Health | Panacea

Normal Laboratory Values: Hematology

2009-03-28T12:53:00.002+08:00

Hematology normal values (Conventional)

Blood Volume = 8.5-9.0% of body weight in kg
Red Blood Cell (RBC) = Male: 4.6-6.2 million/cu. mm Female: 4.5-5.9 million/cu. mm
Hemoglobin (Hgb) = Male: 13-18 g/100 mL Female: 12-16 g/100 mL
Hematocrit (Hct) = Male: 45-52% Female: 37-48%
Leukocytes (WBC) = 4,300-10,800/cu. mm

Bands: 0-5%

Basophils: 0-1%

Eosinophils: 1-4%

Lymphocytes: 25-40%

*B-Lymphocytes: 10-20%
*T-Lymphocytes: 60-80%

Monocytes: 2-8%

Neutrophils: 54-75%

Platelets = 150,000-350,000/cu. mm
Erythrocyte Sedimentation Rate (ESR) = Male: 1-13 mm/hr Female: 1-20 mm/hr

Breast Care: Preventing Abnormal Growths

2009-03-10T11:38:00.010+08:00

Recently, a high school classmate of mine was admitted to the hospital for a 2 cm tumor in her right breast. Good thing is, the biopsy went well but I warned her that this is not the right time to rejoice and taking them for granted. She might be at risk for malignancy and that means she has to submit to annual breast examination and check up. Although fibroadenomas rarely become malignant she should be careful. Women read the tips below:

Wear a good fit bra

A well-fitted bra can prevent unwanted injury of the breast from activities of daily living. Athletic women should be cautioned on choosing the right bra for their sports. Loose bras cause the pulling of the supporting ligaments of the breast which then results to long term sagging. Girls you won't like that right? Your breasts may begin to droop and fall to the bottom of the cup. The breast tissue will role off the chest wall and under the arm, thus pulling on the neck. Headaches results, since the muscles being pulled in the shoulders go all the way to the head. Reduced circulation to the head can cause headaches and backaches, as the extra weight of the bust places more pressure on the back. A tight one can impede breathing since it compresses the chest wall much.

Use hormone replacements cautiously

Long-term hormonal replacement medications are said to cause abnormal growths not only in the breast but also in other organs of the reproductive system. Usually, it increases breast cancer risk.The risk of developing one of the less common lobular or tubular breast cancers increases twice as much under hormone replacement therapy as the risk of the common type of ductal carcinoma, which constitutes 40 to 75 percent of all malignant tumors of the breast—Dr. Wilhelm Braendle, Hamburg-Eppendorf University Hospitals.

Have a monthly breast self-examination

Breast self-exam is taught among the adolescents before they reach their teenage years. Make it sure it is performed right after menses. The recommended time is just after the end of the last period when the breasts are least likely to be swollen and tender. Older, menopausal women should do BSE once a month, perhaps on the first or last day of every month. Report to family physician if anything unusual is observed.

Avoid eating 'junk' foods

Foods with preservatives like processed foods may precipitate abnormal growths in the body. Eat less fat and grilled, charred food and eat more fresh preservative-free foods. The longer the shelf life the bigger the amount of preservatives are added in the food. Be a wise shopper and diner. Go organic!

Knowing Varicella

2009-02-23T22:54:00.004+08:00

A special someone contacted varicella for the past 2 weeks. Lucky enough for me I had my exposure when I was 8. A scar under my eyebrows is the living proof. Blisters suddenly grow after a relief from a fever. They begin to produce purulent fluid within the thin-walled blisters in 12 hours and grow at the center to the limbs of the body until they leave crater-like remnants on the skin that fades eventually. Chickenpox as what everyone calls it, is a highly infectious disease that requires not only contact but also airborne precautions to people who haven't had the disease or did not receive any varicella shot. Shots are readily available in the nearest public health centers but for third world countries early exposure of the disease is undeniably cost-effective. The growth of adult-onset chickenpox is frustrating since blisters are more distributed on the face than the extremities. A child's blister distribution is dispersed compared to an adult's and it fades as the child matures. Take note on this:

Early detection is good
Once 'chickenpox' blisters starts growing at the midline of the body consult a health provider to control the symptoms. Acyclovir, an antiviral medication is usually prescribed before blisters begin to multiply and pus.

Don't touch it!
Touching the pus-filled blisters does not only ruptures it but also promotes infection. Handwashing is essential before checking on them. Fingernails should be cut short.

Itch out!
Along with antivirals, antihistamines like Benadryl is also prescribed to get for the itch. Itch causes scratching and scratching with dirty hands and fingernails causes rupture and infection. Drowsiness is often the side effect of antihistamines. Consult a physician to determine the appropriate medication. Calamine lotion also reduces the itch. It also promotes crusting since it leaves them dry when applied on the affected areas.

Get grounded!
Stay at home & reduce the spread of infection to susceptible individuals especially pregnant women during their first 28 weeks of gestation. It causes harmful effects on the fetus. The crust usually falls off after 7 days. Although one lesion goes through this complete cycle in about seven days, new lesions crop up every day for several days. It may take a week before blisters stop appearing. Children should not be sent back to school until all lesions have crusted over.

Sunscreen helps
Sunscreen helps the darkening of the scars. Avoiding or omitting soy sauce in food also helps. Ointments or creams for the scars may be prescribed by a dermatologist.

Points on Skin Allergies

2008-12-26T20:11:00.006+08:00

Personally, I do have an allergy with a component of a certain nasal decongestant. The symptom I usually get is a scaly appearance on the skin of my hands & feet, the palms and the soles. I'm pretty thankful that it doesn't affect my face or any part of it. The first action that most people do with their symptoms is to seek relief from it. There are a number of steps that can be and should be taken as soon as possible. One of these steps involves determining what is causing an allergic reaction.

Know Your Allergy

For example, do you develop a rash right after doing yard work? If you do, you may have seasonal allergies. Do you develop a rash after holding a cat? If you do, you may have pet allergies, and so forth.

Consult Your Doctor

You may want to consider scheduling an appointment with your doctor. Some individuals are even more surprised to learn that they may have multiple trigger factors, like certain foods or chemicals that are found in many household products, such as laundry detergents and even metal kitchen utensils like copper! One of the many reasons why you will want to consider seeing a doctor is because they can help you determine what you are allergic. Of course, you can try your own experiments at home, but you will want to proceed with caution. This is important if you think the cause of your skin rash or allergic reaction is food, as your symptoms can become much more severe. That is why you are advised against performing your own allergy tests at home, but if you do, just make sure that you aren’t alone when doing so.

Seek Appropriate Relief Per Prescription

Once you are able to determine what is causing your skin to have an allergic reaction, you can better go about seeking relief. First, over-the-counter allergy medications may be examined. There are also lotions and creams that can provide you with relief from itching and or hives. If you visit your doctor, he or she may be able to recommend specific products to you. If a doctor is inaccessible try to ask your local pharmacist for the best drug of choice.

Try Basic Home Remedies/Alternatives & Prevention

It is also important to know that you can seek relief without the use of over-the-counter products. For example, oatmeal when mixed with one cup of boiling water, let cooled, and then strained can provide relief to those who have hives. The water extracted from the oatmeal can be dabbed on the skin. You can also reduce your skin reactions by eliminating or significantly reducing your trigger factors. For example, if you are a pet owner who cannot bear to part with your pet, consider not holding them or petting them without gloves, keeping them out of your bedroom, and perhaps invest for an air purifier.

Tips for Peanut Allergies

2008-12-24T08:40:00.008+08:00

A little overview of peanut allergy, it is one of the leading causes of food-related death due to complicated anaphylactic shock or hypersensitivity allergic reaction. It is important to do as soon as your child can understand the concept of allergies and not eating certain foods. As early as 6 months parents should introduce food one at a time to determine which of it is the infant's allergy. Bear in mind that there should be a 4-day trial period for the newly introduced food. According to experts, he best time to reinforce the teaching occurs at the preschool level. You may need to talk to your child more than once, but it is important to let them know what could happen if they carelessly share food with friends or classmates. Teen should be taught how to check the food labels.

Inform

Inform everyone around the child about the allergy like their teachers in school, seatmates, friends and friends' parents. You may be surprised to know that many food allergies, happen when parents are not around. That is why it is extremely important that all adults know about your child’s allergic reactions to peanuts. When your child leaves your home to visit friends or family, pack safe snacks for them to eat.

Ask Questions

If you and your child are known for eating out, it is important that you ask as many questions as possible. You should do so at all eating establishments, but it is particularly important to do at a bakery. Are all baked goods made in the same spot, like on the same table? Even if not, are gloves changed? What are the chances that a peanut or peanut butter can make its ways into other foods? You should know before feeding your child anything that you did not prepare yourself.

Read the Labels

Speaking of the foods that you do prepare yourself, be sure to read all food labels. When doing so, you may be surprised just how many products have warnings that claim that peanuts may be present. Even if they only “may,” be, you are still advised to proceed with caution and skip. Also, make sure that you always read labels, as food manufacturers are known for updating or changing their ingredients.

Be Alert

It is also important to know how to handle a reaction. There is a good chance that your child’s doctor will teach you the proper steps that you should take, which will likely include administering medicine to help your child breathe. It is also important to educate those around you too. Make sure that all relatives, parents of friends, and school teachers know what to do in the event of an allergic reaction to peanuts. If medication is provided by your doctor, which it should be, make sure the school has some and always carry the medication with you, like in your car or in your purse.

Assess For Allergic Reaction

Vomiting
Diarrhea
Urticaria (hives)
Angioedema (swelling of the lips, face, throat and skin)
Acute abdominal pain
Exacerbation of atopic eczema
Asthma
Anaphylactic shock

Tawa-Tawa: A Remedy for Hemorrhagic Fever

2008-11-27T22:24:00.003+08:00

July 1996, Philippine Southfield School grounds. Time for general cleaning for the upcoming Nutrition Month culmination day. We finally cleared the drainage from mineral water bottles, planted and trimmed the durantas around our classroom and dusted the jalousies, that's the last thing I remembered before it all started. I felt weak and hot. It must be out of exhaustion. I asked permission from the prefect to go home before dismissal. I arrived home at lunch time and went flat at bed. The next day, I was fine. Then I went hot then off the next morning. My temperature was like a switch, on and off. The fourth day, I grew rashes on my arms. I was rushed to the nearest hospital and blood work was pretty bad. A platelet below normal.

Dengue Hemorrhagic Fever is viral disease in the tropics from a vector, a mosquito of either Aedes aegypti or A. albopectus. A few days after the bite, the patient develops an 'on-and-off' of fever and joint pain also known as break-bone fever. The client must be rush to the nearest hospital when the fever subsides for IV fluids. At this time, platelet count drops and bleeding is inevitable. No cure is known for its treatment is palliative in nature. Just IV fluids, pain medication and a stand-by platelet transfusion to prevent hypovolemia and the dangers of it.
Today, with the spread of helpful information about and against Dengue, people discovered a remedy and it grows all throughout the Philippines. Euphorbia pilulifera also locally known as Tawa-Tawa. This is how you prepare the concoction:

Take 25 newly uprooted Tawa-Tawa plants.
Cut off the roots
Wash and clean
Fill pot with 7 glasses of clean water then boil
Slowly boil the Tawa-Tawa for 1 (one) minute
Strain out the Tawa-Tawa leaves and stems from the concoction then let it cool
Sip 1 to 1.5 glasses of Tawa-Tawa concoction every 1 hour for 24 hours

The concoction should be given as early as possible or right after the diagnosis. According to some preliminary research conducted in Davao, Tawa-Tawa has naturall anti-viral and anti-bacterial properties that can cure even at stage 4 of the dreaded disease. For more piece of information about Tawa-Tawa click here

Healthy Fat Intake

2008-11-22T22:07:00.004+08:00

This posting is aimed to help you to reduce not eliminate. your fat intake. The average individual eats too much fat, a factor that's linked to a variety of health problems, and cancer. Diets that are high in fat are associated with breast and colon cancer, with some studies linking high fat to prostate cancer as well. But hereditary also predisposes the likelihood of having such disease.
A majority of people can bring their fat intakes down to a healthy range by making a few adjustments in the way they shop, cook, and prepare the foods they eat. Now days, it's getting easier and easier to control the amount of fat you consume. The fat content of foods are now available through the nutrition label and through brochures distributed by food companies and even fast food restaurants.
You can use this information on nutrition to choose lower fat foods by comparing products and food brands. Once you have a rough idea of what a healthy intake of fat is, you'll know what you can and what you can't have. From day to day, the amount of fat you eat will vary. Some meals and some days will be higher in fat than others. Even high fat meals can be kept in line with healthy eating as long as you balance those days accordingly. The average fat intake over the course of weeks and months is important, not the fat intake of every meal and food you consume.
Younger adults and high active adults who have higher calorie needs can probably eat a little more fat. Older adults and those that aren't very active should aim for a lower fat intake. This way, you can control your fat intake and avoid the many problems that fat is associated with. There are a few postings in my blog that might help you with having a health meal by clicking here.

Physical Assessment: Checking for Fluid Wave

2008-11-21T00:32:00.003+08:00

This test is done to determine ascites or an excess of fluid in the peritoneal cavity, the cavity that encloses most of the abdominal organs. It is performed by having the patient push their hands down on the midline of the abdomen. The examiner then taps one flank, while feeling on the other flank for the tap. Fluid allows the tap to be felt on the other side.

Bisphenol A: An Environmental Risk Factor for Cardiovascular Disease?

2008-11-10T17:28:00.004+08:00

In a cross-sectional analysis, high urine concentrations of a commonly used industrial chemical were associated with diabetes and coronary events.

Bisphenol A (BPA) is added to the plastic used in products such as baby bottles and to the epoxy that lines food cans. Most individuals in industrialized countries are thought to have BPA in their bodies. In humans, BPA may bind to estrogen receptors, and concern has arisen as to whether it might adversely affect health.

In this study from the U.S. National Health and Nutrition Examination Survey 2003–2004, investigators measured total concentration of BPA in urine samples collected from 1455 adult participants and determined whether urine BPA concentrations were associated with self-reported histories of physician-diagnosed arthritis, cancer, cardiovascular disease (angina, coronary heart disease, or heart attack), diabetes, liver disease, respiratory disease (asthma, bronchitis, or emphysema), stroke, or thyroid disease. The odds ratio for a diagnosis of cardiovascular disease or diabetes was 1.39 for each 1 standard-deviation increase in urine BPA concentration (P<0.001>

Comment

Despite recent assertions by the FDA of the safety of bisphenol A, criticism is mounting about its use in consumer products because of its potential neurologic and reproductive health effects. By linking BPA concentrations to increased risks for diabetes and heart disease, these new data raise questions about the current assumptions and assessments the FDA has made. These findings should stimulate additional studies into the potential health effects of BPA.

— JoAnne M. Foody, MD

Eating Healthy For A Healthy Heart

2008-11-05T21:12:00.004+08:00

It's impossible to eat healthy our whole lives, even though we may try hard to do it. Eating healthy for your heart is something everyone should try to do, especially when it comes to restoring health and reducing heart attacks.

Your heart and food
We know these things for sure - a diet high in saturated fats will help raise your cholesterol, which is a risk factor for heart disease and worst fatal heart attacks. People that are obese are more prone to heart disease. A diet high in sodium may elevate your blood pressure, leading to constriction of the blood vessels.

To help prevent heart disease and improve your health, put the tips below to good use.

Eat plenty of fish
Herring, sardines, mackerel, tuna and salmon are all excellent sources of Omega 3 essential fatty acids. Other fish are great to, although Omega 3 may help to get your cholesterol down to a healthier level.

Choosing healthy fats and oils
Saturated fat will increase the risk of heart disease. It's found in meat, butter, and even coconut oil. You should avoid them until your cholesterol levels are down and you are at a healthy weight. Even those that love red meats can enjoy seafood and nuts for their main sources of protein. Monounsaturated fats such as olive oils will help you to protect your heart. Olive oil is an ideal choice for cooking, dressing, or even as a dipping sauce.

Plenty of Roughage
Fiber can help you control your cholesterol. You can find fiber in whole grain products to help control sugar absorption as well, which will help you keep your digestive system healthy.

Choosing the right carbohydrates
Eating for your heart involves staying away from sugary foods such as candy, cookies, cakes, and pastries. Eating a lot of sugar isn't good for your heart disease at all. Healthy carbohydrates involve whole grain breads, whole grain pasta, brown rice, and a lot of vegetables. You should make fruits and vegetables the main aspect of your diet.

Healthy cooking methods
Stir frying and sauteing with olive oil or canola oil are both great methods, as you shouldn't dip your food in batter and fry it anymore. If you cook chicken, remove the skin and bake it in the oven in foil. Instead of frying your fish you should always bake it. Steaming your vegetables can help maintain the most nutrients. You should use cream sauces or lots of butter anymore either. When you eat vegetables, try squeezing lemon juice on them or using your favorite seasonings.

As you make the proper changes to your diet, keep in mind that it takes time for them to become habits. Eating healthy is always great for your body and your lifestyle, especially when it comes to your heart and the prevention of heart disease.

Physical Assessment: Checking for Rovsing's Sign

2008-10-31T10:45:00.004+08:00

A Rovsing's sign is elicited by palpation on the abdomen far from the appendix in the left lower quadrant (LLQ) as in most people the appendix is in the right lower quadrant. While this maneuver stretches the entire peritoneal lining, it only causes pain in any location where the peritoneum is irritating the muscle. In the case of appendicitis, the pain is felt in the right lower quadrant despite pressure being placed elsewhere. If left lower quadrant pressure by the examiner leads only to left-sided pain or pain on both the left and right sides, then there may be some other pathologic etiology. This may include causes relating to the bladder, uterus, descending (left) colon, fallopian tubes, ovaries, or other structures. The maneuver is said to named after a Danish surgeon, Niel Thorkild Rovsing Kimpel.

Cryopreserved Sperm from Men with Malignancies Can Produce Pregnancies

2008-10-27T19:44:00.002+08:00

Preserving sperm before cancer therapy can enhance the likelihood of later fatherhood.

As survival rates after cancer rise, more emphasis has been placed on preserving fertility despite probable chemotherapy- and radiation-induced sterility in both men and women. Does cryopreservation of sperm before treatment allow men who survive cancer to father children later? To address this issue, researchers evaluated data from all 118 couples who underwent in vitro fertilization (IVF) procedures with pretreatment cryopreserved sperm during a 12-year period at a single center in New York City.

Before cancer treatment, about 43% of men had at least one abnormal parameter in their semen analyses, and about 20% had very-low total sperm counts (<5>

Comment

Data on the health of the children born to this cohort are still limited, but no evidence has accrued to date for excess genetic abnormalities. Although we must remain cautious, these findings emphasize the need to discuss future fatherhood with young men who have malignancies and to encourage cryopreservation of sperm before cancer treatments.

— Robert W. Rebar, MD

Smoking, Breaking A Fatal Habit

2008-10-26T01:00:00.007+08:00

Working on to quit smoking is one of the hardest things that many people encounter. There are countless reasons why it is so difficult not to quit. There are two main reasons that are most often cited, the habit of smoking itself is extremely hard to break and procrastination or delaying. The task then becomes an ordeal to break the habit. After all, it took you a while to get into the habit of smoking so reason stands that it will take a while to break the habit.

If you are determined to quit smoking, you have made a good start. Quitting on your own means that you are doing even better. Strange isn't it? You would be surprised at just how many people “decide” to quit smoking by being informed by their doctor, spouse, parent, sibling or friend that they will be quitting. In order to successfully quit smoking for good you need to decide for yourself to quit. There is a popular line saying 'What the mind perceives the body achieves.' If you have actually made this decision on your own, you are doing a terrific job. If you are letting someone push you into quitting you are just setting yourself up for headaches, hassles and complications that are easily avoided.

As a smoker, you have no doubt developed a pattern to your smoking. For example, if you are a typical one pack a day smoker one of your habits is to smoke a pack a day. You need to take small steps to break these habits. Perhaps you will find best luck in simply changing your habits slowly. For example, if you typically smoke a cigarette after each meal, you might find it helpful to brush your teeth. This can have the effect of providing a fresh mouth that you do not want to dirty with cigarette taste. You might find that after each meal you need to try chewing a piece of gum, sucking on hard candy or even attempting nicotine gum. If there are any specific circumstances that always trigger a cigarette craving, you should work to avoid the situation like stress and anxiety we have measures to prevent such occurrences. Diversional activities will help you avoid the itch on grabbing a stick of cigarette. Activities that you enjoy the most that prevents you from giving in the urge to take a cigarette. If it is something that you absolutely cannot avoid, such as dinner times, you need to create an alternative habit that you replace smoking with. For example, if you always smoke as soon as you get to your car after work, you might want to consider carpooling with someone who does not smoke, taking a different route home, stopping for groceries, jamming to some music or even taking a bus. Anything you can do to shake up your normal smoking routine is good. There will of course be times that it is quite difficult to break the habits. If you find yourself in a position where you cannot avoid a typical smoking situation, you need to create a way to deal with it.

Some people use nicotine gum whenever they are faced with a smoking situation. However, nicotine gum has potential side effects that might be even worst for your health and that's addiction. Aside from that you get hiccups from such lame alternative and gum disease which will increase the potential of bad breath and falling teeth. Remember, nicotine is a powerful vasoconstrictor (ability to narrow the lumen of blood vessels). We won't add you up another problem on that. Others find that the stop smoking sticks are beneficial. These sticks can allow you to hold a pretend cigarette that just provides your hands with something to do. If you find these quite useful then you know that your problem is your hands are idle, finding something for your hands to do might help a lot.

Trying to quit is a very difficult process and it entails an amount of time before you see effects of the newly adopted routine. Many people take weeks if not months to quit smoking completely. If you find it too drastic to quit smoking slowing down might help you. Reducing or cutting off your consumption of cigarettes helps a lot in the process. Regardless of the method that you choose, it can take a minimum of 2 weeks to start adapting new habits. This means that any new behavior you adopt in your quest to stop smoking must be repeated continuously for at least two weeks before you will start to see a real difference in your lifestyle. Adherence is the key to achieve this. Giving yourself plenty of time to work on your new habits is essential and will set you on the road to success to a healthier smoke-free lifestyle.

Facts on Regional Entiritis (Crohn's Disease)

2008-10-25T15:59:00.009+08:00

I haven't come across inflammatory bowel diseases much and only know one, ulcerative colitis which I am going to post later. It commonly occurs among adults or young adults but may appear any time in the entire lifespan. Although women are more susceptible but the older population experiences the bouts more than any other age group (Between the ages 50 to 80). The site of affection is commonly located at the distal ileum and colon. Crohn's may be subacute or chronic inflammation which extends through all layers of the intestinal wall. Remissions and exacerbations happen. The pathogenesis begins with intestinal edema and of course, thickening of the mucosa then ulcers begin to appear on the inflammed areas. Lesions are not in continuous contact with each other for they are separated with normal tissue. As the disease progresses into the peritoneum fistulas, fissures and abscesses form. Bowel wall thickens and becomes fibrotic and the intestinal lumen narrows in the advance stage. Granulomas form in almost half of the patients. Diseased bowel loops sometimes adhere to other loops surrounding them.

Clinical Manifestations:

Lower right quadrant pain
Diarrhea unrelieved by defecation
Crampy abdominal pains AFTER MEALS
Abdominal tenderness and spasm
Weight loss
Secondary anemia due to poor nutrient absorption
Nutritional deficiencies
Fever
Leukocytosis
Anoreixa

Complications:

Intestinal obstruction
Perianal disease
Fluid and electrolyte imbalances
Malnutrition secondary to malabsorption
Fistula and abscess formation
Stricture formation

Lab Findings (click here for normal lab values)

Decreased hematocrit and hemoglobin levels
Elevated white blood cell count
Elevated sedimentation rate
Low albumin and protein levels
Positive for occult blood and steatorrhea (excess fat in the feces) in fecalysis

Diagnostics (click here for diagnostic procedures)

Proctosigmoidoscopy
X-Ray barium study of upper gastrointestinal tract
Endoscopy and intestinal biopsy (Confirming diagnosis)
Barium enema
CT Scan

Impression:
Barium enema shows ulcerations (cobblestone appearance)
Classic 'string sign' on X-Ray indicating constriction of a segment of a bowel (most conclusive diagnosis)

Medical Management:

Nutritional therapy
Antidiarrheal and antiperistaltic medications are given
Sulfasalazine which is effective for mild or moderate inflammation, reduces recurrence
Corticosteroids

Surgical Management:

Total Colectomy with Ileostomy
Total Colectomy with Continent Ileostomy
Total Colectomy with Ileoanal Anastomosis

Nursing Management:
Assessment:

Health history
Dietart patterns (include intake of alcohol, nitcotine)
Assess elimination patterns and stool consistency
Nutrition status
Assess abdomen for bowel sounds and characteristics
Pain assessment

Nursing Diagnosis:

Diarrhea R/T the inflammatory process
Acute pain R/T increased peristalsis and GI inflammation
Deficient fluid volume deficit R/T anorexia. nausea and diarrhea
Imbalanced nutrition, less than body requirements
Activity intolerance R/T fatigue
Anxiety
Ineffective coping
Risk for impaired skin integrity

Nursing Intervention:

Relieve pain by administering anticholinergic medications 30 mins. before meals
Maintain fluid intake
Maintain optimal nutrion through parenteral nutrition in severe cases
Record intake and output
Weigh daily
High protein low fat and residue diet
If food is tolerated give small frequent feedings
Promote rest
Establish rapport to reduce anxiety
Provide perianal care and prevent skin breakdown for bed-ridden clients especially over bony prominences

Evaluate:

Elimination status
Pain
Fluid Balance
Nutrition status
Skin integrity
Knowledge of disease process and management
Potential complications must be reported

Image taken: healthheroes.files.wordpress.com

The Benefits of Lemon Grass

2008-10-25T13:08:00.006+08:00

Last Sunday, I enjoyed browsing my cousin's newly installed cable TV. The first show that caught my attention was Lifestyle Network's cooking show (unfortunately I forgot the title) that featured Asian cuisine particular South East Asian cuisine. I've noticed lemon grass is always an ingredient in most of the dishes prepared so today I'm gonna talk about the benefits we get from these herb. But before anything else, lemon grass belongs in the genus Cymbopogon and is widely found in tropical countries. The one found mainly in Southeast Asia is Cymbopogon citratus which gives off a more citrus flavor to teas, soup and curries. This type of lemon grass is abundant in the Philippines and little of it was known to have medicinal properties.

Active Ingredients:

Myrcene has antibacterial and analgesic effect
Citronella or citronella oil is an all natural unadulterated insect-repellent
Geraniol and citronellol is responsible for the flavor that it gives off

Chicken Inasal

Preparation & marinating: 6 hours to overnight
Estimated cooking time: 40 minutes

Ingredients:

Preparation & marinating: 6 hours to overnight
Estimated cooking time: 40 minutes

2 Chickens (free range if available)
3/4 cup Filipino vinegar
1/4 cup Garlic finely minced
2 stalks Lemon grass
Salt
Annatto oil
Wooden skewers
Spiced vinegar
Additional Ingredients Instructions:
2 free-range chickens, approx. 3 pounds each, or if you can find smaller chickens, use 3 of them
3/4 cup Filipino vinegar, palm if you can find it, or cane; or if you must, the equivalent in kalamansi juice (available in the frozen aisle of your Asian market if you don’t have access to fresh)
1/4 cup garlic, minced very finely, or better yet, mashed into a paste with 2 teaspoons sea salt
Achuete or annatto oil, made by steeping 1/4 cup annatto seeds in 1/2 cup hot oil for half an hour (If not available, you may mix a small amount of paprika and tumeric to achieve the same color.)
Thick wooden skewers, soaked for 1 hour in water prior to cooking
Bottled spiced vinegar for serving, or make your own by mixing Filipino vinegar, lots of crushed garlic, a bit of salt, and a handful of Thai peppers or other tiny red hot peppers

Procedure:

Quarter the chickens, or if using the small ones, halve them. Marinate in the vinegar, garlic and salt, several hours or overnight, turning several times.
Preheat grill to 350 degrees. Make sure your grill is cleaned and oiled well. Cook over indirect heat for 20 minutes, basting with the achuete oil.
Turn and cook for 10-15 minutes more, or until thickest parts of chicken exude clear juices when pierced. Can also be made in a grill pan on the stove if no outside barbecue is available.
Serve immediately with the spiced vinegar. Other welcome additions to the vinegar: some soy sauce or fish sauce if you like, or even some minced ginger.

Cooking Variations:

Another technique we’ve found to work well, is to heat the oil in which the annatto is to be steeped, and to steep the garlic (and lemon grass if using) together with the seeds. This ensures a more even distribution of flavors. Just remember to discard this mixture when you’re done with the cooking, as you risk botulism from the garlic. Or, if you want to make it ahead of time, be sure to refrigerate the oil to retard any toxins from developing.

If your chicken is particularly fatty, you could render the fat slowly in a skillet, and use that instead of cooking oil to steep the annatto seeds. In which case, you’ll want to have enough not only for basting but also for serving later, as there’s nothing more appetizing than chicken inasal drizzled with this orange concoction.

Physical Assessment: Obturator Lift

2008-10-21T19:47:00.004+08:00

Another assessment of acute appendicitis.

Diverticular Disease

2008-10-19T11:31:00.018+08:00

Hmm I feel like talking about intestinal disorders. Actually, I'm doing this for my state board review which is due around January of next year. Wish me luck guys. A diverticulum is a sac-like outpouching of the lining of the bowel that extends through a defective muscle layer. It may occur anywhere along the GI tact. Multiple diverticular disease of the colon is called diverticulosis. Diverticulitis results when retention of food and bacteria happens causing infection and inflammation. A congenital predisposition is suspected when the disorder occurs in those younger than 40 years old. An intake of low dietary fiber predisposes the disease but the exact cause is unknown. It forms when the mucosa and submucosal layers of the colon herniate through the muscular wall due to high intraluminal pressure, low volume in the colon wall. Content accumulate in the diverticulum and eventually decompose, causing inflammation and infection. Obstruction can happen while inflammation aggravates the obstruction more. The inflammation tends to spread to the surrounding bowel wall, giving rise to irritability and spascitiy of the colon.

Complications

Bowel Perforation
Peritonitis
Blood vessel erosion
Bleeding
Abscess
Septicemia

Clinical Manifestations

May be asymptomatic
Chronic constipation
Diarrhea
Abdominal cramps left lower quadrant
Low-grade fever
Nausea & anorexia
Bloating
Abdominal distention
Weakness
Fatigue

Lab Tests and Findings (click here for normal lab values)

Complete blood cell count
Elevated leukocyte
Elevated sedimentation rate
Fecalysis

Diagnostics (click here for diagnostic procedures)

CT Scan
Abdominal X-Ray
Barium enema (contraindicated with peritoneal irritation, potential perforation)
Colonoscopy

Impression: Abscesses (CT scan), free air under the diaphragm indicates perforation (x-ray), narrowing of colon (barium enema)

Medical Management
Dietary & Medication Regimen:

Analgesics
Antispasmodics
Clear liquid diet until inflammation subsided THEN high-fiber, low fat diet to increase stool volume decrease colonic transit time and intraluminal pressure
Low-fiber diet until signs of infection decrease
Antibiotics
Bulk-forming laxative
Opioids prescribed but NO MORPHINE

Antispasmodics:

Propantheline bromide (Pro-Banthine)
Oxyphencyclimine (Daricon)

Other medications:

Metamucil
Colace
Dulcolax

Nursing Management
Assess:

Health history
Onset and duration of pain
Past and present elimination patterns (include constipations, diarrhea, tenesmus)
Fiber intake
Auscultate bowel sounds
Stool inspected for pus, mucous or blood
Monitor vital signs

Diagnosis:

Constipation R/T narrowing of the colon from thickened muscular segments and strictures
Acute pain R/T inflammation and infection

Planning & Goals:

Attainment and maintenance of normal elimination patter
Relief from pain
No complications

Nursing Interventions

Recommend a fluid intake of 2 L per day (within the limits of patient's cardiac & renal reserve)
Suggest fiber-rich soft foods that can increase the bulk of the stool to facilitate peristalsis
Exercise program to improve abdominal muscle tne
Adherence to medication regimen
Analgesics for pain
Record intensity, duration and location of pain
Assess for signs of perforation:

-Increased pain and tenderness with abdominal rigidity
-Elevated WBC count
-Elevated sedimentation rate
-Increased temp.
-Tachycardia
-Hypotension

Be ready for surgical emergency when perforation symptoms persist

Image taken: http://apps.uwhealth.org/health/adam/graphics/images/en/15810.jpg

Physical Assessment: Checking for Rebound Tenderness

2008-10-16T16:00:00.005+08:00

Rebound tenderness indicates peritoneal irritation. It refers to pain upon removal of pressure rather than application of pressure to the abdomen. (The latter is referred to simply as abdominal tenderness.) It is a classical sign of peritonitis. Additional tests should be done before coming up with a specific diagnosis.

Peritonitis

2008-10-16T14:52:00.005+08:00

I'm posting this in relation to my previous posting about appendicitis. Peritonitis is the inflammation of the peritoneum, serous membrane lining the abdominal cavity and covering the viscera. It is usually a result of bacterial infection, organisms out from certain diseases of the GI tract or, in women, from the internal reproductive organs. It can also be a result from external sources such as injury or trauma (e.g. gunshot wound, stab wound) or an inflammation that extends from an organ outside the peritoneal area, such as the kidney. Symptoms depend on the location and extent of inflammation. Diffuse pain is felt initially then becomes more constant and aggravates in movement. Abdomen is tender (rebound tenderness) and distended and muscles become rigid. Paralytic ileus may be present. Usually, nausea and vomiting occur and peristalsis is diminished. Purse rate and temperature increases.

Common bacteria:

Escherichia coli
Klebsiella
Proteus
Pseudomonas

Other common causes:

Appedicitis
Perforated ulcer
Diverticulitis
Bowel perforation

May be associated with:

Abdominal surgical procedures
Peritoneal dialysis

Complications

Sepsis
Shock due to septicemia or hypovolemia
Intestinal obstruction due to bowel adhesions
Post-OP tenderness and pain MUST be reported as well as wound dehiscence

Lab Findings (Click here for normal lab values)

Leukocyte count elevated
Potassium, Sodium and Chloride may reveal altered levels

Diagnostics (click here for diagnostic procedures)

Abdominal X-Ray
CT Scan
Impression: Abscess formation, X-Ray shows air and fluid levels as well as distended bowel loops

Nursing Management
Assess:

Vital Signs
GI Function
Fluid/Electrolyte balance
Nature of pain

Nursing Intervention (N/I):

Administer analgesics
Position client for comfort to decrease pain: Side-lying, knees flexed decreases tension of abdominal organs
Monitor intake and output
Monitor CVP
Increase fluid and food intake gradually
Prepare for emergency surgery if complication is inevitable
Observe and record character of drains
Care must be taken when moving and turning t prevent drains from being dislodged

Discharge Teaching:

Teach and demonstrate to the patient and family about the importance of incision and drain care

Image taken: www.bartleby.com

Normal Laboratory Values: Coagulation

2008-10-15T00:50:00.003+08:00

ACT 90-130 sec
aPTT 21-35 sec
Fibrinogen 160-450 mg/dL (1.6-4.5 g/L)
INR (Target Therapeutic) 2-3
Plasminogen 62-130%
Platelets 150,000-300,000/cu. mm
PT (Prothrombin Time) 10-12 sec
PTT (Partial Prothrombin Time) 30-45 sec
Thrombin Time 11-15 sec

Learning Apendicitis

2008-10-12T11:35:00.002+08:00

Alright, I'm fed up of listening to people when they complain of pain during an activity after a large meal and said that they got appendix. Of course, everyone has not unless they undergone any surgical removal of the appendix. The appendix is a finger-like appendage about 4 inches long that is attached to the cecum, the pouch connected to the ascending colon of the large intestine. It is located below the ileocecal valve. The appendix fills with food and regularly empties into the cecum. Since it empties inefficiently and with a small lumen, the appendix is prone to obstruction and is highly vulnerable to infection, appendicitis. Appendicits is known to strike people between ages 10 to 30 years old. The most signature symptom is pain in the abdomen. Appendicitis pain is not like the type of pain you get from gas or indigestion. Pain starts in the navel area. It then moves into the lower right-hand (Right Lower Quadrant/RLQ pain) corner of the sufferer's abdomen. Pain increases as the disease progress. The pain then settles in an area that is near the appendix. This area is called the McBurney point. An inflamed appendix lies on the psoas muscle and the patient will lie with the right hip flexed for pain relief. Checking for a positive Psoas sign will assist in the diagnsis. Other than that lab works are performed to check for infection. A person should report any pain that persists and that is accompanied by loss of appetite, nausea, vomiting, and fever to a physician. Remember, it is an emergency condition and should be managed as early as possible. Surgery is indicated if appendicitis is diagnosed. Fluid and electrolytes imbalance and dehydration should be corrected through intravenous fluids and antibiotics prior to appendectomy, surgical removal of the appendix. Analgesics can be given after the diagnosis is made. Appendectomy can be performed either spinal or general anesthetic with a low abdominal incision or by laparoscopy, Caution should be observed in the elderly population since classic signs and symptoms are altered and may vary greatly. Pain may be absent or minimal. Symptoms may be vague, suggesting bowel obstruction or the like. Thus, diagnosis and prompt treatment may be delayed, which heightens the probablity of potential complications and worse, mortality.

Complications

Perforation of the appendix

Peritonitis

Lab Findings (Click here for normal lab values)

Elevated white blood cell count

Leukocyte might exceed 10,000 cells/ cubic mm

Neutrophils exceeds 75%

Diagnostics (Click here for diagnostic procedures)

Abdominal X-Ray

Ultrasound studies

CT Scan

Impression: RLQ density or localized distension of the bowel

Nursing Management
Goals:

Relieving pain
Preventing fluid volume deficit
Reducing Anxiety
Eliminating infection from potential or actual disruption of GI tract
Maintaining skin integriy
Optimal Nutrition

Nursing Intervention (N/I):

Prepare client for surgery

NO ENEMA it can lead to perforation

Post-OP patient in Semi-Fowler's position, reduces pain and tension on the incision and abdominal organs

Opioid analgesic is prescribed to relieve pain

When tolerated, oral fluids are given

Food given as desired and tolerated on the day of surgery

Check temperature and should be maintained within normal limits

Patient is discharged on the day of surgery if client illicits normal temperature, no undue discomfort, and appendectomy was uncomplicated

Discharge Teaching:

Instruct to make an appointment with the surgeon to remove sutures between 5th and 7th days after surgery

Incision care and dressing changes

Activities can resume within 2 to 4 weeks

Cat Vs. Cat Owner

2008-10-09T13:27:00.004+08:00

Definitely, this is not a brawl between domestic felines and the typical homo sapiens but it is about man's struggle of getting allergies from pets especially those cute cuddly fur balls. This posting will give an idea to cat owners how to combat attacks and getting relief from these symptoms.

Assess Yourself

Nasal congestion? Or...
Postnasal drip when you are around your cat or cats?
Skin rash after close contact?
A change of respiratory pattern?

If so, you might have a cat allergy. I recommend you to have an appointment with your physician to determine whether you really got a pet allergy or not. Aside from that, they may prescribe the best medication to combat such attacks.

Prevention is absolutely better than cure

The best way is to remove your cat or cats from your home. Unfortunately, this isn’t so easy for many cat lovers to do. If you cannot find a good home for your them, like with a trusted friend or family member, you need not to worry. There are still a number of steps that you can take to seek relief.

Avoid cuddling with your cats is a great way to reduce your symptoms. Close contact with a cat is one of the many ways that skin rashes, like those that resemble an eczema outbreak develop. It might be devastating for you to be isolated from them but this is the best way to prevent contacting allergic reactions from especially if your symptoms are severe.

Keep the fur balls off your furniture. This includes your beds, reclining chairs, or couches. This is particularly important if you are known to lie down or nap on your living room furniture. Covers are a nice alternative. Should you choose to use cloth covers, which are more attractive, be sure to wash them every few days or whenever you notice a large accumulation of cat hair.

Another tip involves keep your cat or cats out of your bedroom. As it was previously stated, keep them off your bed. This can help you sleep better at night. But, just keeping them out of your room in general is the best approach.

Vacuum as often as possible. Vacuuming can help to pick up some of the pet hair and pet dander that may be in the carpet, bed and cushion. Vacuum cleaners that use HEPA (High Efficiency Particulate Air) filters are highly recommended. You may want to give these types of vacuum cleaners a close look.

An air purifier can also be used and should be used if you are allergic to your cat. All air purifiers remove potentially harmful particles from the air especially allergens. This includes pet dander. If you have a cat allergy, the removal of dander from the air can be a great source of relief. You can research and find air purifiers that are marketed towards those who suffer form allergies online. As with vacuum cleaners, air purifiers that use HEPA technology, often produce the best results.

For the latest cat info just visit The Catzine by clicking the image above.

Normal Laboratory Values: Cardiac Enzyme Markers

2008-10-06T23:49:00.000+08:00

Cardiac Marker Levels with Onset, Peak and Duration

Troponin-I 0.0-0.1 ng/mL Onset: 3-6 hrs Peak: 12-24 hrs Duration: 4-6 days
Troponin-T <0.18>
CPK <150>
CPK-MB 0-5 ng/mL Onset: 4-6 hrs Peak: 14-20 hrs Duration: 2-3 days
SGOT 1-36 U/L Onset: 12-18 hrs Peak: 12-48 hrs Duration: 3-4 days
LDH 70-180 Onset: 3-6 days Peak: 3-6 days Duration: 7-10 days
Myoglobin Male: 10-95 ng/mL Female: 10-65 ng/mL Onset: 2-4 hrs Peak: 6-10 hrs Duration: 24-36 hrs

Physical Assessment: Checking for Psoas Sign

2008-10-05T11:04:00.001+08:00

It is an indicator of irritation to the ilio-psoas group of hip flexors in the abdomen. An inflamed appendix lies on the psoas muscle and the patient will lie with the right hip flexed for pain relief. A number of clinical and laboratory based scoring systems have been devised to assist diagnosis of appendicitis. The most widely used is the Alvarado Score.

Normal Laboratory Values: General Blood Chemistry

2008-10-04T10:09:00.000+08:00

Albumin 3.5-5.0 g/100 mL
Aldolase 1.8-8.2 U/L
Alkaline phosphatase 13-39 U/L, infants and adolescents up to 104 U/L
Ammonia 12-55 µmol/L
Amylase 4-25 units/mL
Anion gap 8-16 mEq/L
AST, SGT Males: 8-46 U/L Females: 7-34 U/L
Bilirubin (Total) up to 1.0 mg/100 mL
Bilirubin (Direct) up to 0.4 mg/100 mL
BUN 8-25mg/100 mL Male: 0-14 pg/mL Female: 0-28 pg/mL
Calcitonin Male: 0-14 pg/mL Female: 0-28 pg/mL
Calcium (Ca+) 8.5-10.5 mg/100 mL
Carbon dioxide 24-30 mEq/L
Chloride (Cl-) 100-106 mEq/L
Cholesterol <200>
Cortisol A.M. 5-25 µg/100 mL P.M. <10>
Creatine Male: 0.2-0.5 mg/dL Female: 0.3-0.9 mg/dL
Creatine Kinase (CK) Male: 17-148 U/L Female: 10-79 U/L
Creatinine 0.5-1.5 mg/100 mL
Ferritin 10-410 ng/dL
Folate 2.0-9.0 ng/mL
Glucose 70-110 mg/100 mL
Ionized calcium 4.25-5.25 mg/dL
Iron (Fe) 50-150 µg/100 mL
Iron-bonding capacity (IBC) 250-410 µg/100 mL
Lactic acid 0.6-1.8 mEq/L
Lactic dehydrogenase (LDH) 45-90 U/L
Lipase 2 units/mL or less
Magnesium (Mg++) 1.5-2.0 mEq/L
Osmolality 280-296 msm/kg water
Phosphorous 3.0-4.5 mg/100 mL
Potassium (K+) 3.5-5.0 mEq/L
Prealbumin 18-32 mg/dL
Protein, total 6.0-8.4 g/100 mL
PSA 0.0-4.0 ng/mL
Pyruvate 0-0.11 mEq/L
Sodium (Na+) 135-145 mEq/L
T3 75-195 ng/100 mL
T4 (free) Male: 0.75-2.0 ng/dL Female: 0.75-2.0 ng/dL
T4 (total) 4-12 µg/100 mL
Thyroglobulin 3-42 µ/mL
Triglycerides 40-150 mg/100 mL
TSH 0.5-5.0 µU/mL
Urea Nitrogen 8-25 mg/100 mL
Uric Acid 3.0-7.0 mg/100 mL

Noninvasive Risk Stratification for Sudden Cardiac Death

2008-10-03T12:19:00.000+08:00

For now, LVEF is still the most useful basis for decisions about preventive intervention.

Sponsoring Organizations: American Heart Association, American College of Cardiology, Heart Rhythm Society

Background and Purpose: Accurate identification of individuals who are likely to die of cardiac arrhythmias would allow selective use of implantable cardioverter-defibrillators and other therapies to prevent sudden cardiac death (SCD). A vast amount of research energy has been spent in attempts to find noninvasive tests that can separate individuals into high-risk and low-risk groups. This scientific statement summarizes the findings of those studies.

Key Points:
1. Noninvasive tests evaluated to date measure:

Slowed conduction (QRS duration, signal-averaged electrocardiogram)
Variations in ventricular repolarization (QT interval, QT dispersion, T-wave alternans)
Disparities in autonomic tone (heart rate variability, heart rate turbulence, heart rate recovery
after exercise, baroreceptor sensitivity)
Degree of myocardial damage (LV ejection fraction, 6-minute walk)
Ventricular ectopy (long-term ambulatory monitoring)

2. In patients with ischemic or nonischemic cardiomyopathies, LVEF remains the best and possibly the only clinical test currently available to identify high-risk populations.

3. Patients with LVEF 35% are at the highest risk for SCD and, in the absence of comorbidities that severely shorten life expectancy, should undergo ICD implantation.

4. Most patients with LVEF 35% will not suffer SCD. However, at present, no noninvasive test has been proven to adequately identify low-risk patients with LVEF 35% who can be treated without an ICD.

5. Most SCDs occur in individuals with LVEF >35%. However, at present, no noninvasive test has been proven to adequately identify high-risk patients with a preserved LVEF who can be treated with an ICD.

6. In patients with hypertrophic cardiomyopathy, risk factors for SCD include history of resuscitated SCD or unexplained syncope, nonsustained ventricular tachycardia, hypotensive response to exercise, family history of SCD, and massively thick septum. None of the other noninvasive tests studied has been shown to add incremental value to these clinical features for risk stratification in these patients.

Comment:

Despite decades of sometimes quite promising research, LVEF measurement is the only clinically useful test to distinguish patients who need an ICD from those who do not. Although many of the other noninvasive tests studied show promise, at present none is sufficiently sensitive or specific to drive clinical decisions regarding ICD implantation. Such a tool would be most welcome, and we hope one or a combination of the tests described in this report will prove to be a more effective strategy in the coming years.

— Mark S. Link, MD

Images taken from:

http://www.ahealthyme.com/Imagebank/adam/1429.jpg

http://nurse-ratcheds.blogspot.com

Type 2 Diabetes Mellitus: An Evidence-Based Approach to Practical Management

2008-09-29T15:51:00.000+08:00

Type 2 Diabetes Mellitus: An Evidence-Based Approach to Practical Management (Contemporary Endocrinology)

by Mark N. Feinglos, Mary Angelyn Bethel

Publisher: Humana Press
Number Of Pages: 488
Publication Date: 2008-05-15
ISBN-10 / ASIN: 1588297942
ISBN-13 / EAN: 9781588297945
Binding: Hardcover

Product Description:

In this book, the authors of each chapter have synthesized the currently available evidence regarding specific issues in diabetes care. We begin with background information on the epidemiology and pathology of disease. Following are chapters addressing specific issues in the diagnosis and treatment of type 2 diabetes. Chapters integrating the best evidence for the evaluation and treatment of co-morbidities of diabetes, including hypertension, hyperlipidemia, and vascular disease collect a wealth of information in a single resource. Finally, we have highlighted related conditions, including fatty liver disease, pregnancy, and polycystic ovarian syndrome, and barriers to treatment, including stress, depression, and patient motivation.

The chapters in this book have been written by an interdisciplinary team of scientists and medical professionals. Such an approach emphasizes the need for collaboration in the care of any individual with diabetes and in the effort to find new therapies for the disease. We hope that this reference can provide practical guidance in a single resource for clinicians and scientist alike in our combined endeavor to provide the best care and new opportunities for the treatment of type 2 diabetes.

Download Instructions: Click the book title in the actual text. Follow download instructions. Download Zango to avail basic download privileges. Then off you go!

More Medical/Nursing E-Books by clicking here

Basic Home Remedies for Allergies

2008-09-29T15:40:00.001+08:00

Suffer from allergies? If yes, you may be looking for measures for relief. Although many individuals turn to over-the-counter allergy medications that are prescribed by doctors, others venture out to more affordable and natural ways of allergy relief. Before focusing on a few home remedies that are a nice and affordable way to seek relief, it is important to note that sometimes medical advise is essential. For example, if you suffer from food allergies, you may be unable to rely on a large number of natural, home remedies, as many involve the use of certain foods. Also, if you have severe symptoms, such as difficultly breathing, it is important that you do not mess around and seek medical attention immediately.

Vitamin B5 is recommended. It is known for providing relief to allergic people. Vitamin B5 supplements can be taken daily for around a month or two. There are others who recommend taking it on a daily basis for an amount of time, like until allergy symptoms are no longer an issue.

Lime is another natural and easy way to treat allergies from home. When using this natural remedy, squeeze the juice of one lime or a half of a lime into a lukewarm glass of water. If needed, you can sweeten this mixture with about a teaspoon of honey. You will want to drink this lime mixture daily for a few months. Many recommend doing so in the morning. What is nice about this natural remedy for allergies is that it can also help detoxify the body.

Bananas! One or two bananas should be eaten for at least one month on a daily basis. However, those who suffer from food allergies are advised to proceed with caution. In fact, bananas are not only the food that those suffering from food allergies should be cautious with. Those who have food allergies will want to avoid any natural remedies that contain foods that they may be allergic to. Bananas tend to help those who develop skin reactions from their allergies at the most.

Avoid caffeine drinks, such as coffee and soda, as well as alcohol. These items contain many additives. Additives make the body unnatural and impure. This is not what you want if you want to seek relief from your allergies.

ECG Interpretation: The Self-Assessment Approach

2008-09-26T12:24:00.000+08:00

ECG Interpretation: The Self-Assessment Approach
by Zainul Abedin, Robert Conner
Publisher: Wiley-Blackwell
Number Of Pages: 240
Publication Date: 2007-11-28
ISBN-10 / ASIN: 1405167491
ISBN-13 / EAN: 9781405167499
Binding: Paperback
Product Description:

Accurate interpretation of the ECG is an essential skill for all health professionals. Using a unique self-assessment format, this book presents a comprehensive, incremental approach to ECG interpretation, progressing from basic to advanced concepts in electrocardiography . Amply illustrated with electrocardiograms both in the main text and the self-assessments, ECG Interpretation is a must-have practical guide that features:

An appealing, user-friendly format that will help with exam preparation

Clearly defined learning objectives to guide readers efficiently through the intricacies of ECG interpretation

Numerous practical examples of ECG strips to illustrate important concepts, including clean ECG strips to practice skills

Multiple-choice questions to consolidate learning and emphasize pertinent facts

This second edition has been thoroughly revised from the original 12-lead ECG Interpretation: The Self-Assessment Approach, with fully updated text, additional electrocardiograms and new chapters covering a variety of arrhythmias and ion channelopathies.

Download Instructions: Click the book title in the actual text. Follow download instructions. Download Zango to avail basic download privileges. Then off you go!

More Medical/Nursing E-Books by clicking here

Diet’s Effect on Diabetes Risk: Is It the Fat? Or the Carbs?

2008-09-23T21:31:00.000+08:00

In older women, lowering fat intake alone did not affect diabetes risk; in black women, sugar-sweetened drinks were associated with excess diabetes risk.

In the quest for modifiable diabetes risk factors, dietary alteration is a prime target. But should we simply counsel overweight patients to lower their BMIs, or should we also target specific dietary components, such as fats or sugar-sweetened drinks? In two studies, investigators addressed these questions.

In the Women’s Health Initiative Dietary Modification Trial, 48,835 healthy postmenopausal women (age range, 50–79) were randomized to a usual-diet comparison group or to an individualized dietary intervention that specified 20% of energy from fat. The intervention group received self-monitoring instructions and group sessions; the comparison group was given reading material about dietary guidelines. Dietary intake was monitored with a standardized food frequency questionnaire (FFQ) at baseline and at regular intervals; incident cases of treated diabetes were self-reported. Complete data were available for 45,887 women (mean follow-up, 8 years). Diabetes incidence did not differ significantly between the intervention and comparison groups (1303 cases [7.1%] vs. 2039 cases [7.4%]). A trend toward lower diabetes incidence in the intervention group likely was attributable to weight loss rather than to the low-fat diet alone.

The authors of the Black Women’s Health Study investigated the relation of sugar-sweetened beverage consumption to self-reported incident diabetes among women in this ethnic group (who are twice as likely to develop diabetes as are white women). Almost 44,000 women were followed for 10 years and completed standardized FFQs at regular intervals. Participants (age range at baseline, 21–69) reported their intake of "regular" (non-diet) soft drinks, orange or grapefruit juice, and "other fruit juices, fortified fruit drinks, or Kool-Aid." Overall, 2713 women developed diabetes. In analyses adjusted for age, family history, and BMI, daily consumption of 2 soft drinks compared with <1>P=0.002). The highest level of sweetened fruit-drink intake, 2 drinks daily, also was associated with higher diabetes risk (IRR, 1.31; P=0.001) compared with <1>

Comment:

Although these studies both shed some light on the effects of fats and certain refined carbohydrates on the likelihood of developing diabetes in high-risk groups, they probably won’t alter our nutrition advice — most of which, an editorialist observes, is not evidence-based. Until we have more information, our best approach to diabetes prevention is to counsel overweight and obese patients about reducing total calorie intake and exercising more (or at all) and, when possible, to refer them to resources such as nutritionists, diabetes educators, the American Diabetes Association and the American Dietetic Association for additional support.

— Diane E. Judge, APN/CNP

Physical Assessment: Checking for Murphy's Sign

2008-09-22T15:16:00.001+08:00

It is useful in determining cholecystitis but will elicit a negative result in ascending cholangitis and choledocholithiasis. Ultrasound imaging will help in the diagnosis. The most common reason for a Murphy's sign is an inflamed gallbladder, usually due to a stone blocking the duct leading out of the gallbladder. Patients often complain of right-sided abdominal pain and may have vomiting and fever.

Cooking with Oils

2008-09-19T18:56:00.000+08:00

Cooking oil mushroomed nowadays in the grocery shelves claiming health benefits with lesser effects on cholesterol and fat build up. These are but a few that are recommended to moms and chefs who are health-conscious.

Canola oil is a popular oil, physicians claim that it has the ability to lower the risk of heart disease. It is low in saturated fat, high in monounsaturated fat, and offers the best fatty acid composition when compared to other oils. You can use canola oil in sauteéing, as a marinade and even in low temperature stir frying. It is the best oil for foods that contain a lot of spices. Unlike other oils, this one won't affect the taste of your meal since it is bland.
Olive oil offers a very distinct flavor with plenty of heart-healthy ingredients. The oil is rich in monounsaturated fat that helps lower cholesterol levels and reduce risk of cancer. It's also rich in antioxidants. Even though it can be used in cooking, it's the healthiest when uncooked, in salad dressings or sauce. When you use it with cooking, you should heat it on low to medium temperatures, making sure to avoid high heat. Aside from that, it has a very long storage life.
Butter is one food that has been around for many, many years. It tastes good, and provides sources of Vitamin A and other fat soluble vitamins such as E, K, and even D. Butter is also made from natural ingredients and not artificially and chemically processed. Other than cooking and baking, you can use it as a spread in bread.
Margarine was first introduced as an alternative to high fat butter. However, the early forms were loaded with trans fat, a substance raises bad cholesterol in the body. As a cooking oil, the new line of margarine tastes good, it's lower in fat than most oils and butter, and it's quite easy to spread. It's a good source of vitamin E.

There are more than what is mentioned above, which are among the most popular. Eating healthy involves cooking healthy food - which is where your cooking oil really takes do the biggest part of the act.

Duration of Anticoagulant Therapy for Unprovoked Venous Thrombosis

2008-09-18T21:40:00.000+08:00

Researchers identify a subgroup of women who might not need indefinite anticoagulation.

Risk for recurrent venous thrombosis (VT) varies: Patients with single major reversible VT risk factors (e.g., recent surgery) have risk for recurrent VT of 3%, whereas those with unprovoked VT have 10% risk for recurrence. In this multinational prospective study in 600 patients with first episodes of unprovoked VT or pulmonary embolism, researchers attempted to identify factors that predicted low recurrence risk. All patients had received 5 to 7 months of anticoagulation before enrollment. During a mean follow-up of 18 months, the annualized rate of recurrent VT was higher among men than women (13.7% vs. 8.9%). Men with post-thrombotic symptoms (leg hyperpigmentation, edema, or redness) had 24.0% annual risk for recurrence; no subgroup of men could be identified in whom risk for recurrence was while they received warfarin; body-mass index, 30 kg/m2; or age 65. Women with two or more factors had annual risk of 14.1%.

Comment:

The American College of Chest Physicians guideline suggests that patients with first unprovoked venous thromboses be considered for indefinite anticoagulation; however, the guideline recommends a minimum of 6 to 12 months of anticoagulation. In this study, researchers attempted to define a subgroup of patients for whom about 6 months of anticoagulation therapy after unprovoked venous thrombosis would be sufficient. No such group could be identified for men; however, women with [Photo]1 standard risk factor had low risk for recurrence. If the results of this study are replicated, shorter anticoagulation courses should be considered for such women.

— Jamaluddin Moloo, MD, MPH

Physical Assessment: Weber's Test

2008-09-18T12:31:00.002+08:00

A test that detects unilateral (one-sided) conductive and sensorineural hearing loss. A tuning fork (either 256 or 512 Hz) is struck and the stem of the tuning fork is placed at the vertex of the client's head making sure not to touch the tines. The placement should have an equal distance between the fork and the ears. The test does not measure normal hearing since it is not directed to sound sensitivity in a quantitative manner. An affected ear will hear the loudest sound compared to the other. Additional test should be done before confirming a defect.

Malabar Nightshade

2008-09-17T11:55:00.000+08:00

The Malabar Nightshade (Cebuano: Alugbati, Tagalog: Libato) is a soft-stemmed vine found in the tropics. It has a semi-succulent, heart-shaped green or purple leaves that has a mild flavor and thick texture. The flowers are pink that later on turns purple when matured. The stem can be either purplish or greenish. The plant is a rich source of chlorophyll for food coloring. Typical of green leafy vegetables, it is high in vitamin A, vitamin C, iron and calcium. It is low in calories by volume, and high in protein per calorie. The succulent mucilage, found in the leaves and stem is a rich source of fiber thus it is also a mild laxative for pregnant women and children. Roots are employed as rubefacient (external application that causes vasodilation) while the poultice and sap of the leaves is used to reduce local swelling like acne eruptions. Pulped leaves applied to boils and ulcers hastens suppuration. Sugared juice of leaves is useful for catarrhal afflictions.

Visayan Chop Suey:

1 Chicken Broth Cube dissolved in
1 cup coconut milk (second extraction)
2 cups squash cut into cubes
2 cups patola (sponge gourd) sliced
1 small bundle kangkong pluck leaves & slice upper tender stems
4 pcs. okra sliced 1 in. long
1 small bundle alugbati leaves
4 medium tomatoes
1/4 cup coconut cream (kakang gata)
salt and pepper to taste

Instructions:

Bring to boil first 2 ingredients; add squash, patola and kangkong stalks; simmer about 5 min.
Add in the rest of the vegetables. Simmer about 3 min. before adding coconut cream. Adjust seasonings to taste.

Physical Assessment: Rinné Test

2008-09-14T21:49:00.001+08:00

Rinné Test is a hearing test that evaluates the client's capacity to hear through air conduction and bone conduction by placing a vibrating tuning fork (512 or 256 Hz) initially on the mastoid process until sound is no longer heard, the fork is then immediately placed just outside the ear. The client should be able to hear in both tuning fork positions. In a normal ear, air conduction is better than bone conduction. Conductive hearing loss, bone conduction is greater than air conduction while sensorineural hearing loss both air and bone conduction are depreciated.

Obesity and Chronic Kidney Disease

2008-09-12T15:56:00.000+08:00

The association between obesity and chronic kidney disease seems to be mediated by hypertension and diabetes in many — but not all — cases.

Several years ago, U.S. researchers published a biopsy-based case series that involved 71 patients with obesity-related glomerulopathy (ORG), which is characterized by glomerular enlargement, frequent (but not universal) presence of focal segmental sclerosis, and substantial proteinuria. An increasingly recognized association between obesity and kidney disease is the subject of three new reports. A case series from China involved 90 obese patients who had renal biopsy findings consistent with ORG; no patients had diabetic or hypertensive nephropathy. Mean 24-hour urine protein excretion was 1.5 g. Mean serum creatinine level was 0.9 mg/dL, and about half the patients had elevated creatinine clearance, suggesting that hyperfiltration is an early finding in ORG patients. Framingham Heart Study researchers followed 2676 adults (baseline obesity prevalence, 12%). During an average follow-up of 19 years, obesity at baseline was associated significantly with subsequent development of stage 3 chronic kidney disease (odds ratio, 1.7). However, after adjustment for diabetes and hypertension, the association became statistically insignificant (OR, 1.1).

In another study, researchers analyzed data from two other large U.S. epidemiologic studies in which more than 13,000 adults were followed for an average of 9 years. In multivariable analyses, waist-to-hip ratio, but not body-mass index, was associated with development of chronic kidney disease. This association was somewhat attenuated, but remained significant, after adjustment for diabetes and hypertension.

Comment:

Taken together, these studies suggest that the association between obesity and kidney disease is complex. In most cases, the association likely is mediated by coexisting diabetes and hypertension. But in others, obesity could cause glomerular injury directly by mechanisms that are not fully understood. Because waist-to-hip ratio — an indicator of visceral obesity — was a better predictor than BMI, metabolic abnormalities particularly associated with visceral obesity presumably predispose to chronic kidney disease.

-Allan S. Brett, MD

Emergency Drugs

2008-09-11T18:23:00.000+08:00

These are the drugs you usually see in an emergency cart. During an acute attack of a patient of whatever reasons, this is one of the equipment they pull with them together with resuscitation equipment. It contains drugs that are given to a patient during an attack. Before administration of the drug, the nurse must be aware of the mechanism of action, (MOA), indication (IN) and nursing consideration (NC) thus reducing the risk of mortality and untoward complications. The nurse should be alert in every crisis and should pay attention to what the physician orders when the going gets tough.

Adenosine : Antidysrhythmic MOA: Slows conduction through AV node, can interrupt reentry pathways through AV node and can restore normal sinus rhythm in patients with supraventricular tachycardia IN: SVT, as a diagnostic aid to assess myocardial perfusion defects in coronary artery disorders NC: I&O ratio, Electrolytes (K, Na, Cl), B/P, RR, PR, ECG intervals, check for transient dysrhythmias (PVCs, PACs, sinus tachycardia, AV Block)
Amidarone (Calcium Chloride) : Antidysrhythmic MOA: Increase cardiac contractile state IN: Acute hyperkalemia, Hypocalcemia, Calcium Channel Blocker adverse effects NC: ECG for decreased QT and T wave inversion, Calcium levels (Normal=8.5-11.5 g /dl), Cardiac status: PR, Rhythm, CVP (PWP, PAWP if being monitored)
Atropine : Antidysrhytmnic, Anticholinergic, Parasympatholytic, Antimuscarinic MOA: Blocks acetylcholine neuroeffector sites; increase cardiac output, heart rate by blocking vagal stimulation in heart; dries secretions by blocking vagus IN: Bradycardia, bradydysrhythmia, reversal of anticholinesterase agents, insecticide poisoning, blocking cardiac vagal reflexes, decreasing secretions before surgery, antispasmodic with gastric ulcer, biliary surgery, bronchodilator NC: I&O, check for urinary retention, daily output, ECG, bowel sounds, respiratory status, increased ocular pressure, cardiac rate
Epinephrine : Bronchodilator, Non-selective adrenergic agonist vasopressor MOA: Beta 1 and Beta 2 agonist causing increased levels of cyclic adenosine monophosphate producing bronchodilation, cardiac, and CNS stimulation; large doses cause vasoconstriction via alpha-receptors; small doses can cause vasodilation via beta 2 vascular receptors IN: Acute asthmatic attacks, hemostasis, bronchospasm, anaphylaxis, allergic reactions, cardiac arrest, adjunct in anesthesia, shock NC: ECG during administration continuously; if B/P increases, drug is decreased; B/P and PR checked every 5 mins. after parental route; if possible CVP, ISVR, PCWP during infusion, inadvertent high arterial B/P can result to angina, aortic rupture, cerebral hemorrhage, injection site should be checked for tissue sloughing (give phentolamine with NS)
Lasix : Loop diuretic MOA: Inhibits reabsorption of sodium and chloride at proximal and distal tubule and in the Loop of Henle IN: Pulmonary edema, edema in CHF, hepatic disease, nephrotic syndrome, ascites, hypertension NC: Signs of metablic alkalosis: drowsiness, restlessness Signs of hypokalemia: postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness I&O to determine fluid loss, B/P lying and standing, skin integrity, turgor, edema, check mucous membranes of mouth and nose, allergies to drug
Lidocaine : Antidysrhythmic MOA: Increases electrical stimulation threshold of ventricle, His-Purkinje system which stabilizes cardiac membrane, decreases automaticity IN: Ventricular tachycardia, ventricular dysrhythmias during cardiac surgery, myocardial infarction, digitalis toxicity, cardiac catheterization NC: ECG and determine increased PR or QRS segments, B/P, infusion pump must run at less than 4 mg/min., therapeutic level (normal=1.5-5 mcg/mL), I&O, respiratory status must be checked, check for malignant hyperthermia and CNS effects.
Magnesium Sulfate : Electrolyte, anticonvulsant, saline laxative, antacid MOA: Increases osmotic pressure, draws fluid into colon, neutralizes HCl IN: Constipation, bowel preparation before surgery or exam, anticonvulsant in preeclampsia, eclampsia, electrolyte imbalance NC: I&O Magnessium toxicity: thirst, confusion, decrease in reflexes
Morphine : Opioid analgesic MOA: Decreases pain impulse transmission at the spinal cord level by interacting with opioid receptors IN: Severe pain NC: Pain level and location, bowel status, I&O, cardiopulmonary status, CNS changes: dizziness, drowsiness, hallucination, euphria, level of consciousness, pupil reaction, allergies to drug
Naloxone : Opioid antagonist, antidote MOA: Competes with opioids at opiate receptor sites IN: Respiratory depression induced by opioids, pentazocine, propoxyphene, refractory circulatory shock, asphyxia neonatorum NC: Withdrawal symptms: cramping, hypertension, anxiety, vomiting V/S every 3-5 mins. ABGs, cardiopulmonary status, pain level
Nitroglycerine : Coronary vasodilator, antianginal MOA: Decreases preload, afterload, which is responsible for decreasing left ventricular end-diastolic pressure, systemic vascular resistance; dilates coronary arteries, improves blood flow through coronary vasculature, dilates arterial, venous beds systemically IN: Chronic stable angina pectoris, prophylaxis of angina pain, CHF associated with acute MI, controlled hypotension in surgical procedures NC: Orthostatic B/P, PR, pain: duration, level, time started, activity performed, character, headache, light-headedness, decreased B/P may indicate a need to decrease dosage
Vasopressin : Pituitary hormone MOA: Promotes reabsorption of water by action on renal tubular epithelium; causes vasoconstriction IN: Diabetes insipidus (nonephrogenic/nonpsychogenic) abdominal distention postoperatively, bleeding esophageal varices NC: PR, B/P when given IV r IM for irritation, I&O, daily weights, check for edema, water intoxication: lethargy, behavioral changes, disorientation, neuromascular excitability

Eating Healthy For College Students

2008-09-08T16:52:00.000+08:00

For students, eating at college is an entire new ball game, with late night pizza delivery and food from buggies (food carts). Even though some of these quick and simple options taste great, they are probably not healthy for a student's body. The food choices students make can affect whether or not they are able to remain awake during class and whether or not they will come down with mononucleosis when it hits campus. The problem is not only about eating junk food, it's more about not getting the proper proteins, carbs, vitamins, and minerals that people need. A well balance diet is still essential among students.
When it comes to defending against illnesses, vitamins and minerals are very important for the immune system to fight pathogens from the environment. Aside from that nutrients build and repair cells. Just because they are important, isn't a reason for students to run out and stock up on vitamins and supplements. It's best for students to get their nutrition from food. Natural sources of these vitamins are readily available for the body compared to the ones that were synthesized. You can find vitamin C in citric fruits like oranges and pineapples, Vitamin A in milk and diary products, and vitamin E in nuts, whole wheat products, and even green leafy vegetables. This is the ideal way to get nutrition, as your body relies on these vitamins for many reasons. When you eat on campus, skip on the soda's and go right to the juice machines. Soda is potentially dangerous among students for they drink a lot of diet soda which has adverse affects to its weight loss claims. Eat fresh vegetables in the form of green leafy salad. You can also try putting some broccoli and cauliflower in the microwave for steamed vegetables. Always remember that eating healthy isn't just about avoiding greasy foods. Eating healthy involves getting a balanced diet and getting the right nutrients and vitamins to keep your body in peak performance - or at least awake during your classes.

Paying for Performance Can Improve Quality of Care

2008-09-08T16:33:00.000+08:00

Financial incentives can improve care but can also have unintended consequences.

Aligning financial incentives with good clinical practice hasthe potential to improve quality of care. Researchers systematicallyreviewed the literature to find controlled studies that assessedthe effect of explicit financial incentives on quantitativemeasures of health care quality.
Of nine studies of provider-group incentives, two found smallimprovements in quality measures and five found partial effects(e.g., an improvement in cervical cancer screening, but notin mammography). One study of a payment-system incentive foundan increase in nursing home admissions for patients who neededthat level of care (the intended effect). However, in that studyand one other study of a payment-system incentive, there wereunintended negative effects of incentives, such as avoidanceof severely ill patients, or a tendency to claim that patientswere severely ill and then to report short recovery periods.In six studies of physician-level incentives, five found positiveor partial effects. But in two studies (one of a physician incentiveto provide vaccinations and one of a provider-group incentiveto provide smoking cessation advice), there were improvementsin documentation but not in actual provision of these services.

Comment:

Because of the small number and limited scope of thestudies identified, the authors suggest that generalize abilityof the findings is limited. Nonetheless, financial incentivesapparently can have positive effects on quality of care. Butcarefully designed incentives and further study are clearlyneeded to achieve these improvements while avoiding unintendednegative effects.

-Richard Saitz, MD, MPH, FACP, FASAM

Physical Assessment: Tinel's Test

2008-09-08T16:06:00.001+08:00

In relation to carpal tunnel syndrome earlier in my posting, Tinel's is performed by lightly tapping (percussing for those who don't know what "tapping" means) the area over the nerve to elicit a sensation of tingling or "pins and needles" in the nerve distribution.If the patient experienced these symptoms, he/she has elicited a positive (+) Tinel's Sign.

Healthy Eating Tips for the -ber Holidays

2008-09-06T10:52:00.000+08:00

ASEAN countries have numerous holidays in the months ending with -ber like September especially in the Philippines. Last Aug. 27, we celebrated Fiesta de San Agustin and just like fiestas in Christian countries food is always part of the celebration. People are eating voraciously during these times and often forget about their restricted diet. Weight gains of 7 -10 pounds are common between Halloween and Christmas according to an article I've read from the internet. How much more in fiestas where the lechon is never absent in the banquet. To control the growing flabs, these tips will help you with healthy eating through the season and not gaining weight.

Most traditional foods can be made low fat. Chicken (lechon manok) and turkey is very lean without the skin, and gravy can be made without any fat. The beloved pies are nutritious, although it can be made into a fatty dessert with the adding of whipped cream. Eat less cakes or anything with fatty dairy. A scoop of ice cream will do.

Never forget to move an inch by doing some exercise or activity. Keeping weight off during the holiday season is burning off the extra calories. Plan a walk after meals, park farther from stores when you shop, and take a few walks around the mall before you begin shopping.

During holiday parties and at family dinners, feel free to sample foods although you shouldn't advance, then stick to your plan. Eat plenty of vegetables, fruit, low fat dressings, and slices of lean meats. Before you go to a party, eat a small snack before the actual banquet attack to help curb your appetite.

If at all possible, avoid alcohol. Having too many drinks can cripple your discerning power, and also add excess calories to your diet. Aside from that, it overloads your kidney and liver function.Instead, drink water with lemon or iced tea. Water can help limit your appetite and keep you from binging. Just don't drown yourself with it.

Be flexible with your healthy eating, as one bad meal won't ruin your diet. Try to balance your one meal or day.

FYI: The Philippines is known to have the longest Christmas celebration in the world starting from the month of September to January or until the celebration of the traditional Feast of the Three Kings. Aside from Christmas fiestas are celebrated whole year round.

Preventing Carpal Tunnel Syndrome

2008-09-06T00:28:00.000+08:00

I.T. professionals are at risk of contacting carpal tunnel syndrome from repetitive hand strokes from hitting the keys. It is one of the most notorious occupational disorder of most workers of different fields according to occupational safety and health research centers. Carpal tunnel syndrome (CTS) affects the hand, wrist and arm. It is characterized with intermittent numbing, tingling sensation in the hands, arms and sometimes the forearm and the shoulder. Carpal tunnel is a space formed by the bones and ligaments of the wrist. The median nerve runs in this space and is compressed at the wrist leading to CTS. I'm going to describe 3 types of carpal tunnel syndrome (CTS).

Work-related CTS are common among people who work with repetitive hand or arm strokes like those working with vibrating machines (e.g. jackhammer), carpentry, computers and mechanics. Any activity with repetitive grasping and manipulation can lead to CTS.
Trauma-related CTS is secondary to fractures of the arm bone, dislocation of the wrist bones, strong trauma to the hands regardless of mechanism of injury, pressure of the median nerve from a tumor growth or hematoma and also deformities from abnormal healing of old bone fractures.
Systemic disease-related CTS may be due to hypothyroidism and osteoarthritis. Osteoarthritis can lead to structural deformities of the wrist joint leading to median nerve compression. Hypothyroidism can lead to obesity and gradually to arthritis which then contributes to the nerve compression. Diabetes is often linked with CTS due to peripheral neuropathy that has a similar symptoms with CTS.

Aside from the Phalen's Test that I posted earlier, we have the Tinel's Test and Durkan's Test. Tinel's is performed by lightly tapping the area over the nerve to elicit a 'pins and needles' sensation in the area of the nerve's control or distribution. Durkan's or the carpal compression test is done by applying a firm pressure on the palm over the nerve area for 30 seconds to elicit the symptoms. More test should be considered before CTS is confirmed since corrective surgery of the wrist with a misdiagnosis of CTS will likely fail. Prevention should be directed to a modification on occupational modalities that can lessen the likelihood of having CTS like applying ergonomic work tools and lifestyle adjustment. For people who work with keys or keyboards hit them lightly and take at least a 15-20 minute hand break which includes gentle stretching and bending exercises of the wrist, hands and fingers. Avoid too much bending of the wrist and taking breaks reduces the risk of CTS. Warm compresses will improve blood flow and alleviates discomfort and nerve compression from repetitive strokes. Paraffin wax for the hands has benefits over CTS just ensure safety by testing the temperature to prevent burns. A basin of warm water will do. While soaking the hands do open and close exercise. Protect hands from too much cold. Repetitive exposure to cold contributes to vasoconstriction thus limiting blood flow delaying the distribution of the essential nutrients for the nerve. Vitamin B from whole grains, beans and peas, protein-rich foods and green leafy vegetables will help maintain nerve function and prevent degeneration of it.

Physical Assessment: Phalen's Test

2008-09-04T17:46:00.001+08:00

Phalen's Test* is a diagnostic test for carpal tunnel syndrome. The patient is asked to hold their wrist in complete and forced flexion (pushing the dorsal surface against the other) for 30 seconds. With the moderate pressure from it, it pinches the median nerve within the carpal tunnel. A positive Phalen's Test is characterized with symptoms of burning, tingling or numb sensation over the thumb, index, middle and ring fingers. Diagnostic accuracy will range from 51%-91%.

*American orthopedist George S. Phalen discovered carpal tunnel syndrome

Does Flu Vaccination Lower Risk for Pneumonia in Elders?

2008-09-03T02:07:00.000+08:00

In contrast to results of previous studies, flu vaccine did not lower risk in this study. Previous observational studies have shown that influenza vaccination lowers risk for pneumonia in older patients.

In a population-based case-control study, conducted during the preinfluenza and influenza seasons of 2000, 2001, and 2002, Seattle investigators studied managed-care records for 1173 older patients (age range, 65–94) with community-acquired pneumonia (CAP) and for 2346 age- and sex-matched controls without CAP. Both groups were equally likely to have been vaccinated (roughly 60% before the CAP index date and 77% by the end of each influenza season). In unadjusted analyses, vaccinated patients had a 40% lower risk for CAP than unvaccinated patients in the preinfluenza period — when no biologically plausible explanation exists for vaccine benefit — but the difference disappeared when analyses were adjusted for a wide range of chronic diseases and functional impairment. No difference in risk for CAP was observed between vaccinated and unvaccinated groups during the influenza season, whether analyses were adjusted or not, and no difference was observed in risk for CAP that required hospital admission during peak influenza season.

Comment:

According to this provocative study, influenza vaccination offered no benefit in broad measures of risk for community-acquired pneumonia. Editorialists noted that this study has several strengths that have been missing in many other studies: It was conducted during seasons when the antigenic match between influenza strains and vaccine was good; CAP was ascertained with chart audit rather than by evaluating administrative data; the analysis was controlled for a wide range of chronic disease and functional status measures; and both inpatient and outpatient cases were identified.

-Thomas Schwenk, M.D.

Moringa oleifera

2008-09-02T22:50:00.000+08:00

We call that 'Kamunggay' for the Cebuanoes and 'Malunggay' by the Tagalogs. There is a misnomer here it is not horse raddish but it is moringa. One of the most nutritious 'vegetable tree' in the tropics. We usually take this tree for granted, little did we know about the nutritional benefits we get from this tree. The Bureau of Plant Industry, in its report, stated that, weight per weight, moringa leaves have the calcium equivalent of 4 glasses of milk, the vitamin C content of 7 oranges, potassium of 3 bananas, 3 times the iron of spinach, 4 times the amount of vitamin A in carrots, and 2 times the protein in milk. Other than its nutritional value it is also used as an antiseptic for minor wounds. Moringa seeds contain a cationic polyelectrolyte that has proved efficient in water treatment, as a substitute to aluminum sulphate and other flocculent. There is a dual advantage to this property. It will serve as a source of income for potential consumers of its water treatment properties and it is biodegradable which does not result to potential risk to the environment. Oil from the seeds is an excellent edible vegetable oil and as a component for making cosmetics. It was believed that moringa can reduce malnutrition in Africa headed by U.S. National Council of Churches. Moringa is considered as a basic ingredient in making Tinola.

Fish Tinola:

1 lb. fresh fish, cut into small pieces
5 cups water
crushed ginger (as desired)
2 tomatoes sliced wedge
3 green peppers
3 green onions
1 tsp. salt
1 tsp. pepper
1-2 cups of moringa leaves (picked from the stalks)

Instructions:

Boil water, then add fish
Add tomatoes and ginger. Boil for 10 minutes.
Add remaining ingredients. Add moringa leaves last then cook for 5 minutes.

Physical Assessment: Allen's Test

2008-09-02T22:23:00.001+08:00

Allen's Test is to check for the patency of the radial and ulnar artery. The hand is normally supplied by blood from the ulnar and radial arteries. The arteries undergo anastomosis in the hand. Thus, if the blood supply from one of the arteries is cut off, the other artery can supply adequate blood to the hand. A minority of people lack this dual blood supply. The significance of the test is questioned by medical scientist and recommends a modification of the test since fluorescein dye injections or photoplethysmography are a much reliable test. This test is an preoperative assessment of hand circulation and a routine to test for systemic sclerosis and severe Raynaud's Phenomenon.

Physical Assessment: Visual Fields

2008-09-01T17:19:00.001+08:00

I got this clipping from one of my clinical instructors back in college. I just don't have the idea who made this video. So if you think there were rights violated with this posting please leave a message in the message box or post a comment so I can delete it from my blog. I hope this will help a lot. :D

Sweeteners & Diet Soda Kills

2008-08-30T22:13:00.000+08:00

My mom received this e-mail from a relative in the U.S. and we were amazed by a story of a woman who suffered idiopathic (unknown cause) Multiple Sclerosis-like symptoms. This information will surely change your beverage choice this time and shift to a more natural healthy way to quench your thirst.

In October of 2001, my sister started getting very sick. She had stomach spasms and she was having a hard time getting around. Walking was a major chore. It took everything she had just to get out of bed; she was in so much pain.

By March 2002, she had undergone several tissue and muscle biopsies and was on 24 various prescription medications. The doctors could not determine what was wrong with her. She was in so much pain, and so sick. She just knew she was dying. She put her house, bank account s, life insurance, etc., in her oldest daughter's name, and made sure that her younger children were to be taken care of. She also wanted her last hooray, so she planned a trip to Florida (basically in a wheelchair) for March 22nd.

On March 19 I called her to ask how her most recent tests went, and she said they didn't find anything on the test, but they believed she had MS.

I recalled an article a friend of mine e-mailed to me and I asked my sister if she drank diet soda? She told me that she did. As a matter of fact, she was getting ready to crack one open that moment.

I told her not to open it, and to stop drinking the diet soda! I e-mailed her the article my friend, a lawyer, had sent.

My sister called me within 32 hours after our phone conversation and told me she had stopped drinking the diet soda AND she could walk! The muscle spasms went away. She said she didn't feel 100% but she sure felt a lot better. She told me she was going to her doctor with this article and would call me when she got home.

Well, she called me, and said her doctor was amazed! He is going to call all of his MS patients to find out if they consumed artificial sweeteners of any kind.

In a nutshell, she was being poisoned by the Aspartame in t he diet soda...and literally dying a slow and miserable death.

When she got to Florida March 22, all she had to take was one pill, and that was a pill for the Aspartame poisoning! She is well on her way to a complete recovery.

And she is walking! No wheelchair! This article saved her life.

If it says 'SUGAR FREE' on the label; DO NOT EVEN THINK ABOUT IT!

I have spent several days lecturing at the WORLD ENVIRONMENTAL CONFERENCE on "ASPARTAME ," marketed as 'NutraSweet,' 'Equal,' and 'Spoonful.'

In the keynote address by the EPA, it was announced that in the United States in 2001 there is an epidemic of multiple sclerosis and systemic lupus. It was difficult to determine exactly what toxin was causing this to be rampant.

I stood up and said that I was there to lecture on exactly that subject.

I will explain why Aspartame is so dangerous: When the temperature of this sweetener exceeds 86 degrees F, the wood alcohol in ASPARTAME converts to formaldehyde and then to formic acid, which in turn causes metabolic acidosis. Formic acid is the poison found in the sting of fire ants. The methanol toxicity mimics, among other conditions, multiple sclerosis and systemic lupus. Many people were being diagnosed in error. Although multiple sclerosis is not a death sentence, Methanol toxicity is!

Systemic lupus has become almost as rampant as multiple sclerosis, especially with Diet Coke and Diet Pepsi drinkers. The victim usually does not know that the Aspartame is the culprit. He or she continues its use; irritating the lupus to such a d egree that it may become a life-threatening condition.

We have seen patients with systemic lupus become asymptotic, once taken off diet sodas.

In cases of those diagnosed with Multiple Sclerosis, most of the symptoms disappear. We've seen many cases where vision loss returned and hearing loss improved markedly. This also applies to cases of tinnitus and fibromyalgia.

During a lecture, I said, "If you are using ASPARTAME (NutraSweet, Equal, Spoonful, etc) and you suffer from fibromyalgia symptoms, spasms, shooting, pains, numbness in your legs, cramps, vertigo, dizziness, headaches, tinnitus, joint p ain, unexplainable depression, anxiety attacks, slurred speech, blurred vision, or memory loss you probably have ASPARTAME poisoning!"

People were jumping up during the lecture saying, "I have some of these symptoms. Is it reversible?"

Yes! Yes! Yes! STOP drinking diet sodas and be alert for Aspartame on food labels! Many products are fortified with it! This is a serious problem.

Dr. Espart (one of my speakers) remarked that so many people seem to be symptomatic for MS and during his recent visit to a hospice, a nurse stated that six of her friends, who were heavy Diet Coke addicts, had all been diagnosed with MS. This is beyond coincidence!

Diet soda is NOT a diet product! It is a chemically altered, multiple SODIUM (salt) and ASPARTAME containing product that actually makes you crave carbohydrates. It is far more likely to make you GAIN weight!

These products also contain formaldehyde, which stores in the fat cells, particularly in the hips and thighs. Formaldehyde is an absolute toxin and is used primarily to preserve "tissue specimens." Many products we use every day contain this chemical but we SHOULD NOT store it IN our body!

Dr. H. J. Roberts stated in his lectures that once free of the "diet products" and with no significant increase in exercise; his patients lost an average of 19 pounds over a trial period.

Aspartame is especially dangerous for diabetics.

We found that some physicians, who believed that they had a patient with retinopathy, in fact, had symptoms caused by Aspartame.

The Aspartame drives the blood sugar out of control. Thus diabetics may suffer acute memory loss due to the fact that aspartic acid and phenylalanine are NEUROTOXIC when taken without the other amino acids necessary for a good balance.

Treating diabetes is all about BALANCE. Especially with diabetics, the Aspartame passes the blood/brain barrier and it then deteriorates the neurons of the brain; causing various levels of brain damage, seizures, depression, manic depression, panic attacks, uncontrollable anger and rage.

Consumption of Aspartame causes these same symptoms in non-diabetics as well.

Documentation and observation also reveal that thousands of children diagnosed with ADD and ADHD have had complete turnarounds in their behavior when these chemicals have been removed from their diet. So called "behavior modification prescription drugs" ( Ritalin and others) are no longer needed. Truth be told, they were never NEEDED in the first place! Most of these children were being "poisoned" on a daily basis with the very foods that were "better for them than sugar."

It is also suspected that the Aspartame in thousands of pallets of diet Coke and diet Pepsi consumed by men and women fighting in the Gulf War, may be partially to blame for the well-known Gulf War Syndrome.

Dr. Roberts warns that it can cause birth defects, i.e. mental retardation, if taken at the time of conception and during early pregnancy.

Children are especially at risk for neurological disorders and should NEVER be given artificial sweeteners. There are many different case histories to rela te of children suffering grand mal seizures and other neurological disturbances talking about a plague of neurological diseases directly caused by the use of this deadly poison."

Herein lies the problem:
There were Congressional Hearings when Aspartame was included 100 different products and strong objection was made concerning its use. Since this initial hearing, there have been two subsequent hearings, and still nothing has been done. The drug and chemical lobbies have very deep pockets.

Sadly, MONSANTO'S pat ent on Aspartame has EXPIRED!

There are now over 5,000 products on the market that contain this deadly chemical and there will be thousands more introduced. Everybody wants a "piece of the Aspartame pie." I assure you that MONSANTO, the creator of Aspartame, knows how deadl y it is.

And isn't it ironic that MONSANTO funds, among others, the American Diabetes Association, the American Dietetic Association and the Conference of the American College of Physicians?

This has been recently exposed in the New York Times.

These [organizations] cannot criticize any additives or convey their link to MONSANTO because they take money from the food industry and are required to endorse their products.

Senator Howard Metzenbaum wrote and presented a bill that would require label warnings on products containing Aspartame, especially regarding pregnant women, children and infants. The bill would also institute independent studies on the known dangers and the problems existing in the general population regarding seizures, changes in brain chemistry, neurological changes and behavioral symptoms.

The bill was killed.

It is known that the powerful drug and chemical lobbies are responsible for this, letting loosee the hounds of disease and death on an unsuspecting and uninformed public. Well, you're Informed now! YOU HAVE A RIGHT TO KNOW!

Please print this out and/or e-mail to your family and friends.

They have a right to know too.

Diane McCallister
Plan Administrator
MidAmerica Administrative & Retirement Solutions, Inc.
211 E. Main St., Ste. 100
Lakeland, FL 33801
(800) 430 - 7999, ext. 137
(863) 688 - 4200 fax
www.midamerica.biz

Enhance Sexual Prowess With Caution

2008-08-29T16:53:00.000+08:00

Everyday new drugs emerge in the market to treat disease and to improve health. Yet before they are even approved they will undergo a series of test to determine its effectiveness and safety for human use. Recently, a number of new drugs were recalled from their distribution. These includes herbal medicines and of course, sex enhancers that were not tested for human consumption and have been reported to have negative effects to the body. These drugs were mistakenly regarded as safe since small scale drug store sell them unchallenged and even without a prescription from an expert. With the distorting effects on sex by mass media to the young people, they are potential victims of these drugs. Harmful minute ingredients like lead may lead to harmful effects to the body that range from nausea to mental retardation and cardiac/renal affectation. These are some aphrodisiacs from plant and animal source that were believed to enhance sexual prowess: Caution: Not all natural are safe for the human body.

Onions
Ginseng
Kelp
Ginkgo Biloba
Strawberries
Artichokes
Oysters
Mussels
Tomatoes

Aphrodisiac Drugs:

Testosterone
Dopaminergic System Stimulants (e.g. MDPV)
Phenylethylamine (present in chocolate)
Bremelatonide

However, from a historical and scientific standpoint, the alleged results on the use of aphrodisiacs may have been mainly due to mere belief by their users that they would be effective like the placebo effect, a substance or procedure a patient accepts as medicine or therapy, but which has no specific therapeutic activity. Any therapeutic effect is thought to be based on the power of suggestion.

The Other Kiwi

2008-08-28T11:25:00.000+08:00

Every other month, Mom visits my Dad in Davao that's in the south. Dad works in a logistics company and one of their clients is Zespri of New Zealand, an exporter of kiwi to different parts of the world. Since we've first encountered the fruit, we were skeptical what it taste like or how it is eaten. We thought it's the puny flightless bird. The first one was not good at all. The next was splendid. I've realized, out from my ignorance, that there are two types of kiwi, the golden and green variety. The first kiwi I ate was the golden variety and it has this over-ripe taste that made me promise to give them away. The green ones were great. It taste like mango and pineapple. The seeds leave an after taste that makes it even more tasty and luscious. My friends even wanted more! Some of them went to the supermarket and looked for them. They have found a few but unfortunately it costs 30-45 bucks per fruit. I just told them to wait whenever Mom's back from Davao.

Vitamin C...

It has more vitamin C than the orange.

Lutein . . .

This phytochemical is receiving a great deal of recent attention for its effectiveness in reducing the risk of cancer, heart disease, and may help prevent cataracts and macular degeneration - a leading cause of blindness. This carotenoid functions as an antioxidant, and next to yellow corn, a single serving of kiwifruit (2 medium kiwifruit) is the richest source of lutein in the vegetable world

Fiber . . .

Soluble fiber protects against heart disease and diabetes, while insoluble fiber reduces the risk of some cancers, constipation, and diverticulitis. A single serving of kiwifruit contains both types of fiber!

Copper for Kids . . .

California Kiwifruit is high in Copper, vital for infant growth, bone strength, brain development, and building immunity. Copper is a mineral involved in making red blood cells and developing a strong immune system.

More Potassium than Bananas . . .

Potassium from fruits and vegetables helps the heart work more efficiently, and is significantly in controlling blood pressure - the "silent killer". Potassium controls heart activity and maintains fluid balance. A single serving of kiwifruit outranks bananas as the top low-sodium, high-potassium fruit

Not to Mention . . .

Folate, Magnesium, and Vitamin E are all well represented in kiwifruit, offering health benefits that range from bone formation to reduced risks of heart disease. Plus kiwifruit contains no saturated fat or cholesterol.
A single serving containing Folate, helps protect against congenital defects, cancer and heart disease, and helps prevent 70% of neural tube diseases in babies each year. A perfect recommendation to women of reproductive age.

Magnesium found in a serving of kiwifruit is a vital mineral, whose intake often falls short in the American diet, but is important for bone formation, heart rhythm regulation, muscle relaxation and nerve function.

The Vitamin E found in a serving of kiwifruit may reduce the risk of heart disease, cancer and exercise-induced oxidative damage. Unlike most sources of Vitamin E, kiwifruit is a low-fat food source of vitamin E (typically found in high-fat foods like oils and nuts).

Post Natal Circulation

2008-08-28T11:22:00.000+08:00

Like what I've promised in my earlier posting, here is the process of post natal circulation. After obstetrical clamping and cutting of the umbilical cord, circulatory system changes occur within the first 15 hours of life. This is the part where the primitive fetal circulatory system assumes the mature circulatory system with significant emergence of the mature right side and left side heart. The right side heart pumps in deoxygenated blood from the systemic circulation to the lungs and the left side heart pumps oxygenated blood to the system. For an interactive discussion click here.

Fetal Circulation

2008-08-28T11:12:00.001+08:00

During my nursing days, I used to disregard the concepts of the fetal intrauterine life especially fetal circulation. I've learned these concepts before taking the local board exams and that was out of pressure and curiosity. It is important to understand life inside the womb to avoid misconceptions. Before you even study the concept of fetal circulation there are important things to remember. These are:

Lung or pulmonary function is absent during intrauterine life
Pulmonary resistance is high due to the fluid-filled alveoli thus limiting pulmonary circulation
Presence of primitive conduits e.g. ductus arteriosus, foramen ovale & ductus venosus
Placenta as the fetomaternal organ that aids in circulation, endocrine and metabolic activity and as a protective barrier against potential pathogens
A background on the normal adult or mature circulation is essential to fully understand the complexity of fetal circulation

Click on the images above to understand the process. My skills in Adobe Photoshop is not exceptional please bear with me. :D I only made the distribution of blood below the heart, to emphasized the return of deoxygenated blood to the placenta. Be reminded that the aorta delivers blood from the heart to the superior (above the heart) and inferior (below the heart) regions of the body. Please don't hesitate to ask questions or if you want some re-modifications on the images just kindly leave a message either on the message box or leave a comment on this post. Follow the placement of the guide, the compass, and the legend that are provided in the images. The beginning of the process is depicted at the top-most image then down. I hope this will suffice. I'll be posting about postnatal circulatory system changes in my next post so keep in touch! For those of you who want the individual 800x640 jpeg of the 6-part process you can leave a message at the message box with your email ad. Thanks! :D

Mechanisms Of Labor

2008-08-28T11:10:00.000+08:00

A grade school and high school batch mate of mine requested something about obstetrical nursing. He's in the 3rd year of the program now and a second courser from the field of nautical studies. From the shipyard to the nurse's station, from sextants to syringes he deliberately change his career path. Anyway, I have here the mechanisms of labor or the cardinal movements of labor. I have taken some pictures of the movements from the internet and did some modifications and labeling to make it more understandable. I never had a clear overview on these movements during my college days. We were asked to memorize the process but memorizing does nothing good to you nurses. :D Comprehension is essential. In this way, you will be able to know what is the appropriate nursing intervention and management in the labor phase. My knowledge in OB is not exceptional but we're learning here. There are only a few questions on OB in the local board but its quiet tricky you know. Click on the image.

Engagement: The baby is looking across the pelvis at one or other of the mother's hips.
Descent: As the fetal head engages and descends, it assumes an occiput transverse position because that is the widest pelvic diameter available for the widest part of the fetal head.
Flexion: While descending through the pelvis, the fetal head flexes so that the fetal chin is touching the fetal chest. This creates a smaller structure to pass through the maternal pelvis. When flexion occurs, the occipital (posterior) fontanel slides into the center of the birth canal and the anterior fontanel becomes more remote and difficult to feel. The fetal position remains occiput transverse.
Internal Rotation: The fetal head rotates 90 degrees to the occipito-anterior so that the baby's face is towards the mother's rectum. In some cases, the occiput rotates anteriorly and the fetal head assumes an oblique orientation.
Extension: The fetal head passes out of the birth canal. Its head is tilted backwards so that its forehead leads the way through the vagina.
External Rotation Restitution: The shoulders repeat the corkscrew movements of the head, which can be seen in the final movements of the fetal head. The fetal head turns through 45 degrees to restore its normal relationship with the shoulders, which are still at an angle.

Gear Up Against Bronchitis

2008-08-28T11:08:00.000+08:00

For the past few days, after having an internet connection here at home, I have been spending a lot of time in the internet especially at night time. Aside from updating my blog and friendster account, I download lots of mp3s for my player and of course some movies that I have missed out in the theatres. Usually, 3 days after this, my throat starts to ache, an impending danger. I am also constantly exposed to air pollution every time I travel to and from the city. During periods of stress our bodies try to fight back possible infection that tries to invade our body cells and systems. Our body needs nutrition and enough hours of sleep to replenish what we wasted during the periods of work and stress. 8 years ago, I've been diagnosed with allergic rhinitis and acute bronchitis has always been the complication. I usually experience nasal drip when I'm exposed to strong perfumes, spices and a dusty environment. A shifting weather can also cause nasal congestion then eventually, a nasal drip. In my case, nasal drip is not a problem but rather the post nasal drip. What happens with post nasal drip is that mucous from the nasal cavity, with the aid of gravity, drips to the airway down to the lower respiratory system thus blocking the medium-sized air passages with copious mucous. When blockage happens we cough until we hurt our very own pharynx which then leads to another problem other than ineffective airway.

Infection is always possible in bronchitis. I have a simple analogy on how you get the bug in bronchitis. Lets try to look at a fly paper. The sticky portion shall be the copious mucous and the flies, the air-borne microbes in the environment swarming a few centimeters over it. As the gentle breeze blow these flies are trap on the sticky fly paper just like we breathe in airborne microbes from the environment. We constantly breathe in these potential killers and its ready to attack when the defense is ineffective.
A yellowish phlegm or sputum is an indication of an infection. Normally, the body fights the initial battle of infection with typical signs of fever or an increase of body temperature. If proven bacterial by a licensed physician or a specialist, antibiotics are given. I have taken azythromycin, clarythromycin and co-amoxiclav. These drugs are indicated for bronchitis but I would like to tell you that some of these antibiotics may be an allergen for your system so I will recommend you guys to give yourselves a check up with a lung physician before you even think about taking those. Also, these drugs may damage your kidneys and liver from toxic dosages and a potential cause of sterility in both sexes. You won't like that don't you? Get yourselves a check!
Prevention has always been better EVER than cure. These are some tips on how to prevent the sticky and disturbing episodes of bronchitis:

Avoid 2nd hand smoke from smokers
Take at least 8 hours of quality sleep
Drink lots of water and fruit juices
Eat ample amounts of fruits rich in Vit. C or otherwise have at least a daily recommended dose of it (Just read the labels).
Avoid staying in a crowdy place
Avoid allergens that may cause increased production of mucous (e.g. spices, fumes, dust et.)
Wear appropriate gear when dealing with potential exposure (e.g. face mask)
Have a balanced diet
Regularly breathe in fresh air from a clean environment or do some deep breathing exercises to avoid pooling (sorry for the word) or stasis (much appropriate term) of mucous
A check up is necessary to prevent complications

Contradictory practices are common among health professionals but I don't want to disturb people during a class or the climax of a theatre musical production. I reckon that would be embarrassing and you don't want to be on the spot like I've experienced a couple of times. I'm trying to save you from their stares you know and it's about time to stay healthy.

Impulsive Me, 'Super' Me and Strawberry-filled Dougnuts

2008-08-28T11:05:00.000+08:00

After repeated bouts of tossing and turning around the bed last night, I finally had a good night sleep but I was disturbed by the noise outside my room. Workers from my family's newly constructed pad were re-piling blocks and lumber from the site and placed it right at the side of my room. I wanted to yell at them but I've realized some of the workers were my relatives so I just went out of my bed and ran to my pond. I instructed the housekeeper the other day to refill the pond every morning. I suspected a leak and Mom does not have the time to fix that crack underneath those lily pads. Lucky enough for its inhabitants! She's busy supervising the construction and administering my cousin's allowances for the entire month. Their parents are working abroad so that means, she got two families to run. She's a superwoman! Every time someone's sick in the family specially the old guys, she's readily available for them. I can't blame her if I don't see her in the house every waking moment. Love her though.

Last April my grandfather, Mom's dad, died from a stroke and she has always been on his side ever since he started to deteriorate 3 years ago. Two weeks ago, grandfather's elder sister, my Mom's aunt died of respiratory failure. She was always there, processing the needed transactions, the certificates and of course, nursing the sick. Mom was consistently mentioned in the eulogy. Anyway, I know Mother's Day is 2 months ago but I just want to give her the credit of being a good homemaker. After taking my light breakfast, I prepared myself for the day. I was asked by a special someone to buy a freshwater angelfish but I don't have the time. I went to our 'nest' and spend our vacant time together until 2 pm. The skies were gloomy but the weather was fine. The review centre where I am currently reviewing is a kilometer or two from my 'special someone's' place so I have to leave approximately 30 minutes before 2 pm. Unfortunately, I arrived late. My classmates were already sticking their noses on their answer sheets. Hilda, the review coordinator smiled reluctantly then checked her tarnished wrist watch and gave me the answer sheet. The only vacant desk was at the front so I scooted the aisle for it. I only got 50 minutes to answer the 3-part test and I made it right on time. After the test, we checked and rationalized. As always, Hilda has the habit of asking one-by-one for our scores and repeats them in front of the class. You get a low score you'll be on the spot. I got 37 out of 40 and that was my highest score ever since I started reviewing. While Hilda's doing her roll call from the back, I noticed most of my classmates' scores were below 30 but one made it with 3 mistakes too. I was the last person called and said, "37," reluctantly. She nod and said, "27. 27 has a bandscore of 6.5 I'll be having your answer sheets then you can go home." I froze and I couldn't take it back if I did, that would mean something else. If I protested, I might be misunderstood so I left it that way. The recognition... gone!

I went down the steep staircase smiling yet my heart was really aching. The impulsive me and my 'super' me was in a moot but just like many other men, the impulsive me was more dominant at that time. I needed something that could bring back the equilibrium of the personality components. According to Freud, we got 3 personality components: the id, the impulsive, pleasure-seeking behavior; the superego, the person's nature that reflects moral values and ethics; and lastly, ego the balancing or mediating force. Ego was too weak to drawback the conflicting forces in me. I just took hold of myself and said, "There's only one thing that can balance the forces... and that's strawberry-filled doughnuts!" Right, strawberry-filled doughnuts. I went straight to Divisoria and bought strawberry-filled doughnuts. As I bit into the soft doughnut and felt the luscious sweet of the strawberry filling, everything was OK. Darn! I should have uttered 37 clearly but... it does not matter. As long as I get a good score and never cheated that would be fabulous.

Rumi

2008-08-28T11:04:00.001+08:00

If we come to ignorance, that is His prison. And if we come to knowledge, that is His balcony. If we come to sleep, we are His drowsy ones. And if we come to wake, we are in His hands. If we come to weeping, we are His cloud of raindrops. And if we come to laughing, we are His lightning in that moment. If we come to anger and battle, it is the reflection of His wrath. And if we come to peace and pardon, it is the reflection of His love.

The name Mowlana Jalaluddin Rumi stands for Love and ecstatic flight into the infinite. Rumi is one of the great spiritual masters and poetical geniuses of mankind and was the founder of the Mawlawi Sufi order, a mystical brotherhood of Islam.

Pondering Philosophies

2008-08-28T11:02:00.001+08:00

There is only one sin. And that is theft. Every other sin is a variation of theft. When you kill a man, you steal a life. You steal his wife's right to her husband, his children's right to their father. When you tell a lie, you steal someone from the truth...

-Khaled Hosseini, author of The Kite Runner

Pain Of Sprain

2008-08-28T11:00:00.001+08:00

Last Thursday, right after the most anticipated June 2008 nursing exam results emerged in the world wide web, I was brought into a trance. I was dancing and jumping with joy when I saw my friends' names in the list. I ran all over the living room and the kitchen vice versa then tripped on the floor up in the hallway. The hallway is half-a-foot elevated from the living room. I stood up in shame and went back to my room to check some of my batch mates' names who did not make it last December, hoping to see their names too. After a run through of my year book for their names on the list, I went to sleep. Not until morning, I felt an ache on my right ankle. After doing some assessment and a flexion, I presume that no fracture of any sort happened to my ankle but rather a sprain. It is an injury of the ligaments surrounding by a sudden overstretching of the muscles. Tearing of the ligaments also happens but usually on a more complex mechanism of injury. Here are the steps to alleviate the discomfort from minor sprains and conservative treatment:

Immediate treatment should be R.I.C.E. but the P.R.I.C.E. is much better.
Protection: It is necessary to protect the injured site from elements that will aggravate the injury like extremes of temperature or a bump from your stubborn nieces and nephews.
Rest: The sprain should be rested. No additional force should be applied on site of the sprain. If, for example, the sprain were an ankle sprain, then walking should be minimized.
Ice: Ice should be applied immediately to the sprain to minimize swelling and ease pain. Apply it for 20-30 minutes, 3-4 times a day.
Compression: Dressings, bandages, or wraps should be used to immobilize the sprain and provide support.
Elevation: Keeping the sprained joint elevated above heart level will also help minimize the swelling.

I would like to tell everyone if symptoms persists consult your doctor. My intentions are for minor sprains. Radiographic test are still recommended to ensure the diagnosis of the injury and a good history (this includes mechanism of injury, hearing a snap at the injured site, discoloration and swelling etc.) is essential. The extent of tissue damage that occurs during an injury depends on the direction and magnitude of the forces and the position of the foot and ankle during the trauma. Ankle sprains occur more often in athletes who have had previous ankle sprains. The most common mechanism of injury is a person or athlete who “rolled” over the outside of his or her ankle like what I've experienced last Thursday (the image above).

Jesters Of the Operating Table

2008-08-28T10:57:00.000+08:00

The other day, I enjoyed browsing and reading a blog that reminds me of my college days in nursing school. I remembered my first clinical exposure at the city hospital, a dead investment of the local government but as a whole all went well there. Exposure to specialized areas were supplemental although 4 other nursing schools were fighting for the chance to be expose not only to the specialized area but to infectious diseases as well. Private hospital experience was of great help for a little touch of the close-to-ideal setting. The much anticipated, by a student-nurse, psychiatric (in Manila) and orthopedic center affiliation. Photos were all lost by a careless computer technician. All I can do is reminisce on them but no matter how I try to describe every detail of the experience, the primitive human mind cannot quantify the quality of a memory without a mere image of it. Yet a very unusual experience might haunt you.

And again I won't be talking about all the cheery happenings and the awe of the marvels of the human body and its vulnerability but rather I will be sharing the realities of health care in the third world. After the heated Vicente Sotto Hospital (Cebu City) Scandal early this year, the world made a different view on medical and allied health education in the country. The world saw a substandard, unethical, scandalous health provider. A jester of the operating table. Since childhood, I always want to become a physician but during my exposure at the clinical area I have seen too much bias and it seems I don't want to be like them. Does med school teach equality among the rich and the poor patients? Patients should recieve equal non biased quality health care no matter the variables are. One incident of last year in X Medical Center, we were trying to complete our operating room cases for the board exams, a 14 yr. old mother was scheduled for a c-section due to dystocia and cephalopelvic disproportion, she was less than 5 feet, small women are at high risk of having this during labor. Probably an indigent from the outskirts of the province, she was too reluctant to climb the gurney for a short trip to the OB-Gyne OR. Our group was assigned at the Orthopedic OR. We've been there for ages assisting a bone doctor to amputate a bad leg. To suffice, first, the muscle tissues were transected then the bone was sawed through a oscillating saw. You can even feel the vibrations and see bone fragments thrown away by the saw. I feel my enamel ache as the surgeon sawed through the femur. I was a student-circulating nurse at that time. My role was to conduct a sponge count from time to time and get what the surgical team needs outside the sterile field. I was asked to get a bag of IV in the main OR as I walked through the OB-Gyne OR the teenage mother was strapped on the operating table. Crucified and cut alive they say. The anesthetist had already run the anesthetics through the spine and the surgeon, an OB-Gyne had don her gloves. The way to the main OR was just a couple of meters away but I needed to slow down to keep me away from the sterile field. The scrub nurse passed the scalpel to the surgeon she took it and held it like holding a candle. And like a flame from a candle, it glistened as she twist it between her thumb and index finger. Under a spinal anesthesia, in a c-section or any procedure that requires it, a patient is normally conscious. It blocks nerve transmission below the diaphragm thus, eliminating pain, motor signals and sensation. She already received spinal anesthesia a few minutes ago but something happened, an event that contradicted my personal values. The surgeon transversely swish the scalpel unto the patient's abdomen, sorting the skin from the fatty tissue. Surely, if I try to examine it with a tissue forceps jagged edges of fatty tissue possibly reveal the muscle tissues underneath. The patient was screaming in pain, she was hysterical. Then immediately, the anesthetist administered general anesthesia through a face mask to fully sedate the patient more likely to stop her from screaming and writhing. Her head dropped and loss consciousness in a matter of seconds. I was left dumbfounded. Confused. My mind was battling with the images I've seen in the OR. I stared at the newly born neonate in disbelief. My thoughts were gathered after receiving a pat on my shoulder. I wasn't frightened with the pat but rather the coldness of the hand touching my nape. It was my clinical instructor. That was the nastiest operation made by a licensed physician. The neonate was in perfect condition after an hour of extra-uterine life. Finally, we took off our patient's leg and ready for closure. Right after the surgery, we cleaned all the instruments, mopped the floor and made our documentation. I remained silent for 2 hours of the entire shift. We took our dinner then I started to share what I saw earlier. My colleagues made a lot of assumptions about what I saw. Some said that the physicians might be upset or resentful for the 14 year old girl. Another colleague on her mid 30s said that she deserved that for being a slut, an ungrateful daughter to her parents. I never said a word during their argument. No matter what were the circumstances she's into, she deserved to be treated with dignity in her surgery. I always want to become a doctor but I don't want to be like them. Even right at this very moment, I can hear her screaming in excruciating pain. We've seen such scenarios like in House, M.D. but a patient has their rights. Nursing and medicine is humanity. We should maintain that notion for our profession is noble for its cause.

Fast Food and The Bug

2008-08-28T10:53:00.000+08:00

2 weeks ago, me and Adam went out to visit our grade school classmate Dang, working as a management trainee in a famous original Filipino fast food chain. The term 'original' here means, 'not derived from something else.' I use the term original based on the fact that it was established in the Philippines by a Filipino entrepreneur not to mention the idea of fast food was taken from McDonald's which is an American restaurant. You can copy or replicate almost anything nowadays. I feel remorseful for that. It's like wearing a fashionable pin-striped trousers in a cozy coffee shop with the exact prints and fabric hanging on the windows and under your water goblets or folded into a fan on top of the platter. But it will be pity to see them on the awning of a vegetable or fruit peddler. I'm sure you won't stand beside it. You wish your companion won't point at it. Today, I won't be talking about fashionable trousers and cozy coffee shops but rather I will be sharing a horrible experience on food preparation. You see, in a developing country where high tech locomotives or MagLev (Magnetic Levitation) Trains to commute for home are not available, where not everything is accessible like your kitchen or your frige we dine with fast food. It's fast, cheap especially for the yuppies on the rush for a deadline or a spoiled hungry brat with mommy from the grocery. They love the give aways so much which were recently recalled from the market for its high lead content. The ones made in China though. Now going back, we decided to have lunch at Dang's so we can avail discounts from the manager's company privilege. We texted her to inform our visit and the privilege of having a discount will mean a relief on our meager allowance. But just like a lawyer in a court hearing or a surgeon making burr holes on the patient's skull, she was unable to respond our message. Right after we get through the door, she greeted us with a smile like the ones you see in fast food TV commercials. I knew she was reluctant you know. I bought one piece fried chicken, thigh part and a cup of rice while Adam ordered double. She swiped her access card on the register and the orders were automatically marked 10% down. We headed up to the second level and seated next to a bough of a mahogany tree right across the street. Dang was on duty so she wasn't able to join us upstairs. As I sliced into my fatty chicken, the insides were not deep fried to the bones. Bloody. I remembered the creepy crawlies that are not vissible with the naked eye. It contains lavish amounts of cholesterol approximately 60mg. Some of its components shall take form of flabs and love-handles in a matter of weeks of eating fast food but colonies of bugs, microbes can kill you in a matter of days! Here are bugs that can kill: 1. Campylobacter jejuni -> A bacterium common in poultry, leading cause of bacterial foodborne disease in the U.S. Exposure to a small number of it can cause illness. Recovery happens within a week. (Click on the image to view full size) 2. Escherichia coli O157:H7 -> Produces a powerful toxin that can cause bloody diarrhea and occasionally kidney failure. Usually from undercooked beef. 3. Salmonella enteriditis -> Any food smeared with animal feces will carry Salmonella. Poultry especially chicken and eggs are high-risk carriers. An emerging strain shows high rates of drug resistance. 4. Listeria monocytogenes -> Can thrive in refrigeration, it is found in many foods, including soft cheeses and processed meats like salami and hot dogs. Pregnant women, neonate and the immuno-compromised are highly susceptible. 5. Shigella sonnei -> Irrigation water contaminated with sewage or manure transfers Shigella to food. It is highly infectious and spread through physical contact. Children in day-care settings are most vulnerable. I told Dang about the bloody chicken and immediately she referred me to her senior manager. She offered me to take the same order but this time hot and well done but I refused. I was too full from Adam's fries, macaroni soup and rocky road sundae. The damage has been done so they better jab their fried chicken and patties with a pyrometer, to check if it reached the standard temperature that assures us from contacting food-borne diseases.

Diagnostics For Nursing Reviewees

2008-08-28T10:51:00.000+08:00

Cardio

(1) ECG/EKG- records electric conduction of heart

Types: (a) Resting ECG: secure electrodes, remain still, reassure pt. will not receive electric shock

(b) Holter Monitoring- portable ambulatory ECG monitoring (24 hrs): secure electrodes, continue normal activity, maintain a log of activities & note s/s

(c) Stress Test- multi-lead ECG monitoring during controlled and supervised exercise, usu. on treadmill or stationary bike: consent signed, light meal 1-2 hrs before exam or fasting for 4hrs, [ (-) caffeine, ROH, smoking], comfortable clothing, rubber shoes, secure electrodes, obtain baseline B/P & resting ECG, instruct pt. to exercise as instructed [report pain, weakness, SOB or other s/s], monitor B/P & ECG cont. record @ intervals w/ any s/s or changes in V/S esp. cardiac rhythm

(2) Echocardiography (2D Echo)-U/S of heart evaluate structure, FXN of heart chambers & valves: fast for 6hrs, remain still, secure electrodes for ECG, monitor B/P, reassure no pain or electric shocks rather the lubricant placed on skin will be cool, cleanse lubricant from pt’s chest, cont. fasting for 4hrs after study

(a) Transesophageal Echocardiography (TEE)- transducer thru esophagus: Throat is anesthetized before transducer insertion, ECG & B/P monitoring

*for2D-Echo w/ pharmacologic stress testing(Adenosine, dipyridamole, dobutamine) IV for sedation is started before study

(3) Phonocardiography-graphic recording of heart sounds: remain still, secure electrodes for ECG, and reassure no pain

No Postprocedure Nsg Care

(4) CT Scan-cross-sectional images of the chest, heart & great vessels: Explain procedure that pt. will lie on table while scanner rotates, contrast IV may be started (as in Cardiac Cath prep), remain still

(5) MRI-powerful magnetic field & computer-generated pics to image physiologic & anatomical properties: C/I in clients w/ pacemakers, metallic implants, prosthetic joints & orthodontic appliance, mild sedatives for claustrophobic pts., remain still

INVASIVE PROCEDURES:

Coronary Angio/Arteriography (Cardiac Cath)-physician injects dye into coronary arteries thru brachial or femoral artery, takes a series of X-Ray films to assess structure of arteries: consent signed, allergies of dye & shellfish, fast 8-12 hrs, will end <2hrs,>

Hemodynamic Monitoring:

Central Venous Pressure (CVP)-assess RIGHT VENTRICULAR FXN & venous blood return to the RIGHT SIDE of the heart: consent signed, skin prep, insertion to either external jugular, antecubutal or femoral vein, secure dry, air occlusive sterile dressing (Observe sterile technique); placement is confirmed thru X-Ray

Increased CVP-hypervolemia
Decreased CVP-hypovolemia

(b) Pulmonary Artery Pressure (PAP)- assess LEFT VENTRICULAR FXN via right side of heart & into pulmonary artery can also measure RV fxn or RA pressure, pulmonary systolic & diastolic pressure, mean pulmonary artery pressure & pulmonary artery wedge pressure. To evaluate medical interventions (to include effects of medications)

Complications of CVP/PAP:

Infection
Infarction (PAP)
Pulmonary thromboembolism
Catheter kinking
Dysrhythmias
Air Embolism

________________________________________________

Pulmo

Pulmonary FXN Test (PFT)- routinely used in pts. w/ chronic respiratory disorders, assess respiratory fxn & extent of dysfxn, measures lung volumes, ventilatory fxn & mechanics of breathing, diffusion & gas exchange, thru spirometer or spirometer w/ volume-collecting and recording device

Arterial Blood Gas (ABG)- measures blood pH & arterial O₂ & CO₂ thru radial, brachial, femoral artery or indwelling arterial cath blood extraction.

Pulse Oximetry- measures O₂ saturation of HGB

*Unreliable results in cardiac arrest pts & shock, when dyes (methylene blue) or vasoconstrictor meds have been used, severe anemia or high CO level.

Cultures- Nasal swabs, throat cultures, sputum studies

Sputum Exam- identify pathogenic organisms & malignant cells as well as hypersensitivity states & drug sensitivity: cleanse nose & throat, rinse mouth prior to expectoration, taken early morning specimen delivered to lab w/in 2 hrs

ENDOSCOPIC PROCEDURES ARE HIGHLY INVASIVE:

Bronchoscopy- direct inspection and exam of larynx, trachea & bronchi thru either a flexible fiberoptic bronchoscope or rigid bronchoscope: consent signed, remove dentures & other oral prosthesis, lidocaine anesthetic spray on pharynx, IV sedation may be started esp. for rigid bronchoscopy, ice chips & fluids when cough reflex is demonstrated, assess resp. status, observe s/s of hypoxia, hypotension, dysrhythmias, hempotysis & dyspnea-report promptly, pt shall not be discharge until cough reflex is adequate, report bleeding & SOB

Purpose:

Examine tissues & collect secretions
Biopsy & determine location & extent of pathology
Determine if tumor can be surgically resected
Diagnose bleeding sites

Thoracoscopy- pleural cavity is examined w/ endoscope, chest tube may be inserted and pleural cavity is drained by negative-pressure water-seal drainage: consent signed, IV sedation started, monitor for SOB (as in pneumothorax), chest tube in place and monitoring chest tube drainage system is essential, minor activity restrictions

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Thoracentesis- aspiration of pleural fluid or air for diagnostic or therapeutic purposes (medications instillation), needle biopsy may be performed at the same time: consent signed, assess for allergies to local anesthetics, IV sedation may be started, remain still, expect minimal discomfort and pressure sensation, position client either: straddling on chair w/ arms & head resting on the backrest of chair, sitting edge of bed w/ feet supported & arms & head on a padded over-the-bed table, lying on unaffected side w/ bed elevated 30-45degrees, skin prep (germicide solution), refrain coughing, apply pressure on small sterile dressing over puncture site, encourage bed rest, record amount of fluid, colour, viscosity; monitor SOB, chest asymmetry in movement, chest tightness, vertigo, faintness, uncontrollable cough; blood-tinged, frothy mucus, tachycardia & s/s of hypoxemia

Biopsy- excision of a small amount of tissue from pharynx, larynx, nasal passages, pleura & lungs: SAME AS ENDOSCOPY (Thora/broncho)

X-Ray/Roentgenogram: provide privacy w/ less body exposure & follow instructions during procedure

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Gastro_x

Stool Exam- for consistency, color, occult blood, fecal urobilinogen, fat, nitrogen, parasites, pathogens, food residues & other substances: for quantitative24-72hr collection must be kept refrigerated until taken to lab, follow prescribed diet or refrain meds as instructed by MD (for special stool tests)
Abdominal U/S- high frequency sound waves are passed into internal body structures: fast for 8-12hrs to decrease amount of gas in the bowel, fat-free meal for gallbladder studies, barium studies should be performed after the test
Upper Gastrointestinal Tract Study (Upper GI Series)- x-ray of GI tract w/ ingested contrast agent (barium sulphate): low residue diet for several days, NPO after midnight before test, take laxatives as prescribed, no smoking the morning before exam, w/hold all med, assess for allergies of contrast agent; after procedure, increase fluids to evacuate stool & barium, monitor color of stools (barium appears clay-like), a laxative or enema may be needed.
Lower Gastrointestinal Tract Study- detect polyps, tumors & other lesions of large intestine, barium enema to visualize lower GI tract or w/ the use of water-soluble iodinated contrast agent: low residue diet 1-2days before test, clear liquid diet & laxative the night before, NPO after midnight, cleansing enema w/ clear returns the following morning, barium enemas should be before upper GI series, increase fluid intake to evacuate barium and as well as enema or laxative.
5. Gastric Analysis- yields info about the secretory activity of the gastric mucosa by NGT thru aspiration of gastric contents every 15 minutes of 1hr: NPO for 8-12hrs. PO meds w/held for 24-48hrs, smoking not allowed, NGT secured to the pt’s cheek & pt in semi-reclining position, label specimen
1. Gastric Acid Stimulation Test- histamine or pentagastrin given per SQ to stimulate gastric secretions, specimen aspirated thru NGT every 15 minutes for 1hr: expect flushed feeling after administration of histamine/pentagastrin, monitor B/P & PR for hypotension, label specimens
*Gastric Analysis, Gastric Stimulation Test may be in conjunction w/ Gastric pH monitoring

ENDOSCOPIC PROCEDURES ARE HIGHLY INVASIVE: Lubrication necessary for GI endoscopy
1. Upper Gastrointestinal Fibroscopy / Esophagogastroduodenoscopy- fibroscopy of the upper GI tract allows direct visualization through a lighted endoscope (gastroscope): consent signed, NPO for 6-12 hrs, spray or gargle local anesthetic, IV sedation started as ordered (medazolam-moderate sedation & relieves anxiety, atropine to decrease secretions, position pt on left side to facilitate saliva drainage and easy access; after procedure, position pt. in Simms position until awaken then Semi-Fowler’s, instruct not to eat or drink until gag reflex returns (1-2 hrs) then offer lozenges, saline gargles & oral analgesic-relieve throat discomfort, assess s/s of perforation i.e. pain, bleeding, difficulty swallowing & elevated temp., monitors pulse & B/P
2. Anoscopy, Proctoscopy & Sigmoidoscopy- use of endoscope, anoscope-anus & lower rectum, proctoscope & sigmoidoscope-rectum & sigmoid colon: consent signed, no dietary restrictions, warm tap water/Fleet’s enema until clear, pt assumes position on left side w/ right leg bent & placed anteriorly (knee-chest at the edge of bed w/ back inclined at about 45degree angle for rigid endoscope); during procedure, monitor V/S, skin color, temp., pain tolerance & vagal response; after procedure, monitor for rectal bleeding & s/s of intestinal perforation i.e. fever, rectal drainage, abdominal distention & pain
3. Fiberoptic Colonoscopy- inspection of the colon to the cecum, used for cancer screening and for surveillance in pts. w/ previous colon cancer or polyps, can removed visible polyps: consent signed, limit intake of liquids for 24-72hrs, cleansing of bowels (laxative for 2 nights before test, Fleet’s or saline enema till returns are clear-morning of test), start clear liquid diet at noon the day before test then ingest lavage solutions (intestinal lavage for optimal intestinal cleansing) @ 3-4 intervals, NPO after midnight (can take meds but w/ minimal water), position to left side, monitor V/S, O₂ saturation; assess color & temp. of skin, LOC, abdominal distention, vagal response & pain, assess RR due to sedation, supplemental O₂should be used as necessary; after procedure, bed rest until fully alert; observe s/s of bowel perforation i.e. rectal bleeding, abdominal pain & distention, fever, focal peritoneal signs; if midazolam was used, pt is unable to recall verbal info. due to its amnesic effect-provide written instructions, report bleeding to MD
4. Peritoneoscopy (Laparoscopy)- performed thru small incision of abdominal wall, biopsied may be taken, requires general anesthesia and decompression of stomach & bowel, usu. CO2 is insufflated into the peritoneal cavity to create more space for visualization, indicated to evaluate peritoneal disease, chronic abdominal pain, abdominal masses, gallbladder & liver disease: consent signed, IV sedation started, ensure safety during ambulation due to orthostatic hypotension after procedure, assess RR for resp. depression
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Renal
1. Urinalysis (U/A), Urine Culture & Sensitivity- provides info on kidney function & helps diagnose other diseases e.g. diabetes, identify bacteria & as well as their strains, identify appropriate antimicrobial therapy
Evaluates:
- Urine color
- Urine clarity & odor
- Urine pH & specific gravity
- Urine RBCs, sediments, casts, crystals, pus & bacteria
- Urine protein, ketones, glucose

2. KUB X-Ray- x-ray of abdomen or kidney, ureters & bladder to delineate size, shape & position, presence of calculi, cysts, tumors & kidney displacement: provide privacy w/ less body exposure

3. U/S: lower abdomen & genitalia exposed-provide privacy & minimal exposure, requires full bladder encourage fluid intake before testRetrograde Pyelography- catheters are advanced thru the ureters into the renal pelvis by means of cystoscopy, contrast agent injected, may be used before extracorporeal shock-wave lithotripsy: consent signed, allergies of dye & shellfish

ENDOSCOPIC PROCEDURES ARE HIGHLY INVASIVE: Lubrication necessary for GU endoscopy

2-way approach:

Percutaneous
Per Urethra (Lubrication necessary)

Cystoscopy- visualization of urethra, bladder, uretral orifices, prostatic urethra, renal pelvis w/ the use of a cystoscope, lidocaine to reduce discomfort, general anesthesia given: consent signed, NPO, explain procedure to pt & family for preparation & to allay fears, after procedure, assess RR for resp. depression, bed rest until fully alert, reduce/ relieve discomfort thru moist heat over lower abdomen, warm sitz baths, monitor for urine retention-intermittent catheterization may be necessary, monitor for UTI & obstruction (due to edema)

Brush Biopsy thru Cystoscope- cystoscope examination is first conducted followed by introduction of ureteral catheter, followed by biopsy brush passed thru the catheter, brushes back & forth to obtain cells, lidocaine to reduce discomfort, general anesthesia: consent signed, NPO, explain procedure to pt & family for preparation & to allay fears, after procedure, assess RR for resp. depression, bed rest until fully alert, expect hematuria w/in 24hrs & clearing after 24-48hrs, renal colic occasionally occurs yet responds to analgesics

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Kidney Biopsy- renal cortex tissue specimen taken thru either percutaneously (needle biopsy) or thru small flank incision: Obtain coagulation studies to check for bleeding tendencies, consent signed, fasting 6-8hrs, IV line established, U/A taken, for needle biopsy-pt. on prone position w/ sandbags under abdomen, instruct to hold breath while needle is inserted to prevent kidney from moving, for open biopsy-preparation similar to major abdomen surgery, pressure applied to biopsy site, bed rest for 6-8hrs kept in prone position

Reference: Brunner and Suddarth's Medical-Surgical Nursing 7th Edition

10 New Mantras For A More Sexier You

2008-08-28T10:26:00.000+08:00

I got this from a magazine unfortunately I cannot remember the publication. But if any one reacts on the rights of this clipping please message me so I can delete this from my blog as well as the pic. This clipping is one of must-knows that I like. It helps you to be empowered especially at times when you're so wasted and down. Hope you'll have time to relax using this tips I got for you guys. It will help I tell you. :D

10 New Mantras For A Sexier More Empowered You

1. Lower your head into the strong stream of warm water of the morning shower.

"I anoint myself with the powers of the universe. I am eternal and indomitable. I send out waves of irresistible appeal."

2. Stand under the shower and close your eyes.

"I am renewed. I am liberated. I am free."

3. As you vigorously towel yourself dry.

"From my skin emanates the essence of desire, producing longing in all who come near."

4. As you gel, wax or molding-mud your hair.

"This crown, it rocks!"

5. Professional or social rival riles you. Using very expensive foot cream, rub between great toe and second toe using thumb and index finger, slowly enunciating:

"I'm all that."

6. Boss says your work sucks, your fashion sense sucks, you suck. Clasp your hands together behind your back, lifting them away from your body as you toss your head backwards; you should hear your upper spine crick. Take in a long breath through the mouth, silently saying to yourself:

"Sucking, it is good."

7. Lover dumps you for someone younger, better-looking, richer and socially prominent than you. Bring a pitcher of water to you bedside. Assume fetal position. Weep for three days, drinking water when necessary (you won't need food). This is suicidal. On the third day, rise and flail your arms around as you twirl on your feet in a dance of acceptance and self-redemption. Utter:

"I'm still all that."

8. Management committee meeting you're in is in its third hour and everyone's saying the same thing they said last week, not to mention just an hour ago. Sitting with feet at shoulder width and firmly planted on the ground, rest both arms on your knees raising the hands in gesture of discreet benediction under the conference table. In your mind, say:

"Blessings to all God's creatures." or "Shut the f*** up already. You said that na kanina pa!"

9. On a weekend stay at parents', laundress bleaches carefully blow-torched Helmut Lang jeans into a pristine, preppie white. With both hands quickly trace a large Z in the air, snapping at each corner of the letter. To the rhythm of the snaps, say:

"Easy come, easy go."

10. Martini arrives tepid. There is no known consolation to this horror. Feel free to hurl invective and furniture.

Oats Will Trim You Down

2008-08-28T10:20:00.000+08:00

Southeast Asia is one of the most abundant food bowl in the world. One major export is rice but for people who want to trim down it doesn't matter. For as long as we get the figure we want no famine shall end our wildest ambition. A lot of Asians consume kilos of rice in a day, that makes them prone to obesity and diabetes. We know the rule of eating right, enough rest and exercise. I have been looking for ways to reduce my weight and eventually I found something that is effective for me. Oats. Honestly, I've tried weight loss supplements during my 1st year in the gym and the scale does not seem to move a notch lower. My weight fluctuated 1-2 pounds lower or higher then goes back to the baseline in a matter of days. Normally, I ate 2 meals in a day and did a lot of cardio exercise about 30 mins. everytime I go to the gym. Sometimes I spend an hour on a stationary bike on moderate to high speed. But nothing changed. That's why I decided to change my diet. I know oats does not taste so good but I tell you the effects is dramatic. I added something to improve the taste of it. This is how I prepare my oats:

For those of you who love cream soup do this:

4 Tbsp. of instant oats (1 serving)
2-3 Tsps. of either cream soup powder (either mushroom, corn, asparagus)
175 mL water

Mix cream soup powder with water, stir well then add it to your oats. Put it on the microwave for 2.5 minutes on medium to high power. That's all!

2 servings of oats a day is good for the heart. It is known to lower your bad cholesterol level and it also has soluble fiber to clean up your guts reducing the risk of colon cancer. Oats can be a rice substitute and eat it with a dish like lean meat. I would like to remind everyone that everything should be in moderation. Now I'm refering to the use of cream soup powder, it contains some amount of MSG and too much of it will do harm to the body. You can try something else to improve the taste of your oats. Fruits like berries, apples and bananas are still recommended. Anyways, I lost 3-4 lbs in a week!