion / tribe, the people of the State, the language used, the responsible include: name, address, relationship with the client.
  2. Patterns of health perception
    Review the status of a medical history of having experienced the client, what efforts and where clients get medical help, then what makes the client’s health status declined.
  3. The pattern of metabolic nutrients.
    Ask the client about the type, frequency, and amount of eating and drinking in a day. Assess client’s excessive appetite or reduced, assess nausea or vomiting or any intravenous therapy, use of enteric tube, also measuring weight, measure height, upper arm circle and calculate the ideal weight client to obtain nutritional status.
  4. The pattern of elimination :
    • Review of rekuensi, characteristics, difficulties / problems and also the use of assistive devices such as catheters Folly, also measuring intake and output every shift.
    • Elimination of the process, review the frequency, characteristics, difficulties / problems defecation.
  5. The pattern of activity and exercise
    Assess the ability of activities both before illness or condition now and also the use of aids such as canes, wheel chairs and others. Ask the client about the use of leisure time. Does the client complain of breathing, such as pounding heart, chest pain, weak body.
  6. The pattern of sleep and rest
    Ask the client’s daily sleep habits, how long sleep, a nap. How sleep the client whether in light or dark. Often wake up during sleep caused by pain, itching, urination, difficulty and others.
  7. The pattern of cognitive perception
    Ask the client whether to use tool for seeing, hearing. Is there any client trouble remembering things, how clients cope with discomfort: pain. Is there a perception of sensory disturbances such as blurred to see, hearing impaired. Assess the level of orientation to time place and person.
  8. Patterns of perception and self-concept
    Review about his behavior, whether the client has experienced despair / frustration / stress.
  9. The pattern of role relationships
    What is the role of clients in the community and family, how client relationships in society and family and coworkers. Assess whether there is disruption and disturbance of verbal communication in interactions with family members and others.
  10. The pattern of sexual production
    Ask the client about the use of contraception and the problems that arise. How many children of clients and client’s marital status.
  11. The pattern of sexual production
    Ask the client about the use of contraception and the problems that arise. How many children of clients and client’s marital status. The pattern of coping mechanisms and tolerance to stress.
    Assess the factors that make the client angry, where clients exchange opinions and coping mechanisms that are used for this. Assess client’s current situation against conformity, expression, denial / rejection of self.
  12. he pattern of belief system
    Assess whether the client is often worship, clients follow a religion?. Assess whether there are values on which clients embrace religion contrary to health.

Nursing Diagnosis and Nursing Intervention
Ineffective airway clearance related to the disruption of production increased secretions, retained secretions


Goal : Ventilation / oxygenation to the needs of clients.  


Outcome : Maintain a patent airway and breath sounds clean  


Intervention

  • Review / monitor respiratory frequency, record the ratio of inspiration / expiration.
  • Assess the patient to a comfortable position, such as raising the head of the bed, seat and backrest of the bed.
  • Auscultation for breath sounds, record the sound of breath for example: wheezing, and rhonchi krokels.
  • Note the presence disepnea, for example: complaints restlessness, anxiety, respiratory distress
  • Help the abdominal breathing exercises or lip.
  • Observation of the characteristic cough, for example: persistent, hacking cough, wet, auxiliary measures to improve the effectiveness of the airway.
  • Increase fluid intake to 3000 ml / day according to tolerance of the heart.
  • Bronchodilators, eg, β-agonists, efinefrin (adrenaline, vavonefrin), albuterol (Proventil, Ventolin), terbutaline (brethine, brethaire), isoeetrain (brokosol, bronkometer).

    • (Doenges, 1999. P. 156).

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Healthy Diet for Child

November 21st, 2010 · Nursing

By the time they are five years old; children should be eating a similar diet to the rest of the family and joining in with family meals. But as they’re still growing, they may need a few extras to ensure they get enough energy.

Make Sure the Whole Family Eats Well

Children will only develop healthy eating habits if the rest of the family sets a good example:

  • Sit down together to eat as a family whenever possible
  • Meals should provide a good balance of carbohydrates, proteins, fats, vitamins and minerals
  • Cut down on junk food, processed food and high-fat, high-sugar snacks

Don’t Forget About Breakfast

Research shows that many children go off to school without eating a good breakfast or grab a chocolate bar instead. Most families are in a hurry in the mornings, but a bowl of fortified cereal with milk and a glass of fruit juice takes no time at all to prepare and eat. Alternatively, a couple of slices of wholemeal toast and spread with a banana and a glass of milk will provide an energy-rich start to the day. Children are much more likely to concentrate at school if they’ve had something good to eat first.

Lunch on Schooldays

If children have a school lunch, parents can chat with them about healthy choices – although peers may have an increasing influence at this stage. Some schools send out menus in advance, which children and parents can look at together.

If children have a packed lunch, parents can still monitor what they eat and many schools make it easier by banning things like crisps and chocolate bars. Try to include a balanced selection such as a sandwich, samosa or filled pitta, some fresh or dried fruit, raw vegetables like carrot sticks or cherry tomatoes and a yoghurt or a piece of cheese.

Snacks

Children often need snacks during the day to keep going. Avoid keeping too many biscuits, cakes and crisps in the cupboards and stock them instead with crackers, bread sticks and dips, plenty of fruit (children love fruit that’s easy to eat, like grapes, strawberries, dried apricots and raisins) and raw vegetables. Other good snack ideas include breakfast cereal and milk; baked beans, cheese or peanut butter on toast; yoghurt; and home-made smoothies.

Drinks

Keep sugary drinks to a minimum because of the large amount of sugar they contain. The diet varieties have lots of artificial ingredients too, so are best avoided. If children want fizzy drinks, try sparkling water with fruit juice or a little high juice squash. Milk and water are good drinks at any time of day, but avoid filling up on milk before meals. Children over the age of two no longer need full fat milk.

Vitamins

Some parents give their children vitamin supplements. Most experts agree that this is unnecessary if children are eating a balanced diet.

Family Members with Different Tastes

If parents try to please everyone, they can end up running a café at home. Try to strike a balance between acknowledging that everyone is an individual – with their own likes and dislikes – and a certain level of cooperation over eating healthy food.

There are some simple strategies that will help. For example, if one child prefers their pasta plain, put some to one side before adding sauce. Or if they only like one or two vegetables, buy in frozen ones that can be cooked with a minimum of fuss – but don’t deprive everyone else of variety. Let children help choose healthy menus and get them involved in shopping and cooking – that way, they’re more likely to feel consulted.

Do serve foods that children will like, but offer new tastes too and praise them for trying. It’s best not to force children to eat what’s on their plates, but don’t offer too many alternatives either or let them fill up on puddings.

Source : www.kidsandnutrition.co.uk



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Nursing Care Plan for Diabetes Mellitus

November 21st, 2010 · Nursing Care Plans

NCP – Nursing Care Plan for Diabetes Mellitus

Nursing Care Plan for Diabetes Mellitus

Diabetes Mellitus

Diabetes mellitus, often simply referred to as diabetes—is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).

There are three main types of diabetes :

  • Type 1 diabetes: results from the body’s failure to produce insulin, and presently requires the person to inject insulin. (Also referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes.)
  • Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency.
  • Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM.

Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of monogenic diabetes.

All forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications. Both type 1 and 2 are chronic conditions that usually cannot be cured. Pancreas transplants have been tried with limited success in type 1 DM; gastric bypass surgery has been successful in many with morbid obesity and type 2 DM. Gestational diabetes usually resolves after delivery. Diabetes without proper treatments can cause many complications. Acute complications include hypoglycemia, diabetic ketoacidosis, or nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, chronic renal failure, retinal damage. Adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as smoking cessation and maintaining a healthy body weight.en.wikipedia.org

Causes

The cause of diabetes depends on the type. Type 2 diabetes is due primarily to lifestyle factors and genetics.

Type 1 diabetes is also partly inherited and then triggered by certain infections, with some evidence pointing at Coxsackie B4 virus. There is a genetic element in individual susceptibility to some of these triggers which has been traced to particular HLA genotypes (i.e., the genetic “self” identifiers relied upon by the immune system). However, even in those who have inherited the susceptibility, type 1 diabetes mellitus seems to require an environmental trigger.

Signs and Symptoms

The classical symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). Symptoms may develop rapidly (weeks or months) in type 1 diabetes while in type 2 diabetes they usually develop much more slowly and may be subtle or absent.

Prolonged high blood glucose causes glucose absorption, which leads to changes in the shape of the lenses of the eyes, resulting in vision changes; sustained sensible glucose control usually returns the lens to its original shape. Blurred vision is a common complaint leading to a diabetes diagnosis; type 1 should always be suspected in cases of rapid vision change, whereas with type 2 change is generally more gradual, but should still be suspected.

People (usually with type 1 diabetes) may also present with diabetic ketoacidosis, a state of metabolic dysregulation characterized by the smell of acetone; a rapid, deep breathing known as Kussmaul breathing; nausea; vomiting and abdominal pain; and an altered states of consciousness.

A rarer but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 diabetes and is mainly the result of dehydration. Often, the patient has been drinking extreme amounts of sugar-containing drinks, leading to a vicious circle in regard to the water loss.

A number of skin rashes can occur in diabetes that are collectively known as diabetic dermadromes.

Nursing Care Plan for Diabetes Mellitus

Assessment

  • Family Health History
    Are there families who suffer from illnesses such as client ?
  • Patient Health History and Previous Treatment
    How long suffered from DM client, how to handle, get what kind of insulin therapy, how to take the medicine whether regular or not, what is done to cope with illness clients.
  • Activity / Rest:
    Tired, weak, hard Moves / walking, muscle cramps, decreased muscle tone.
  • Circulation
    Is there a history of hypertension, AMI, claudication, numbness, tingling in the extremities, ulcers on the feet long healing time, tachycardia, changes in blood pressure
  • Ego Integrity
    Stress, anxiety
  • Elimination
    Changes in the pattern of urination (polyuria, nocturia, anuria), diarrhea
  • Food / Fluids
    Anorexia, nausea, vomiting, do not follow the diet, weight loss, thirst, the use of diuretics.
  • Neurosensori
    Dizziness, headache, numbness, muscle weakness numbness, paraesthesia, visual disturbances.
  • Pain / Leisure
    Abdominal strain, pain (is / weight)
  • Respiratory
    Cough with or without purulent sputum
  • Security
    Dry skin, itching, skin ulcer.

Nursing Diagnosis and Nursing Intervention

Fluid volume deficient related to osmotic diuresis from hyperglycemia

Planning

After 8 hours of nursing interventions, the patient will demonstrate adequate hydration.

Intervention

  • Monitor orthostatic blood pressure changes.
    Rational : Hypovolemia may be manifested by hypotension and tachycardia.
  • Assess peripheral pulses, capillary refill, skin turgor, and mucous membrane.
    Rational : Indicators of level of dehydration, adequacy of circulating volume.
  • Monitor respiratory pattern like Kussmaul’s respirations and acetone breath.
    Rational : Lungs remove carbonic acid through respirations, producing a compensatory respiratory alkalosis for ketoacidosis.
  • Monitor input and output. Note urine specific gravity.
    Rational : Provides ongoing estimate of volume replacement needs, kidney function, and effectiveness of therapy.
  • Promote comfortable environment. Cover patient with light sheets.
    Rational : Avoids overheating, which could promote further fluid loss.
  • Monitor temperature, skin color and moisture.
    Rational : Fever, chills, and diaphoresis are common with infectious process; fever with flushed, dry skin may reflect dehydration.

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Hepatitis happens….

November 21st, 2010 · Nursing

Hepatitis C is a virus that attacks the liver and causes inflammation and liver damage but it can be a silent virus with no symptoms until late in the infectious process. The infection is on the rise worldwide, and is replacing HIV/AIDS as the most feared disease among those at high risk as there is no cure and the treatments are difficult to tolerate. The CDC estimates that 150,000-170,000 new cases of Hepatitis C are documented each year! For this reason, I wanted to let you know about the disease, its transmission, treatments, ways to live with this chronic disease, and prevention.

What is Hepatitis C?
It is a chronic viral infection that causes liver inflammation and liver damage, and the most serious of all the Hepatitis infections.  The liver damage can lead to the need for a liver transplant, which won’t cure the disease, but allow for the person with the infection to live longer and keep the infection at bay for a while; there is NO CURE.  It is transmitted through blood to blood contact, in a similar way to HIV transmission.

Symptoms:
Fever
Fatigue
Nausea
Decreased appetite
Muscle and joint pains
Tenderness over your liver (right upper quadrant of your abdomen under your rib cage)
Jaundice of the skin (yellowing of the skin)
Jaundice of the sclera (the whites of the eyes become yellow)
*The symptoms can be none at all and the Hep C is merely detected through lab tests at a routine physical with your HCP- it can be unknown by a patient for years.  But you should be aware that generalized long term flu-like symptoms, if you are at risk, can be a sign of Hep C, so you should go see your HCP for a work up and let them know of your risk.

Are you at risk?
Screening criteria usually include:
-Anyone who has injected drugs
-Anyone with abnormal Liver Function Tests (aka LFT’s)
-Babies born to mothers with Hep C
-Healthcare workers with past needle sticks or other blood exposures
-Hemophiliacs treated with clotting factors or blood prior to 1987
-Long-term dialysis patients
-People with blood transfusions or transplants before 1992
-People with sexual partners (protected or unprotected) that are Hepatitis C positive

Transmission:
Hepatitis C is a very strong virus and can live outside of the body for up to 4 days, which is a long time for a virus, and it means that you can even contract Hep C from dried blood.  For example, if you use someone else’s toothbrush that may has bleeding gums, and you have just flossed or have a canker sore or any other opening of the mucosa in your mouth, you could contract Hep C.  Also, another reason why you wouldn’t want to use someone else’s tweezers….not to mention others used needles to inject!  It is also transmitted through unprotected sexual intercourse, from blood transfusions or solid organ transplant (heart, kidney, lung, liver, pancreas, kidney) prior to 1992 (the testing for Hep C then became universal), and some babies can become infected through childbirth from infected mothers.

Complications from the Disease:
Due to the chronic inflammation from the virus, the liver can become damaged through a build up of scar tissue (cirrhosis) and not work well which can lead to total liver failure, sometimes requiring a liver transplant.  As well, patients with Hep C are at a higher risk for liver cancer due to all the stress on the liver from the chronic infection.  Due to all of the stress and inflammation on the liver, there are numerous changes that can occur such as chronic kidney insufficiency, skin rashes, jaundice, increased bleeding times, and a build-up of stomach fluid called ascites (it can make the stomach look pregnant).  Ascites can only be removed by certain diuretics and though paracentesis (where a needle is inserted into the stomach to drain the fluids off) and despite treatment it always comes back.  Also, because the liver filters out toxins from the blood, when it doesn’t work well, because it becomes scarred and hard (cirrhosis) it doesn’t filter well which can lead to a build up of ammonia in the brain and can cause confusion and lead to coma or death, the confusion is called encephalopathy.  When the liver becomes very diseased, patients need to have a low sodium and low protein diet to prevent further complications.

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Treatment options:
Not all patients require treatment, despite its severity.  The chronic infection can start slowly and only allow for small amounts of initial inflammation; once your liver function tests become deranged (abnormal) your HCP will most likely send you to an Infectious Disease or Hepatology specialist for treatment. A Hepatologist will perform a core punch biopsy in which they put a large bore needle into your liver, and take those cells out and study the actual damage under a microscope to visualize the damage that is shown in the abnormal LFT’s.  You will be started on antiviral medications, which attempt to clear the virus from your body, you will have one treatment “round” which lasts 4-6 weeks, have your liver functions re-tested, then based on those results either get another round of treatment OR just be watched closely by your HCP through blood tests and liver ultrasounds. One antiviral medication, Interferon, is still being tested, and thus far the results are mixed because while it seems to work well at eradicating the virus, many patients cannot handle the side effects and stop taking the drug, plus it is very expensive and not available everywhere.  There are currently 25 new drugs being studied for the treatment of Hepatitis C, as of this summer/fall and I will update the drugs as they show promising results and are closer to approval by the FDA, and hopefully more available.

Alternative Therapies:
The one alternative therapy that is used sometimes, although the studies are poor due to size and design, milk thistle supplementation is said to help up-regulate the liver, so it works more efficiently, and prevent/treat jaundice.

Living with Hep C:
The best things you can do to help yourself live a happy and healthy life with Hepatitis C are:
Be honest with your family/partner/HCP’s about your disease to prevent/limit their exposure
Limit (if not stop) all alcohol intake
Live a healthy life with  a diet full of fresh foods, exercise, and water (lay off preservatives and things that do not come from the earth directly!)
Stop injecting drugs, if you cannot stop, please use clean new needles and find a needle exchange (I urge you to get help)
Cover all cuts with bandages to limit blood exposure to others
Don’t let others share your grooming products (razors, tweezers, toothbrushes, etc.)
Talk to your HCP about all medications you take to prevent taking ones that are toxic to the liver.
Get adequate sleep
Keep stress to a minimum! ( I know, so much easier said than done!!)

And most importantly….Prevention:
If you are going to get tattoos or piercings, please go to a place that is clean in appearance and ensure that they are using new clean sterile needles on you and new pots of INK- the blood can be in the ink and the virus then transmitted.
Don’t share needles for injections (again please get help to stop)
Don’t share grooming products
Practice safe sex
Ask your partners for their status of HIV/AIDS and Hep C
Most importantly, if you are at risk, go to your HCP and ASK to be tested!!

While Hepatitis C can be a silent killer, in that the symptoms can be really generic, and it can be slow to onset, along with no current cure or vaccination.  So, please be aware of the signs and symptoms and be proactive about your life, if you feel that you are at risk, or you are unsure, then please got o get tested, the earlier you know that you have the disease, the earlier you can start treatment and get on the road to a healthy life to prevent further damage to your liver!

Yours in Good Health
B



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