Thyroid Storm Symptoms, Causes, and Treatment

Medical Author: Charles P. Davis, MD, PhD Medical Editor: Melissa Conrad Stppler, MD There are really not many emergencies that we need to worry about regarding the thyroid gland - but thyroid storm is one of the rare exceptions. Thyroid storm is a medical emergency condition and needs to be treated emergently; even before all confirmatory diagnostic tests are performed. Thyroid storm is a crisis or life-threatening condition characterized by an exaggeration of the usual physiologic response seen in hyperthyroidism. Whereas hyperthyroidism can cause symptoms such as sweating, feeling hot, palpitations and weight loss - symptoms of thyroid storm are more severe, resulting in complications such as:

fever dehydration rapid heart rate nausea/vomiting diarrhea irregular heart beat weakness heart failure confusion/disorientation death

Fever tends to be one of the hallmarks of thyroid storm and can be as high as 105-106 F (40.5-41.1 C). The actual diagnosis of thyroid storm is made on the basis of suspicion in patients with symptoms described above and physical findings of an enlarged thyroid gland (thyromegaly), wide pulse pressure, and exophthalmos (protruding eyes). Not all affected individuals will exhibit all symptoms. These symptoms in addition to the findings of elevated thyroid hormones and other tests that may be performed emergently provide a strong presumptive diagnosis of thyroid storm. Conditions such as severe sepsis, pheochromocytoma, and malignanthyperthermia can mimic thyroid storm; consequently, determination of a definitive diagnosis should still be performed with appropriate tests.

Causes of thyroid storm may include:

discontinuing needed medications for hyperthyroidism over-replacement of thyroid hormone recent treatment with radioactive iodine severe infection or illness, usually in a patient with hyperthyroidism severe medical stressors, such as heart attack, in a patient with hyperthyroidism

Thyroid storm requires emergent treatment and hospitalization. The main treatment is to decrease the circulating thyroid hormone levels and decrease their formation. Moreover, the high fever and possible dehydration is treated emergently with cooling of the body and IV hydration. PTU andmethimazole are two agents that decrease thyroid hormone synthesis and are usually prescribed in fairly high doses. To inhibit thyroid hormone release from the thyroid gland, sodium iodide, potassium iodide and/or Lugol's solution can be given. Beta blockers such as propranolol (Inderal, Inderal LA) can help to control the heart rate, and intravenous steroids may be used to help support the circulation. Earlier in this century, the mortality of thyroid storm approached 100%. However, now, with early clinical recognition and the use of aggressive therapy as described above, the death rate from thyroid storm is less than 20%. REFERENCES: MedscapeReference.com. Hyperthyroidism, Thyroid Storm, and Graves Disease. Previous contributing medical author: Ruchi Mathur, MD
Last Editorial Review: 6/28/2011

Thyroid crisis
- life threatening clinical extreme of hyperthyroidism - F>M - mortality 10-20% with treatment - FT3 and FT4 correlate poorly with severity of condition: condition is essentially an inability of end-organs to modulate their response to excess thyroid hormone

Aetiology
- usually occurs in patients with poorly controlled or unrecognized hyperthyroidism - precipitated by intercurrent illness, in particular:

infection trauma surgery uncontrolled DM labour eclampsia

- other precipitants include excessive palpation of thyroid, incomplete pre-op preparation, inadequate peri-operative dose of beta blockers, use of radio-iodine in unprepared patients, drugs such as iodides in patients with impaired autoregulation, haloperidol, massive overdose of thyroid hormone

Clinical features
Exacerbation of features of hyperthyroidism - hyperpyrexia. May be extreme (>41oC) and is generally considered essential to diagnosis. Skin usually moist and warm - confusion, fits, coma, muscle weakness. Very common. Features of UMN lesions have been described as has rhabdomyolysis and sudden onset of thyrotoxic periodic paralysis - arrhythmias, cardiac failure. Decreasing pulse rate and BP with the development of shock are associated with poor prognosis - vomiting, diarrhoea. Occasionally jaundice: associated with poor prognosis - hypercalaemia relatively common (15%) but rarely a problem in itself - rarely apathetic hyperthyroidism (usually elderly patients) may present in crisis with features of profound exhaustion, tachycardia, hyporeflexia, severe myopathy, marked weight loss and hypotension

Differential diagnosis
- malignant hyperpyrexia

Hypoglycemia (Low Blood Sugar)

CAUSES: ONSET: Too little food, too much insulin or diabetes medicine, or extra exercise. Sudden, may progress to insulin shock.

BLOOD SUGAR: Below 70 mg/dL. Normal range: 70-115 mg/dL Drink a cup of orange juice or milk or eat several hard candies Test Blood sugar WHAT CAN YOU Within 30 minutes after symptoms go away, eat a snack e.g. DO? sandwich, and a glass of milk Contact doctor if symptoms dont stop

Top Hyperglycemia (High Blood Sugar)

CAUSES: ONSET: BLOOD SUGAR: WHAT CAN YOU DO? Too much food, too little insulin, illness or stress. Gradual, may progress to diabetic coma. Above 200 mg/dL. Normal range: 70-115 mg/dL Test blood sugar If over 250mg/dL for several tests, CALL YOUR DOCTOR!


Source: With permission from Sugerbugs, Inc.

nswer:
Improve

The classic symptoms of myocardial infarction (MI), also called a heart attack, are: chest pain or pressure (usually in the center of the chest) that may radiate to the neck, jaw or one or both arms/shoulders. This may occur with exertion or at rest shortness of breath diaphoresis, or generalized sweating nausea and vomiting palpitations weakness anxiety, or a sense of impending doom or death lightheadedness or loss of consciousness

Unfortunately, there is a moderately high percentage of patients whose initial presentation of MI is sudden death. There are also groups of people who do not always have the "classic" symptoms of MI. This group includes the elderly, women, those with diabetes, and many minorities. In fact, about the only group that presents with classic symptoms are young, otherwise healthy white men... how's that for counter-intuitive? Findings that make a physician suspicious of MI, include a compelling history in a patient with appropriate risk factors. These include age (typically over 50), hypertension, hypercholesterolemia, history of diabetes, smoking, obesity, sedentary lifestyle, and family history of MI - particularly if the MI occurred early (< 55 in males, < 60 in females). Specific physical exam findings are usually absent, but may include moist skin from diaphoresis, pallor, anxiety, rapid breathing, sounds of fluid in the lungs, altered heart sounds and rapid or slow heart rate. EKG findings may show changes indicative of MI, and lab tests will show evidence of myocardial damage.

Potassium is an important electrolyte in the body that can be problematic in excessive or inadequate amounts.

Potassium is an electrolyte substance that is necessary for survival. It facilitates various cellular functions and is especially important for nerves, muscles, and the heart's electrical system. In order to maintain these functions, the body regulates the amount of potassium in the body. Even so, consequences may ensue when there is too much or too little potassium.

Regulation of Potassium
Potassium is obtained from one's diet in foods such as various fruits and meats. It is entirely absorbed into the bloodstream from the digestive system and predominantly stays within the body's cells. Normally, the human body maintains a serum potassium level between 3.5 and 5.3 milliequivalents per liter (mEq/L).
Ads by Google

Liver & Kidney Detox Naturally Help Remove Toxins. Master Herbalist Formulated. TheLifeTree.com/detoxify.htm NGAL ELISA Kit Quantitative determination of NGAL Levels in a Range of Human Samples www.argutusmed.com/products Most excess potassium is eliminated from the body through the kidneys. When blood passes through these organs, fluid and small substances, including potassium, are filtered into the tubules of the kidneys. Most of this filtrate is reabsorbed back into the blood. If potassium needs to be excreted, the kidneys can secrete it into their own collecting ducts, mediated by a hormone called aldosterone. Meanwhile; a small amount of potassium is excreted from the body by secretion into the colon of the gastrointestinal tract.

Hyperkalemia
Hyperkalemia is defined as a serum potassium level greater than 5.3 mEq/L. This often occurs with kidney failure, particularly when the patient increases his or her intake of potassium. In addition, hyperkalemia can result from drugs that inhibit potassium excretion (e.g., potassium-sparing diuretics) and conditions that shift potassium out of cells, such as destruction of skeletal muscle (rhabdomyolysis) and destruction of tumor cells following chemotherapy (tumor lysis).

POPULAR TOPICS
Potassium Finding the Proper Balance to Maintain a Healthy Body Potassium: Essential Mineral for Heart Health and Overall Health How to Lower Potassium Levels

Symptoms of hyperkalemia stem from effects on skeletal muscles and the heart, including fatigue, weakness, and palpitations. Treatment of hyperkalemia first requires restriction of potassium intake. From there, methods to lower serum potassium include glucose and insulin to stimulate cellular uptake of potassium, saline and diuretics to increase urine production and renal potassium excretion, Kayexalate to increase gastrointestinal secretion of potassium, and, as a last resort, emergency dialysis.

Hypokalemia
Hypokalemia is when the serum potassium level is less than 3.5 mEq/L. Many causes of hypokalemia are the reverse of those of hyperkalemia. For example, patients with hypokalemia may have inadequate intake of potassium coupled with use of diuretic drugs or excessive aldosterone (hyperaldosteronism). A common cause of hypokalemia is diarrhea because of potassium loss via the gastrointestinal tract.

The symptoms of hypokalemia are similar to those of hyperkalemia: fatigue, weakness, and palpitations. Treatment involves stopping any medications that contribute to hypokalemia and providing potassium supplementation orally or through an intravenous line.

References

eMedicine - Hyperkalemia eMedicine - Hypokalemia

Digoxin toxicity
From Wikipedia, the free encyclopedia

Digoxin toxicity
Classification and external resources

Digitalis purpurea drawings by Franz Khler

ICD-10

T46.0

ICD-9

972.1

Digoxin toxicity is a poisoning that occurs when excess doses of digoxin (from plants of the genus Digitalis) are consumed acutely or over an extended period. The classic features of digoxin toxicity are nonspecific: fatigue, blurred vision, change in color vision (eg. "yellow vision"), anorexia, nausea, vomiting, diarrhea, abdominal pain, headache, dizziness, confusion, delirium.

Characteristic EKG changes include bradycardia (the most frequent vital sign abnormality in toxicity), a prolonged PR interval. An accelerated junctional rhythm or bidirectional ventricular tachycardia suggests digoxin toxicity until proven otherwise.
Contents
[hide]

1 Classifi cation 2 Sympt oms 3 Treatm ent

4 Refere nces

[edit]Classification
Digoxin toxicity is often divided into acute or chronic. The therapeutic level for digoxin is 0.5-0.8 ng/mL. Low serum potassium increases the risk of digoxin toxicity and cardiac dysrhythmias. The classic arrhythmia is a paroxysmal atrial tachycardia with block. Digoxin toxicity occurs because it is very easy to overdose. Overdose commonly occurs because its therapeutic effect works only within a very narrow window. The most common source of digoxin is from the Foxglove plant.

[edit]Symptoms
Symptoms include hypersalivation, fatigue, nausea/vomiting, changes in heart rate and rhythm, loss of appetite (anorexia), diarrhea, visual disturbances (yellow or green halos around objects), confusion, dizziness, nightmares, agitation, and/or depression, as well as a higher acute sense of sensual activities.

[edit]Treatment

Digoxin immune Fab used to treat digoxin toxicity

The primary treatment of digoxin toxicity is digoxin immune Fab. Digoxin should not be given if the apical heart rate is below 60 BPM (beats per minute). Other treatment that may be tried to treat life-threatening arrhythmias, until digoxin Immune Fab is acquired are magnesium, phenytoin, andlidocaine.[1] Atropine is also used in cases of bradyarrhythmias.

19OCT
NCLEX-CGFNS: Patient Positioning
Posted by sunandar Labels: Positioning

The concept of patient positioning is important to understand as preparing for NCLEX or CGFNS. What position will you place your patient in? That is the question you can ask to yourself. Specific position will aggravate or lessen the patient condition. Abdominal aneurysm surgery: Fowler position to prevent pressure on the graft. Air embolism: Left side position and lower head of the bed to promote air to the right atrium and prevent to be carried to the systemic circulation. Appendicitis: Any position if unruptured, and semi fowler if ruptured. Asthma: Sitting position, leaning forward, to promote patient breathing Autonomic dysreflexia: High fowler. It will prevent patient from hypertension stroke. Bronchoscopy: Semi Fowler, to prevent aspiration after procedure. Broncholitis: Tripod position. Cast: elevate extremity to prevent edema. Cataract surgery: Semi fowler to prevent edema at the operative site. Cerebral aneurysm: Semi fowler. Cleft lip: Supine after operation, prevent pressure on the suture line. Cleft palate: Prone position. Congestive heart failure: High Fowler that improve oxygenation.

Craniotomy: Semi fowler if supratentorial, and Flat if infratentorial that can promote drainage from the head. Cerebro vascular accident: Elevate the head to reduce intra cranial pressure. Dumping syndrome: Supine position after meal. It prevents rapid emptying or the stomach. Epistaxis: Leaning forward to prevent blood aspiration. Flail chest: Keep patient on affected side to promote expansion of the unaffected lung. Hemorroidectomy: Side lying. Hiatal hernia: Upright position after meals to prevent reflux of stomach contents. Hip surgery: Legs in abduction position that can prevent dislodge of the head of the femur from acetabulum. Hypophysectomy: Elevate head of the bed to prevent increase intracranial pressure Increased Intracranial Pressure (ICP): Elevate head of the bed. Laminectomy: Prevent twisting of the spine with keeping the back as straight as possible. Laryngectomy: Semi fowler for maintaining airway and reduce edema. Liver biopsy: Right side position post procedure to prevent patient from bleeding. Lobectomy: Semi fowler Lumbar puncture: Lateral side lying during procedure and flat after procedure. Mastectomy: Elevate the extremity of the affected side (on pillow) to prevent edema. Myelogram: Elevate the head if water based dye was used, and flat if oil based dye was used. Placenta previa: Sitting position that can minimize bleeding. Prolapse cord: Knee-chest Position to prevent pressure on the cord. Pulmonary edema: Fowler position. Pyloric stenosis: Right side lying position after meal, to facilitate entry of the stomach contents into the intestines. Radium implant in the cervix: Flat to prevent dislodge of the implant. Retinal detachment: The affected side toward the bed to help the detached retina to fall back in place. Seizure: Side lying position Shock: Modified trendelenburg to promote venous return. Spinal cord injury: Immobilize the patient Thoracentesis: Fowler position during procedure and any position after Thrombophlebitis: Bed rest and elevate the affected leg to promote circulation Thyroidectomy: Semi Fowler ad avoid hyperflexion and hyperextension of the neck. Tonsillectomy: Sidelying or prone Total Parenteral Nutrition: Trendelenburg during tube insertion to prevent air embolism Tracheoesophagel Fistula (TEF): Supine with the head elevated at least 30 degrees Varicose veins: elevate the legs above the level of heart Vein stripping and ligation: Legs are elevated to prevent venous stasis

What position should a patient be after a liver biopsy?

Before the test: the position is supine with the client's right hand placed under the head. an alternative position is the left side-laying position. the client is instructed to remain still as much as possible during the test.

after the test: on your right side for at least 2 hours

The liver is a very vascular organ, and very prone to bleeding after any injury, including biopsy. Lying on the right side is a simple way to place pressure on the liver and biopsy site, and reduce the risk of post op bleeding and hemorrhage.

Complications post thyroidectomy

1. 2.
Hypothyroidism/Thyroid insufficiency in up to 50% of patients after ten years Laryngeal nerve injury in about 1% of patients, in particular the recurrent laryngeal nerve: Unilateral damage results in a hoarse voice. Bilateral damage presents as laryngeal obstruction after surgery and can be a surgical emergency: an emergency tracheostomy may be needed. Recurrent Laryngeal nerve injury may occur during the ligature of the inferior thyroid artery. 3. Hypoparathyroidism temporary (transient) in many patients, but permanent in about 1-4% of patients 4. Anesthetic complications

5. 6. 7. 8. 9.
10. 11.

Infection Stitch granuloma Chyle leak Haemorrhage/Hematoma (This may compress the airway, becoming life-threatening.) Surgical scar/keloid Removal or devascularization of the parathyroids. Thyroid storm in operations performed for hyperthyroidism

A thyroidectomy is an operation that involves the surgical removal of all or part of the thyroid gland. Surgeons often perform a thyroidectomy when a patient has thyroid cancer or some other condition of the thyroid gland (such as hyperthyroidism) or goiter. Other indications for surgery include cosmetic (very enlarged thyroid), or symptomatic obstruction (causing difficulties in swallowing or breathing). Thyroidectomy is a common surgical procedure that has several potential complications or sequela including: temporary or permanent change in voice, temporary or permanently low calcium, need for lifelong thyroid hormone replacement, bleeding, infection, and the remote possibility of airway obstruction due to bilateral vocal cord paralysis. Complications are uncommon when the procedure is performed by an experienced surgeon. The thyroid produces several hormones, such as thyroxine (T4), triiodothyronine (T3), and calcitonin. After the removal of a thyroid, patients usually take a prescribed oral synthetic thyroid hormone - levothyroxine (Synthroid) - to prevent hypothyroidism. Showing posts with label Delegation. Show all posts

07NOV
NCLEX-CGFNS: Delegation
Posted by sunandar Labels: Delegation

In real work situation, when the staffs are shortage, a registered nurse shoulddelegates some intervention to an unlicensed assistive personel and/or nurse aid.

Just remember the concepts that:

DO NOT DELEGATE assessment, teaching and evaluation.

A registered nurse can delegate: feeding patient, taking vital signs, hygiene care, and stable patients. There are five rights of delegation:

Right Right Right Right Right

task circumstances person communication supervision

Treating a venous leg ulcer

A venous ulcer can be healed by: the application of strong sustained compression with a bandage or a stocking, and treating the underlying cause of the ulcer When appropriate, both treatments can be used at the same time. Venous ulcers are caused by failure of valves in the veins of the leg (see previous sections). Commonly, this arises in the surface veins and causes varicose veins. These can be treated using one of the modern methods mentioned in the section on Varicose veins - treatment. Sometimes, it is the deep veins of the leg that are the problem. These may be damaged following a deep vein thrombosis. Unfortunately, the valves in deep veins are not easily repaired and compression treatment is the best method in most cases. There are no drugs that can be taken or topical ointments that can be applied to heal the ulcer. Treatment for venous leg ulcers should always be carried out by a healthcare professional trained in leg ulcer management. In most cases, this will be a trained practice or district nurse.

Compression treatment
Application of a firm compression bandage or a graduated elastic medical compression stocking to a leg with a venous ulcer is one of the most effective methods of treatment. This will lead to about 70% of ulcers healing within six months. Before starting compression treatment, it is essential that a Doppler test is used to measure the ankle and arm blood pressures to make sure that the arteries are working normally in the leg. Gangrene may result from the use of compression treatment in patients with severe peripheral arterial disease in the leg. Graduated elastic medical compression stockings can be used by patients with reasonable strength in their hands, since they can be a little difficult to put on. Modern systems are available that contain two stockings; both are worn on the ulcerated leg during the day and one is removed at night. These are easier to use than one heavy stocking.

Ulcer dressings can be applied after removing both stockings. Many patients find that they can manage this themselves. There are many different types of bandage that can be used to treat venous leg ulcers. Some use just one type of bandage, while others are made up of several layers. The application of a compression bandage is a skilled procedure and should be done by a healthcare professional trained in leg ulcer management. Bandaging of the leg is usually done after a leg ulcer dressing change. The bandage and ulcer dressing can then remain in place for a period of one to seven days, depending on how often ulcer dressing changes are required.

Ulcer dressings
The aim of applying a dressing to an ulcer is to provide conditions for the ulcer to allow healing. It has been found that the actual dressing type that is used does not influence how quickly the ulcer heals. The first stage is to clean the ulcer. This can be done by gentle washing in warm tap water. Sometimes saline (salt water) is used instead. The aim of this is to remove debris and dead tissue that accumulates on the surface of the ulcer between dressing changes. Removal of this helps ulcer healing. If there is a large amount of dead tissue, the nurse may need to remove it using a technique called debridement. Specially designed dressings may be used to pull away dead tissue or chemicals to dissolve the dead tissue. It is performed under local anaesthetic (where the area is numbed), so it does not hurt. A simple, non-sticky dressing will be used to dress your ulcer. This will aid healing, improve comfort and control any pus. Many patients find that they can manage cleaning and dressing of their own ulcer under the supervision of a district nurse.

Treating an infected leg ulcer

Sometimes an ulcer will produce a large amount of pus and become more painful, and some red inflammation may develop around the ulcer. These symptoms may be a sign of infection. Cleaning of the ulcer will continue as usual and a dressing will be applied. Where possible, application of compression treatment will also be used. However, sometimes the leg may be too painful to allow this. Temporarily, compression can be reduced or avoided until the leg is more comfortable. You will be prescribed a seven-day course of antibiotic tablets to treat your infection. In most cases you will be given penicillin. If you are allergic to penicillin, an alternative antibiotic such as erythromycin can be used. Side effects of antibiotics are usually mild and short-lived. They include: nausea vomiting abdominal pain diarrhoea

You will need to return to your nurse daily or every other day to ensure that your antibiotics are working, until the infection has cleared. If there is no improvement, your nurse may change your antibiotic, which you may need to take for up to two weeks. In rare cases where the infection worsens and you begin to feel very unwell, you may need intravenous antibiotic treatment (antibiotics injected into the vein) in hospital. The aim of antibiotic treatment is to treat the infection - however, antibiotics have no beneficial effect on ulcer healing and should only be used in short courses to treat ulcers that have become infected.

Follow-up treatment
You should return to your nurse once a week to have your dressings and compression bandages changed. They will also monitor the ulcer to see how well it is healing. Once your ulcer is healing well, you may only need to see your nurse once a month.

Treating associated symptoms

Pain Venous leg ulcers can often be painful. Mild to moderate leg pain can be treated using paracetamol. However, if your pain is more severe and does not respond to paracetamol, your healthcare professional may prescribe a combination of paracetamol and codeine phosphate. If after treatment your leg pain has continued to worsen, you should inform your nurse because you may have developed a complication such as an infection. Leg swelling (oedema) Venous leg ulcers are often accompanied by oedema (fluid-filled swelling of your ankles and feet). This is very effectively controlled with the use of compression bandages or graduated elastic medical compression stockings. Keeping your affected leg elevated will also usually help to ease any swelling. Try keeping your leg raised above hip level for 30 minutes, three or four times a day. Putting pillows or cushions under your feet when you are asleep may also help. Itchy skin Itchy and irritated skin associated with a venous ulcer is known as varicose eczema, and is caused by the fluids leaking out of your veins into the surrounding tissue. If you have severe or worsening varicose eczema, your nurse will first need to rule out cellulitis (a bacterial infection of the deep layer of skin). If you have cellulitis, you will be given antibiotics. To treat varicose eczema, your nurse may suggest using an emollient (moisturiser) on the affected area, as well as a mild corticosteroid cream or ointment. These will ease the itching and encourage your skin to heal. If your venous eczema does not improve or continues to get worse despite treatment, you may have an allergic reaction known as contact dermatitis. You may be allergic to your dressing, emollient or corticosteroid.

If contact dermatitis is suspected, you may need to be referred to a dermatologist (skin specialist) for a patch test. This involves taping a small amount of the suspected allergen to your skin for 48 hours to see how it reacts. Contact dermatitis can occur at any stage of your treatment for a venous ulcer, and not just at the start.

Specialist treatment
If your venous leg ulcer does not heal, even after two to three months of treatment, you will need to be referred for specialist treatment to find out why it has not healed. The specialist will be able to arrange further investigations such as colour duplex ultrasound imaging or biopsy of the ulcer to determine the things that are preventing your ulcer healing. Varicose veins are a common cause of leg ulcers and modern methods of management of these can be used alongside compression treatments to improve and maintain ulcer healing. In very rare cases, a venous leg ulcer may not heal, even after specialist treatment. If this is the case, your healthcare professional will aim to make your ulcer as easy to live with as possible by controlling any associated symptoms and improving your mobility. You may be offered long-term psychological support if it is needed.

After the leg ulcer has healed

Once a leg has suffered a venous ulcer, there is a one in four chance of further ulceration developing within the next two years. The most effective method of preventing this is to wear a graduated elastic medical compression stocking at all times when you are out of bed. Your nurse will help you find a stocking that fits correctly and which you can manage yourself. Various accessories are available to help you put these on and take them off. Varicose veins is a common cause of venous leg ulcers. These can be managed by modern methods of treatment. The risk of a further leg ulcer developing is greatly reduced if varicose veins causing an ulcer are treated. You should discuss referral to a vascular specialist for assessment for this treatment as part of the management of your leg ulcer.

The following advice may help your venous leg ulcer to heal more quickly:
Try to keep active by walking regularly. Immobility can worsen venous leg ulcers and the associated
symptoms, such as oedema (swollen, fluid-filled areas).

Whenever you are sitting or lying down, try to keep your affected leg elevated. Be careful not to injure your affected leg, and wear only comfortable well-fitting footwear. If you are prescribed an emollient by your nurse for venous eczema, use it as often as possible. The motion
of rubbing in the emollient boosts your circulation and there is no limit to how often you can use it.

Wear your compression bandage exactly as instructed by your nurse. If you have any problems with it, do
not remove it yourself.

Deep vein thrombosis (DVT) is a blood clot in one of the deep veins in the body. Blood clots that develop in a vein are also known as venous thrombosis. DVT usually occurs in a deep leg vein, a larger vein that runs through the muscles of the calf and the thigh. It can cause pain and swelling in the leg and may lead to complications such as pulmonary embolism. This is when a piece of blood clot breaks off into the bloodstream and blocks one of the blood vessels in the lungs. DVT and pulmonary embolism together are known as venous thromboembolism (VTE).

Smoking and diet

You can reduce your risk of DVT by making changes to your lifestyle, such as:
not smoking eating a healthy balanced diet getting regular exercise maintaining a healthy weight or losing weight if you are obese anticoagulant medicine, which helps prevent blood clots compression stockings or a compression device, to help keep the blood in your legs circulating

How to tell if you might have a DVT or pulmonary embolism

Signs to look out for after your hospital treatment include:
pain or swelling in your leg the skin of your leg feeling hot or discoloured the veins near the surface of your leg appearing larger the normal becoming short of breath pain in your chest or upper back coughing up blood Signs and Symptoms Of Mania:

Becomes angry quickly.

Distracted by environmental stimuli. Extroverted personality Flights of idea Delusional self-confidence. Grandiose and persecutory delusions Inability to eat or sleep. High and unstable affect. Inappropriate dress. Inappropriate affect. Initiation of activity Restlessness Pressured speech Sexually promiscuous Unlimited energy Urgent motor activity Significant decrease in appetite

Signs and Symptoms Of Depression:

Decreased emotion and physical activity Decrease in activities of daily living Easily fatigue Inability to make decisions Introverted personality Internalizing hostility Lack of initiative Lack of energy Lack of self-confidence Lack of sexual interest Withdrawn from groups

Interventions for maniac patients: Remove hazardous objects from the environment Assess the client closely for fatigue Promote sleep Provide rest periods Provide private room Hypnotic or sedative medication as prescribed Encourage the patient to ventilate feeling Calm and slow interaction Encourage patient to focus on one topic during conversation Ignore and distract patient from grandiose thinking Present reality to patient Do not argue with patient Provide high-calorie finger foods and fluids Reduce environmental stimuli Set limits on inappropriate behaviors

Provide physical activities and outlets for tension Avoid competitive games Provide gross motor activities such as walking and writing Provide structured activities with nurse Provide simple and direct explanations for routine procedures Supervise the administration of medication

Deal With Aggressive Behavior Patients: Assist patient to identify feeling of frustration and aggression Encourage patient to talk out instead of acting out Assist patient in identifying precipitating events or situations lead to aggressive behavior Describe the consequences of the behavior on self and others Assist in identifying previous coping mechanism Assist in problem solving techniques.

Deal With De-escalation Techniques: Maintain safety for the patient, others and self Maintain a large personal space and use non-aggressive posture Calm in approaching and communicating Clear tone of voice, be assertive not aggressive Avoid verbal struggles Assist the patient with problem-solving and decision making Provide the patient with clear option

Deal With Manipulative Behaviors: Set clear, consistent, realistic and enforceable limits Communicate the expected behaviors Be clear with the consequences associated with exceeding limits Discuss the patients behavior in non-judgmental and non-threatening manner Avoid power struggles with the patients

The Mental Health Nurse's Role depressed

Some mental health nurses work in the community and some in the more acute hospital setting. A hospital-based psychiatric nurse admits the patient and ideally remains the key worker for that patient. Depressed patients usually benefit from continuity, and the mental health nurse's good interpersonal skills will enable her to build a therapeutic relationship, based on trust with the patient. The patient should feel safe in the presence of the nurse.

Seizure is defined as a sudden, transient alteration in brain function due to excessive levels of electrical activity in the brain. It can be classified as partial or generalized, or unclassified, that is depended on the area of the brain involved.

Nursing Assessment of Seizure in Child

Obtain information from the parent about the onset time, precipitating events, and behavior before and after the seizure. Assess the child's history in relation to seizures.

Seizure Precautions:
Raise the side rails when the child is sleeping or resting Place a waterproof mattress or pad on the bed or crib Pad the side rails and other hard object Instruct child to wear medical identification Instruct the child about precaution during potentially hazardous activities Instruct the child not to swim without a companion Instruct the child to wear a helmet and padding during bicycle riding, skateboarding, and inline skating Alert caregivers to the need for any special precautions

Emergency Treatment for Seizures:

1. Ensure airway patency 2. Identify time of seizure episode 3. If the child is in sitting or standing position, ease the child down to the floor, placing the child in a side-lying position 4. Place a pillow or folded blanket under the child's head, or place your own hands under the child's head, or place the child's head in your own lap 5. Loose the child's clothes 6. Remove eye glasses if present 7. Clear area from any hazard or hard objects 8. Allow seizure to proceed and end without interference 9. Turn child to one side (as a unit) if vomiting 10. Do not restrain the child, place anything in the child's mouth or give any food or liquid to the child 11. Remain with the child until the child fully recovers 12. Prepare to administration some medication as prescribed 13. Observe for incontinence 14. Document the occurrence

MYOCARDIAL INFARCTION
Labels: ...Cardiac System, Myocardial Infarction | Myocardial infarction is a condition in which myocardial tissue is abruptly and severely deprived of oxygen. It can lead to necrosis of myocardial tissue if blood flow is not restored.

Physical changes in the heart do not occur until 6 hours after the infarction, the infarcted area becomes blue and swollen, and yellow and gray after 48 hours. By 8-10 days, granulation tissues form, and develop into scar over 2-3 months.

There are three location of Myocardial Infarction:

1. Anterior or septal MI or both: due to obstruction of the left anterior descending. 2. Posterior wall MI or lateral wall MI: due to obstruction of circumflex artery. 3. Inferior MI: due to obstruction of the right coronary artery

Risk Factors of Myocardial Infarction: Coronary artery disease Atherosclerosis Smoking Elevated cholesterol levels Hypertension Obesity Impaired glucose tolerance Stress Physical inactivity

Diagnostic Procedures for MI: Total Creatine Kinase Level: rises with 3 hours and peaks within 24 hours

CK-MB isoenzyme: peaks within 18-24 hours after the onset of chest pain and returns to normal 48-72 hours later Troponin level: rises within 3 hours and remains elevated up to 7 days Myoglobin: rises within 1 hour, peaks in 4-6 hours, and returns to normal within 24-36 hours LDL level: rises 24 hours after MI, peaks 48-72 hours, and normal in 7 days White blood cell count: elevated WBC on 2nd day of MI Electrocardiogram: ST segment elevation, T wave inversion, and abnormal Q wave

Signs and Symptoms of MI: Pain: crushing substernal pain, radiate to the jaw, back and left arm. Pain occurs without any causes primarily early morning and unrelieved by rest or nitroglycerin and last 30 minutes or longer. Diaphoresis Nausea and vomiting Dysrhythmias Dyspnea Feeling of fear and anxiety Pallor, cyanosis, coolness of extremities

Complication of MI: Heart failure Dysrhythmias Pulmonary edema Thrombophlebitis Cardiogenic shock Pericarditis Mitral valve insufficiency Ventricular rupture Postinfarction angina

Intervention in Acute Stage: Assess a description of the chest pain Assess vital sign Assess and monitor cardiovascular status

Administer oxygen at 2-6 L/min by nasal cannula Establish IV access Administer nitroglycerin as prescribed Administer morphine sulfate as prescribed (if unresponsive to nitroglycerin) Obtain a 12-lead ECG Administer IV nitroglycerin and antidysrhythmias as prescribed Monitor thrombolytic therapy Monitor for signs of bleeding Administer beta blocker as prescribed Monitor for cardiac dysrhythmias Monitor for complication of Myocardial infarction Assess and monitor distal peripheral pulses and skin temperature Monitor intake and output Assess respiratory rate and breath sounds Monitor blood pressure closely

Intervention Following Acute Stage: Bed rest for the first 24-36 hours, allow patient to stand to void or use a bedside commode Provide range of motion exercises Monitor the complication of MI Encourage patient to verbalize feeling.

The International Normalized Ratio (INR) is used to monitor the effectiveness of anticoagulants such as warfarin (COUMADIN). These drugs help inhibit the formation of blood clots. They are prescribed on a long-term basis to patients who have experienced recurrent inappropriate blood clotting. This includes those who have had heart attacks, strokes, and deep vein thrombosis (DVT). Anti-coagulant therapy may also be given as a preventative measure in patients who have artificial heart valves and on a short-term basis to patients who have had surgeries, such as knee replacements. The anti-coagulant drugs must be carefully monitored to maintain a balance between preventing clots and causing excessive bleeding.

How is Warfarin (Coumadin) Monitored and What Dose Do I Take? Warfarin (Coumadin) is monitored by a blood test called an INR (International Normalized Ratio). Warfarin belongs to a category of drugs known as narrow

range of effectiveness drugs. This means that there is a very narrow range where the drug is considered therapeutic. For most indications, the INR range is 2.0 to 3.0. For people with mechanical heart valve replacements and certain other conditions, the range is 2.5 to 3.5. These ranges are general recommendations. Your healthcare provider might prescribe a different range, depending on your particular condition.

1.

The purpose of the ESWL procedure is to pulverize stones in the urinary tract (both kidney and ureter) into small sand like particles that may be passed spontaneously.

2.

Discomfort and redness at the treatment site are common. While the goal is to reduce the stone to particles small enough to pass painlessly, this is not always possible, especially with larger stones. A prescription for a narcotic analgesic will be provided. You may use this medication for severe pain, or acetominophen for minor discomfort. If the pain is so severe that the pain medication is not helping, phone your doctor.

3.

Seeing blood in the urine is not uncommon. It should clear with rest and hydration. Do not resume any aspirin containing medications or anticoagulants without consulting your doctor.

4.

Straining the urine post procedure will enable fragment analysis through your urologist's office. The particles will look like sand, and may be brown, tan, or black. Bring the fragments to your first post procedure visit with your doctor.

5.

Once you arrive home there are no dietary restrictions. You should increase your fluid intake. No alcohol should be consumed for 24 hours after the procedure.

6.

In most instances normal activity may be resumed in 24-48 hours. If you are taking the narcotic analgesic, do not drive or operate dangerous machinery.

7.

You need not take your temperature, but if you begin to feel feverish, and have chills, call your physician if your temperature should be greater than 101 F

8.

Prior to your discharge, you will be provided with an appointment for a post-operative office visit. In some instances another ESWL, or supplemental treatment will be required if the stone is not completely fragmented.

ESWL post-op instructions: You may see some blood in your urine while the stone fragments are passing and a few days afterward. Do not be alarmed, even if the urine was clear for a while. Push fluids and refrain from strenuous activity until clearing occurs. If you have difficulty passing clots or don't improve, call us. You can also try sitting in a warm tub of water to help to urinate if needed. Avoid medications such as Aspirin, Advil, Motrin, Plavix, or Coumadin, which thin the blood and cause bleeding

Diet: You may return to your normal diet immediately. Alcohol, spicy foods, acidy foods and drinks with caffeine may cause irritation or frequency and should be used in moderation. To keep your urine flowing freely and to avoid constipation, drink plenty of fluids during the day (8-10 glasses). Activity: While the kidney is healing do not engage in strenuous activity. If you are active, you may see more blood in the urine. We would suggest cutting down your activity under these circumstances until the bleeding has stopped, perhaps two weeks. Bowels: It is important to keep your bowels regular during the postoperative period. Straining with bowel movements can cause bleeding. A bowel movement every other day is reasonable. Use a mild over-the-counter laxative if needed, such as Milk of Magnesia 2-3 tablespoons, or 1-2 Dulcolax tablets. Call if you continue to have problems. Narcotics can worsen constipation; if you had been taking narcotics for pain, before, during or after your surgery, you may be constipated. Ditropan for bladder spasms may also cause constipation. Problems you should report to us: 1. 2. 3. 4. Fevers over 101.5 degrees Fahrenheit. Inability to urinate. Drug reactions (hives, rash, nausea, vomiting, diarrhea) Severe burning or pain with urination that is not improving.

Why High concentration of oxygen is contraindicated for a patient with copd?

There is a perpetuated myth in the healthcare community that high levels of oxygen can "stop a patient from breathing". This concept is widely viewed as a reason to withhold oxygen from people suspected of suffering from COPD, with the result being under-treated patients. There is research that suggests that administration of too much oxygen in the blood can cause negative changes in the cardiovascular system. Please note the main difference between DELIVERING high concentrations and the patient absorbing too much oxygen. People with breathing problems may receive high concentrations but not be able to absorb it. This is not a reason to withhold oxygen. Current protocols suggest that heathcare practitioners deliver as much oxygen as is necessary to achieve and maintain normal blood concentrations but not to allow too much to enter the bloodstream (they can check it easily without having to take blood).

Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases. It makes it difficult to breathe. There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus Emphysema, which involves destruction of the lungs over time

Most people with COPD have a combination of both conditions.

Causes
Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop COPD. However, some people smoke for years and never get COPD. In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema.

Other risk factors for COPD are: Exposure to certain gases or fumes in the workplace Exposure to heavy amounts of secondhand smoke and pollution Frequent use of cooking fire without proper ventilation

Symptoms
Cough, with or without mucus Fatigue Many respiratory infections Shortness of breath (dyspnea) that gets worse with mild activity Trouble catching one's breath Wheezing

Because the symptoms of COPD develop slowly, some people may not know that they are sick.

Exams and Tests

The best test for COPD is a lung function test called spirometry. This involves blowing out as hard as possible into a small machine that tests lung capacity. The results can be checked right away, and the test does not involve exercising, drawing blood, or exposure to radiation. Using a stethoscope to listen to the lungs can also be helpful. However, sometimes the lungs sound normal even when COPD is present. Pictures of the lungs (such as x-rays and CT scans) can be helpful, but sometimes look normal even when a person has COPD (especially chest x-ray). Sometimes patients need to have a blood test (called arterial blood gas) to measure the amounts of oxygen and carbon dioxide in the blood.

Treatment
There is no cure for COPD. However, there are many things you can do to relieve symptoms and keep the disease from getting worse. Persons with COPD MUST stop smoking. This is the best way to slow down the lung damage. Medications used to treat COPD include: Inhalers (bronchodilators) to open the airways, such as ipratropium (Atrovent), tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil), or albuterol Inhaled steroids to reduce lung inflammation Anti-inflammatory medications such as montelukast (Singulair) and roflimulast are sometimes used

In severe cases or during flare-ups, you may need to receive:

Steroids by mouth or through a vein (intravenously) Bronchodilators through a nebulizer Oxygen therapy Assistance during breathing from a machine (through a mask, BiPAP, or endotracheal tube)

Antibiotics are prescribed during symptom flare-ups, because infections can make COPD worse. You may need oxygen therapy at home if you have a low level of oxygen in your blood. Pulmonary rehabilitation does not cure the lung disease, but it can teach you to breathe in a different way so you can stay active. Exercise can help maintain muscle strength in the legs. Walk to build up strength. Ask the doctor or therapist how far to walk. Slowly increase how far you walk. Try not to talk when you walk if you get short of breath. Use pursed lip breathing when breathing out (to empty your lungs before the next breath)

Things you can do to make it easier for yourself around the home include: Avoiding very cold air Making sure no one smokes in your home Reducing air pollution by getting rid of fireplace smoke and other irritants

Eat a healthy diet with fish, poultry, or lean meat, as well as fruits and vegetables. If it is hard to keep your weight up, talk to a doctor or dietitian about eating foods with more calories. Surgery may be used, but only a few patients benefit from these surgical treatments: Surgery to remove parts of the diseased lung can help other areas (not as diseased) work better in some patients with emphysema Lung transplant for severe cases

it knocks out their hypoxic drive to breathe. COPD patients bodies are used to a lower oxygen and a higer carbon dioxide in their blood. as time goes on the COPD patient becomes dependent on the lower oxygen in their blood to tell the body to keep breathing. their SPO2 is probably lower than 95% at this point. when you put a COPD patient on a lot of oxygen and the SPO2 goes up to 100% the body isn't used to that and says "hey were good, don't need to breathe that much anymore" and they slow the breathing down and sometimes can even stop breathing. It is not correct to say that you can not give more than 2 liters of O2 however. the correct information is to just not give them too much oxygen to increase the SPO2 to above 97%. if they get to 100% saturation they can stop breathing. some COPD patients can be on 4 or 5liters of oxygen and still be at 95% saturation or less. so it all depends on the patient and how bad the disease has gotten. Source(s): I am a respiratory therapist.

Common Signs and Symptoms of Congestive Heart Failure

The most common congestive heart failuresymptoms are:

Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs.

Shortness of breath or difficulty breathing Cough Feeling tired Swelling in the ankles, feet, legs, and sometimes the abdomen Weight gain Frequent urination Limitations on physical activity.

g. Staggering, dizziness, or drowsiness. h. Incr ease d intracranial pressure (paragraph 5-4). 5-4. IDENTIFY S I G NS A N D S Y M P T O M S OF INCREASED INTRACRANIAL PRESSURE I ncrea sed intracranial pressure may be d u e to brai n tissue swelling, blood or o t h e r fluid accumulati ng inside t h e skul l, or to a combination of t h e se situations. The followi ng signs a n d s y mp t o ms may indicate increased intracranial pressure. a. Headache. b. Na u s e a and/ or vomiting. c. Loss of consciousness (either c ur r e nt or recent unconsci ousness). d. Dilated pupils t h a t do n o t constrict when exposed to bright light ( a n e a r l y sign of serious h e a d i nj ur y) or ch a ng e s in pupi l s y mme t r y. e. Lateral loss of mo t o r n e r v e f unct i o n in w h i c h o n e side of t h e b o d y becomes paral yze d ( m a y n o t o cc ur immediately). f. S l o w respiratory rat e or c h a n g e in respiratory pattern. g. A st ea dy rise in t h e systolic blood pressure ( m a y n o t be present if t h e r e is significant bleeding elsewhere). h. A rise in t h e pu l s e pressure (systolic pressure m i n u s diastolic pressure). i. Elevated b o d y temperature. j. Restlessness (indicates insufficient oxygenat i on of t h e brain). k. Slurred speech. l. Co nvul si ons or twitching. m. Abno rmal posturing. M

Intracranial pressure (ICP) is the pressure inside the skull and thus in the brain tissue and cerebrospinal fluid (CSF). The body has various mechanisms by which it keeps the ICP stable, with CSF pressures varying by about 1 mmHg in normal adults through shifts in production and absorption of CSF. CSF pressure has been shown to be influenced by abrupt changes in intrathoracic pressure during coughing (intraabdominal pressure), valsalva (Queckenstedt's maneuver), and communication with the vasculature (venous and arterial systems). ICP is measured in millimeters of mercury (mmHg) and, at rest, is normally 715 mmHg for a supine adult, and becomes negative (averaging 10 mmHg) in the vertical position.[1]Changes in ICP are attributed to volume changes in one or more of the constituents contained in the cranium. Intracranial hypertension, commonly abbreviated IH or raised ICP, is elevation of the pressure in the cranium. ICP is normally 715 mm Hg; at 2025 mm Hg, the upper limit of normal, treatment to reduce ICP may be needed.[2] Complications of spontaneous miscarriages and therapeutic abortions include the following: Complications of anesthesia Postabortion triad (ie, pain, bleeding, low-grade fever) Hematometra Retained products of conception Uterine perforation Bowel and bladder injury Failed abortion Septic abortion Cervical shock Cervical laceration Disseminated intravascular coagulation (DIC) The term "septic abortion" refers to a spontaneous miscarriage or therapeutic/artificial abortion complicated by a pelvic infection.
1. Incomplete Miscarriage An incomplete miscarriage means that you still have tissue retained in your uterus from the pregnancy. Sometimes this condition will resolve on its own, but other times you might need aD&C. Ads Instant Back Pain ReliefFree yourself from back pain today. Get your F.R.E.E trial pack herewww.elmoreoil.com.ph Uterine ManipulatorGlobal Shipping Medical Instruments Shopwww.endoscopechina.com/ What is Carpal Tunnel?Signs & Symptoms Carpal Tunnel Learn how to treat Carpal Tunnelwww.TherapyGloves.com 2. Excessive Bleeding The general rule is that if you're soaking through a menstrual pad in under an hour, you should seek medical attention immediately. A small percentage of women have hemorrhaging as a complication of miscarriage. 3. Infection A post-miscarriage infection can be dangerous but is easily treated with antibiotics. Be sure to contact your doctor if you think you have symptoms of an infection after miscarriage. 4. Depression Grief is a normal reaction to miscarriage and pregnancy loss. But if you start to show signs of clinical depression, it could be helpful to talk to a counselor or other mental health professional.

5. Anxiety Disorders Even more common than clinical depression after miscarriage are anxiety and stress disorders. It is even possible to develop symptoms of post-traumatic stress disorder (PTSD) after a miscarriage. 6. Recurrent Miscarriages Sadly, some women will have more than one miscarriage. If you have two or three consecutive miscarriages, it can be a good idea to talk to a doctor about testing for possible causes. 7. Asherman's Syndrome Asherman's syndrome is a rare complication of a D&C. The syndrome involves scarring and adhesions in the uterus that can cause fertility problems and further miscarriages. First Trimester Miscarriages Miscarriage Questions and Answers Natural Miscarriage What to Expect Physically After Miscarriage Miscarriage Causes Are Miscarriages Ever Anyone's Fault? Infections and Miscarriage Other Common Miscarriage Causes Other Questions Pregnancy Symptoms After Miscarriage When There's No Known Reason for Miscarriage Why Do Doctors Use the Word Abortion for Miscarriage?

Oral thrush nystatin (eg Nystan oral suspension), amphotericin (eg Fungilin
lozenges) ormiconazole (eg Daktarin oral gel).

What to expect during the recovery period following Cardiac Catheterization?

After the Cardiac Catheterization procedure, you will be taken to your room where you will be instructed to lie flat, with your leg straight for at least for 4 - 6 hours. Your vital signs and heart function will be closely monitored. If the catheter insertion site was in your elbow, a few stitches will be used to close the wound. If the insertion site was in your wrist or groin, firm pressure will be applied to the area for about 10 minutes to stop the bleeding. Then a pressure dressing will be placed over the area. You should drink plenty of fluids to avoid dehydration and removal of the contrast dye (through your kidneys) that was injected during Cardiac Catheterization. The dressing will be removed 5 - 7 days following the procedure of Cardiac Catheterization.

Cardiac Catheterization
Synonym: Heart Catheterization

What is Cardiac Catheterization?

Cardiac Catheterization is a procedure where a thin, flexible tube (catheter) is inserted and threaded through your artery or vein in the groin (femoral or iliac), neck (carotid) or forearm either elbow or wrist (radial). The catheter reaches the coronary artery in the heart where it can monitor the function of the heart,

measure pulmonary arterial pressure, inject contrast material in to the coronary blood vessels or the chambers of the heart. During the procedure of Cardiac Catheterization, angiograms or images are also recorded - this portion of the test is called Coronary Angiography. Radial approach Cardiac Catheterization (Trans-radial Cardiac Catheterization) is certainly advantageous as you will be mobilized quickly and there will be fewer vascular complications.

Why is Cardiac Catheterization performed?

Cardiac Catheterization is performed to assess the status of your coronary arteries. The procedure of Cardiac Catheterization helps your doctor to determine the site and extent of the blockage in your coronary arteries and to assess whether a minimally invasive surgical procedure like Coronary Angioplasty or Coronary Stenting is needed. Cardiac Catheterization also helps your doctor to decide whether a major procedure like Heart Bypass Surgery is needed or not to treat the problem. The procedure of Cardiac Catheterization has diagnostic as well as therapeutic value.

Post-Catheterization

1. Assessment a. when the patient returns from the cardiac catheterization laboratory, the stability of the patient should be established initially. This will include, but is not limited to, EKG, vital signs, oxygenation level, urine output, cardiac, respiratory, pulmonary, gastrointestinal, and gentle urinary assessment. b. Particular attention must be paid to the peripheral vascular assessment of the lower extremities. c. Often the patient may return from the cardiac catheterization laboratory with a sheath in place. if this is the case, the institutional procedures for caring for sheaths should be applied. Some institutions, may allow the nurse to remove that sheath. Other institutions, require that the physician removes the sheath.in the latter instance, the institutions policies and procedures must be followed. d. In some institutions a ACT may be required to check the patients clotting time prior to sheath removal. e Generally, the nurse should monitor vital signs, and distal pulses every 15 minutes X 4, every 30 minutes X 2, then every hour X 2, then routine. If there is any change in the patient's neurovascular status for physician should be notified immediately. d. If the cardiac catheterization was done under conscious sedation to institutional policy for conscious sedation should be followed. 2. Interventions:

a. Before the patient returns to the unit, the nurse should ensure that all equipment is avialble to evaluate and maintain the patient once he arrives. these are things such as, intravenous pole with plump, blood pressure cuff, pulse oxmetry, telemetry if ordered, and sand bag. b. when the patient returns he may be placed on bed rest with the head of the bed no higher than 30 degrees. The patients affected extremity must be kept straight. c.Insure the patient is fully awake, encourage the patient to drink at least two liters of fluid during the first 12 hours post cardiac cath. if his condition warrants and if it is not counterindicated. d. Maintain the patient on hourly intake and output. f. If the patient starts to bleed at the puncture site, hold pressure above the insertion site until the bleeding is stopped. Do not hold pressure directly on the departure site. Notify the physician. f. If patient re-bleeds at catheter site: find pulse above the insertion site and hold pressure with a guaze sponge until hemostasis is achieved. Note: do not totally obliterate distal pulses. 3. Teaching: Reinforce post cath teaching. 4. Documentation: a. Document Initial vital signs/observations on approved Medical Record Form. b. Document further observations in nursing note or on approved Medical Record Form.

Definition
By Mayo Clinic staff A coronary angiogram is a procedure that uses X-ray imaging to see your heart's blood vessels. Coronary angiograms are part of a general group of procedures known as cardiac catheterization. Heart catheterization procedures can both diagnose and treat heart and blood vessel conditions. A coronary angiogram, which can help diagnose heart conditions, is the most common type of heart catheter procedure.

During a coronary angiogram, a type of dye that's visible by X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at the inside of your blood vessels. If necessary, your doctor can perform procedures such as angioplasty during your coronary angiogram.

After the procedure When the angiogram is over, the catheter is removed from your arm or groin and the incision is closed with manual pressure, a clamp or a small plug. You'll be taken to a recovery area for observation and monitoring. When your condition is stable, you return to your own room, where you're monitored regularly. You'll need to lie flat for several hours to avoid bleeding. During this time, pressure may be applied to the incision to prevent bleeding and promote healing. Sometimes, the plastic sheath that was first inserted into your blood vessel is left in place for several hours or even overnight if you've had angioplasty or stent placement. If you received anticoagulants during the procedure, removing the sheath too soon could trigger heavy bleeding. You may be able to go home the same day, or you may have to remain in the hospital for a day or longer. Drink plenty of fluids to help flush the dye from your body. If you're feeling up to it, have something to eat. Ask your health care team when you should resume taking your medications, bathe or shower, return to work, and resume other normal activities. Avoid strenuous activities and heavy lifting for several days. Your puncture site is likely to remain tender for a while. It may be slightly bruised and have a small bump. Call your doctor's office if: You notice bleeding, new bruising or swelling at the catheter site You develop increasing pain or discomfort at the catheter site You have signs of infection, such as redness, drainage or fever There's a change in temperature or color of the leg or arm that was used for the procedure You feel faint or weak You develop chest pain or shortness of breath

If the catheter site is actively bleeding or begins swelling, apply pressure to the site and contact emergency medical services.

People with leukemia are at significantly increased risk for developing infections,anemia, and bleeding. Other symptoms and signs includeeasy bruising, weight loss,night sweats, and unexplained fevers.

Both are obviously important, however hydration is essential in the handling of an acute sickle crisis.TREATMENT
Pain relief using narcotics Hydration Oxygen administration Treatment of infections Blood transfusion

Prevention Genetic counseling

Care of patients with chest tubes a. b. c. Assess patient for respiratory distress and chest pain, breath sounds over affected lung area, and stable vital signs Observe for increase respiratory distress Observe the following: (1) Chest tube dressing, ensure tubing is patent (2) Tubing kinks, dependent loops or clots (3) Chest drainage system, which should be upright and below level of tube insertion Provide two shodded hemostats for each chest tube, attached to top of patients bed with adhesive tape. Chest tubes are only clamped under specific circumstances: (1) To assess air leak (2) To quickly empty or change collection bottle or chamber; performed by soldier medic who has received training in procedure (3) To change disposable systems; have new system ready to be connected before clamping tube so that transfer can be rapid and drainage system reestablished (4) To change a broken water-seal bottle in the event that no sterile solution container is available (5) To assess if patient is ready to have chest tube removed (which is done by physicians order); the solider medic must monitor patient for recreation of pneumothorax Position the patient to permit optimal drainage (1) Semi-Flowers position to evacuate air (pneumothorax) (2) High Flowers position to drain fluid (hemothorax) Maintain tube connection between chest and drainage tubes intact and taped (1) Water-seal vent must be without occlusion (2) Suction-control chamber vent must be without occlusion when suction is used Coil excess tubing on mattress next to patient. Secure with rubber band and safety pin or systems clamp Adjust tubing to hang in straight line from top of mattress to drainage chamber. If chest tube is draining fluid, indicate time (e.g., 0900) that drainage was begun on drainage bottles adhesive tape or on write-on surface of disposable commercial system

d.

e. f. g. h.

(1) (2)

Strip or milk chest tube only per MD/PA orders only Follow local policy for this procedure

Problems solving with chest tubes a. Problem: Air leak (1) Problem: Continuous bubbling is seen in water-seal bottle/chamber, indicating that leak is between patient and water seal (a) Locate leak (b) Tighten loose connection between patient and water seal (c) Loose connections cause air to enter system. (d) Leaks are corrected when constant bubbling stops (2) Problem: Bubbling continues, indicating that air leak has not been corrected (a) Cross-clamp chest tube close to patients chest, if bubbling stops, air leak is inside the patients thorax or at chest tube insertion site (b) Unclamp tube and notify physician immediately! (c) Reinforce chest dressing Leaving chest tube clamped caused a tension pneumothorax and mediastinal shift

Warning: (3)

b.

Problem: Bubbling continues, indicating that leak is not in the patients chest or at the insertion site (a) Gradually move clamps down drainage tubing away from patient and toward suction-control chamber, moving one clamp at a time (b) When bubbling stops, leak is in section of tubing or connection distal to the clamp (c) Replace tubing or secure connection and release clamp (4) Problem: Bubbling continues, indicating that leak is not in tubing (a) Leak is in drainage system (b) Change drainage system Problem: Tension pneumothorax is present (1) Problems: Severe respiratory distress or chest pain (a) Determine that chest tubes are not clamped, kinked, or occluded. Locate leak (b) Obstructed chest tubes trap air in intrapleural space when air leak originates within patient (2) Problem: Absence of breath sounds on affected side (a) Notify physician immediately (3) Problems: Hyperresonance on affected side, mediastinal shift to unaffected side, tracheal shift to unaffected side, hypotenstion or tachycardia (a) Immediately prepare for another chest tube insertion (b) Obtain a flutter (Heimlich) valve or large-guage needle for short-term emergency release or air in intrapleural space (c) Have emergency equipment (oxygen and code cart) near patient (4) Problem: Dependent loops of drainage tubing have trapped fluid (a) Drain tubing contents into drainage bottle (b) Coil excess tubing on mattress and secure in place (5) Problem: Water seal is disconnected (a) Connect water seal

(6)

(7)

(b) Tape connection Problem: Water-seal bottle is broken (a) Insert distal end of water-seal tube into sterile solution so that tip is 2 cm below surface (b) Set up new water-seal bottle (c) If no sterile solution is available, double clamp chest tube while preparing new bottle Problem: Water-seal tube is no longer submerged in sterile fluid (a) Add sterile solution to water-seal bottle until distal tip is 2 cm under surface (b) Or set water-seal bottle upright so that tip is submerged

Best Ways to Approach the Alzheimers Patient

1. 2. 3. 4. 5. 6. Move slowly when approaching the patient. Approach patients from the front where they can see you coming, so they do not get startled or surprised. Once you have approached the person, stand alongside him instead of face to face. Standing face to face can seem confrontational, whereas standing alongside is perceived as supportive. If the patient is seated, crouch low so that you are looking at her eye to eye. Do not grab or touch the person, this may feel threatening. Instead, offer your hand so he may take it. Call the person by name. Alzheimers patients remember their own names even very late in the disease. However their married name often disappears from memory.

A mastectomy is surgery to remove the entire breast, including the skin, nipple, and areola. It is usually done to treat breast cancer. hormonal therapy, radiation therapy, and chemotherapy.

COMMUNICATION TIPS WHEN INTERACTING WITH DEMENTIA PATIENTS It has been noted widely that non-verbal communication, such as body language, voice tone and facial expressions relay great amounts of information to the cognitively impaired adult. As their ability to process verbal information is impaired, the way in which we use language is extremely important when working with cognitively impaired adults. Clear communication, verbal and non-verbal alike, is the essence of any quality interaction. The

following suggestions will enhance your effectiveness with your family member or patients. 1. In your interactions with the patient, try to: * Be calm and reassuring * Speak slowly and distinctly * Use simple words 2. Remember that the patient is dealing with: * Confusion * Anxiety * Loss of self-esteem * Irritability * Feeling of depression (when he is aware enough)
Dementia is an acquired deterioration in cognitive abilities impairing activities of daily living. Impaired cognitive abilities can include deficits in memory (most commonly), language, visuospatial ability, calculation, judgment, and problem solving. If activities of daily living are not impaired but deficits exist, the condition is referred to as mild cognitive impairment(MCI).

A renal biopsy is the removal of a small piece of kidney tissue for examination.

How the Test is Performed

There are many ways to do a kidney biopsy. They include: Ultrasound-guided kidney biopsy CT-guided kidney biopsy Surgical biopsy

The most common kidney biopsy uses ultrasound to guide the doctor to the proper area in your kidney. The biopsy is done in the hospital. Your doctor will go over the procedure, benefits, and risks in great detail. You will lie face down for at least 20 - 30 minutes. A towel may be placed under your belly area so you stay in the correct position. A numbing medicine (anesthetic) is injected under the skin near the kidney area. The health care provider makes a tiny cut in the skin. The doctor uses ultrasound images to find the proper location. A biopsy needed goes through the skin to the surface of the kidney .You will be asked to take and hold a deep breath as the needle goes into the kidney.

If the health care provider is not using ultrasound guidance, you may be asked to take deep breaths to verify the needle is in place. The doctor removes the biopsy needle. Pressure is applied to the biopsy site to stop the bleeding. The needle may need to be inserted again (possibly several times) before enough tissue is collected. After the procedure, a bandage is applied to the biopsy site.

You will need to stay in bed for 6 - 8 hours after the procedure and will remain in the hospital for at least 12 hours. The health care team will give you pain medicines and fluids by mouth or a vein. Your urine will be checked for excessive bleeding. (A little bleeding usually occurs.) Blood counts and vital signs are monitored. Kidney biopsies may also be done using CT scan guidance. In some cases, your doctor may recommend a surgical biopsy. Although surgical biopsies have traditionally required a 3 to 5 inch cut, they can often be done laparoscopically, which uses smaller surgical cuts. Surgical biopsies involve a longer recovery than a simpler needle biopsy.

How to Prepare for the Test

Tell your health care team if you are pregnant or if you have any drug allergies or bleeding problems. Make sure the health care team knows what medications you are taking. You may be told to avoid foods or fluids before the test.

How the Test Will Feel

The amount of pain during and after the procedure depends on the patient. Numbing medicine is used, so there is usually minimal pain during the procedure. The numbing medicine may burn or sting when first injected. After the procedure, the area may feel tender or sore for a few days. You may see bright, red blood in the urine the first 24 hours after the test. If the bleeding lasts longer, tell your health care provider.

Why the Test is Performed

Your doctor may order a kidney biopsy if you have an unexplained drop in kidney function, persistent blood in the urine, or protein in the urine. The test is sometimes used to evaluate a transplanted kidney.

Normal Results
A normal value is when the kidney tissue shows normal structure. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

An abnormal result means there are changes in the kidney tissue. This may be due to: Infection Poor blood flow through the kidney Connective tissue diseases such as systemic lupus erythematosus Other diseases that may be affecting the kidney, such as a kidney Kidney transplant rejection, if you had a transplant

Abnormal results may also be due to: Acute nephritic syndrome Acute tubular necrosis Alport syndrome Atheroembolic renal disease Chronic glomerulonephritis Complicated urinary tract infection Diabetic nephropathy Focal segmental glomerulosclerosis Goodpasture syndrome IgA nephropathy (Berger's disease) Interstitial nephritis Lupus nephritis Medullary cystic kidney disease Membranoproliferative GN I Membranoproliferative GN II Membranous nephropathy Minimal change disease Nephrotic syndrome Post-streptococcal GN Rapidly progressive glomerulonephritis

This list is not inclusive.

Risks
Risks include: Bleeding from the kidney (in rare cases, may require a blood transfusion) Bleeding into the muscle, which might cause soreness Infection (small risk)

Considerations
Avoid strenuous activities and lifting heavy objects for 2 weeks after the test. Sometimes a repeat biopsy is needed.

Following the biopsy, the patient made to lie flat on their back for six hours to minimize any risk of
bleeding, blood pressure and urine are frequently monitored to ensure the patient is not suffering any complications.

Biopsy was done in the prone position with patients lying with the abdomen on a pillow
Delirium: A sudden state of severe confusion and rapid changes in brain function, sometimes associated with hallucinations and hyperactivity, during which the patient is inaccessible to normal contact. Delirium can be due to a number of conditions, including infection, drug toxicity or withdrawal, seizures, brain tumor, poisoning, head injury, and metabolic disturbances.

Adverse Effects
Common side-effects include insomnia (about 8% of patients), agitation, anxiety and headache. Less frequent side-effects include somnolence, tiredness, dizziness, poor concentration and nausea, and dysfunctions of erection, ejaculation and orgasm. Average weight gain of about 1-2 kg is a side-effect[38]. Orthostatic hypotension can occur, particularly initially. Risperidone appears to have less potential for causing EPS than conventional antipsychotics and as such may be more suitable as a maintenance antipsychotic than conventional dopamine blockers[39-

SIDE EFFECTS: The most commonly-noted side effects associated with risperidone are extrapyramidal effects (sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes), dizziness, hyperactivity, tiredness, abdominal pain, fatigue, fever and nausea. Risperidone may cause a condition called orthostatic hypotension during the early phase of treatment (the first week or two). Patients who develop orthostatic hypotension have a drop in their blood pressure when they rise from a lying position and may become dizzy or even lose consciousness.

GENERIC NAME: risperidone BRAND NAME: Risperdal, Risperdal Consta

DRUG CLASS AND MECHANISM: Risperidone is an atypical antipsychotic drug that is used for treating schizophrenia, bipolar mania and autism. Other atypical antipsychotic drugs include Olanzapine (Zyprexa), Quetiapine(Seroquel), Ziprasidone (Geodon), Aripiprazole (Abilify) and paliperidone (Invega). Atypical antipsychotics differ from typical antipsychotics due to the lesser degree of extrapyramidal (movement) side effects and constipation. Risperdal Consta is an injectable, long-acting form of risperidone.