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• hree basic parts to a Neuron
• The main function of the nervous system
• Nursing Diagnosis: Impaired Gas Exchange Ventilation or Perfusion Imbalance
• Corneal ulcers and infections
• Low blood pressure or hypotension
• Addison’s disease,Symptoms,Risk factors, treatment Addison’s disease

hree basic parts to a Neuron Posted: 18 Jan 2011 04:48 AM PST The Neurons Has many functions and vary in size and in length. Three basic parts to a Neuron a. cell body b. axon c. dendrites Each Neuron has one cell body with a nucleus. Neurons cannot divide and multiply by mitosis like other cells in the body. Once the body is destroyed it is gone forever. The axon is an extension that carries impulses away from the neuron cell body. Some have a covering called myelin and others do not. Myelin sheath is a fatty covering. Those axons that have myelin are called myelinated axons. Myelinated axons conduct impulses more rapidly than unmyelinated axons. These sheaths help to insulate the nerve cell and conduct impulses easily and rapidly. Dendrites are the short, highly branched parts of the cell body. They carry impulses from the axon and send and receive impulses across the synapse. A synapse is the junction or space between the axon of one neuron and the dendrites of another. A nerve can only transmit impulses in only one direction because of the location of neruotransmitters. These are chemicals that the axon releases to allow nerve impulses to cross the synapse and reach the next nerves dendrites. The dendrites release opposing chemicals to slow down impulses. Neurons can be classified as follows: a. Sensory ( afferent) neurons- receive and send messages to the central nervous system from all parts of the body. b. Motor ( efferent) – neurons receive and transmit messages from the central nervous system to all parts of the body. c. Interneurons ( connectory/ association neurons/ or integrators) can be thought of as a link between the two other types of neurons. They are interconnecting neurons. Sensory neurons make up sensory nerves. Motor neurons make up motor nerves- which cause muscle activity and gland secretion. Put together, sensory and motor neurons make up Mixed nerves. source three basic parts to a Neuron

The main function of the nervous system Posted: 18 Jan 2011 04:44 AM PST The main function of the nervous system is communication and control. Communication 1. Monitors impressions and information from external stimuli 2. Monitors information from internal stimuli 3. Responds to danger, pain and other situations 4. Responds to internal and external changes 5. Helps maintain homeostasis 6. Responds to conscious decisions and thoughts 7. Coordinates the process of new learning Control 1. Directs all body activities 2. maintains blood pressure, respiration and other vital functions 3. Regulates body systems 4. coordinates reflexes 5. Controls instinctual behavior 6. Controls conscious movement and activities 7. Stores unconscious thoughts source The main function of the nervous system

Nursing Diagnosis: Impaired Gas Exchange Ventilation or Perfusion Imbalance Posted: 18 Jan 2011 04:32 AM PST NOC Outcomes (Nursing Outcomes Classification) Suggested NOC Labels * Respiratory Status * Gas Exchange NIC Interventions (Nursing Interventions Classification) Suggested NIC Labels * Respiratory Monitoring * Oxygen Therapy * Airway Management NANDA Definition: Excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane By the process of diffusion the exchange of oxygen and carbon dioxide occurs in the alveolar-capillary membrane area. The relationship between ventilation (airflow) and perfusion (blood flow) affects the efficiency of the gas exchange. Normally there is a balance between ventilation and perfusion; however, certain conditions can offset this balance, resulting in impaired gas exchange. Altered blood flow from a pulmonary embolus, or decreased cardiac output or shock can cause ventilation without perfusion. Conditions that cause changes or collapse of the alveoli (e.g., atelectasis, pneumonia, pulmonary edema, and adult respiratory distress syndrome [ARDS]) impair ventilation. Other factors affecting gas exchange include high altitudes, hypoventilation, and altered oxygen-carrying capacity of the blood from reduced hemoglobin. Elderly patients have a decrease in pulmonary blood flow and diffusion as well as reduced ventilation in the dependent regions of the lung where perfusion is greatest. Chronic conditions such as chronic obstructive pulmonary disease (COPD) put these patients at greater risk for hypoxia. Other patients at risk for impaired gas exchange include those with a history of smoking or pulmonary problems, obesity, prolonged periods of immobility, and chest or upper abdominal incisions. * Defining Characteristics: Confusion * Somnolence * Restlessness * Irritability * Inability to move secretions * Hypercapnia * Hypoxia * Related Factors: Altered oxygen supply * Alveolar-capillary membrane changes * Altered blood flow * Altered oxygen-carrying capacity of blood * Expected Outcomes Patient maintains optimal gas exchange as evidenced by normal arterial blood gases (ABGs) and alert responsive mentation or no further reduction in mental status. Ongoing Assessment * Assess respirations: note quality, rate, pattern, depth, and breathing effort. Both rapid, shallow breathing patterns and hypoventilation affect gas exchange. Shallow, “sighless” breathing patterns postsurgery (as a result of effect of anesthesia, pain, and immobility) reduce lung volume and decrease ventilation. * Assess lung sounds, noting areas of decreased ventilation and the presence of adventitious sounds. * Assess for signs and symptoms of hypoxemia: tachycardia, restlessness, diaphoresis, headache, lethargy, and confusion. * Assess for signs and symptoms of atelectasis: diminished chest excursion, limited diaphragm excursion, bronchial or tubular breath sounds, rales, tracheal shift to affected side. Collapse of alveoli increases physiological shunting. * Assess for signs or symptoms of pulmonary infarction: cough, hemoptysis, pleuritic pain, consolidation, pleural effusion, bronchial breathing, pleural friction rub, fever. * Monitor vital signs. With initial hypoxia and hypercapnia, blood pressure (BP), heart rate, and respiratory rate all rise. As the hypoxia and/or hypercapnia becomes more severe, BP may drop, heart rate tends to continue to be rapid with arrhythmias, and respiratory failure may ensue with the patient unable to maintain the rapid respiratory rate. * Assess for changes in orientation and behavior. Restlessness is an early sign of hypoxia. Chronic hypoxemia may result in cognitive changes such as memory changes. * Monitor ABGs and note changes. Increasing PaCO2 and decreasing PaO2 are signs of respiratory failure. As the patient begins to fail, the respiratory rate will decrease and PaCO2 will begin to rise. Some patients, such as those with COPD, have a significant decrease in pulmonary reserves, and any physiological stress may result in acute respiratory failure. * Use pulse oximetry to monitor oxygen saturation and pulse rate. Pulse oximetry is a useful tool to detect changes in oxygenation. Oxygen saturation should be maintained at 90% or greater. This tool can be especially helpful in the outpatient or rehabilitation setting where patients at risk for desaturation from chronic pulmonary diseases can monitor the effects of exercise or activity on their oxygen saturation levels. Home oxygen therapy can then be prescribed as indicated. Patients should be assessed for the need for oxygen both at rest and with activity. A higher liter flow of oxygen is generally required for activity versus rest (e.g., 2 L at rest, and 4 L with activity). Medicare guidelines for reimbursement for home oxygen require a PaCO2 less than 58 and/or oxygen saturation of 88% or less on room air. Oxygen delivery is then titrated to maintain an oxygen saturation of 90% or greater. * Assess skin color for development of cyanosis. For cyanosis to be present, 5 g of hemoglobin must desaturate. * Monitor chest x-ray reports. Chest x-rays may guide the etiological factors of the impaired gas exchange. Keep in mind that radiographic studies of lung water lag behind clinical presentation by 24 hours. * Monitor effects of position changes on oxygenation (SaO2, ABGs, SVO2, and end-tidal CO2). Putting the most congested lung areas in the dependent position (where perfusion is greatest) potentiates ventilation and perfusion imbalances. * Assess patient's ability to cough effectively to clear secretions. Note quantity, color, and consistency of sputum. Retained secretions impair gas exchange. Therapeutic Interventions * Maintain oxygen administration device as ordered, attempting to maintain oxygen saturation at 90% or greater. This provides for adequate oxygenation. Avoid high concentration of oxygen in patients with COPD. Hypoxia stimulates the drive to breathe in the chronic CO2 retainer patient. When applying oxygen, close monitoring is imperative to prevent unsafe increases in the patient's PaO2, which could result in apnea. NOTE: If the patient is allowed to eat, oxygen still must be given to the patient but in a different manner (e.g., changing from mask to a nasal cannula). Eating is an activity and more oxygen will be consumed than when the patient is at rest. Immediately after the meal, the original oxygen delivery system should be returned. * For patients who should be ambulatory, provide extension tubing or portable oxygen apparatus. These promote activity and facilitate more effective ventilation. * Position with proper body alignment for optimal respiratory excursion (if tolerated, head of bed at 45 degrees). This promotes lung expansion and improves air exchange. * Routinely check the patient's position so that he or she does not slide down in bed. This would cause the abdomen to compress the diaphragm, which would cause respiratory embarrassment. * Position patient to facilitate ventilation/perfusion matching. Use upright, high-Fowler's position whenever possible. High-Fowler's position allows for optimal diaphragm excursion. When patient is positioned on side, the good side should be down (e.g., lung with pulmonary embolus or atelectasis should be up). * Pace activities and schedule rest periods to prevent fatigue. Even simple activities such as bathing during bed rest can cause fatigue and increase oxygen consumption. * Change patient's position every 2 hours. This facilitates secretion movement and drainage. * Suction as needed. Suction clears secretions if the patient is unable to effectively clear the airway. * Encourage deep breathing, using incentive spirometer as indicated. This reduces alveolar collapse. * For postoperative patients, assist with splinting the chest. Splinting optimizes deep breathing and coughing efforts. * Encourage or assist with ambulation as indicated. This promotes lung expansion, facilitates secretion clearance, and stimulates deep breathing. * Provide reassurance and allay anxiety: o Have an agreed-on method for the patient to call for assistance (e.g., call light, bell). o Stay with the patient during episodes of respiratory distress. * Anticipate need for intubation and mechanical ventilation if patient is unable to maintain adequate gas exchange. Early intubation and mechanical ventilation are recommended to prevent full decompensation of the patient. Mechanical ventilation provides supportive care to maintain adequate oxygenation and ventilation to the patient. Treatment also needs to focus on the underlying causal factor leading to respiratory failure. * Administer medications as prescribed. The type depends on the etiological factors of the problem (e.g., antibiotics for pneumonia, bronchodilators for COPD, anticoagulants/thrombolytics for pulmonary embolus, analgesics for thoracic pain). Education/Continuity of Care * Explain the need to restrict and pace activities to decrease oxygen consumption during the acute episode. * Explain the type of oxygen therapy being used and why its maintenance is important. Issues related to home oxygen use, storage, or precautions need to be addressed. * Teach the patient appropriate deep breathing and coughing techniques. These facilitate adequate air exchange and secretion clearance. * Assist patient in obtaining home nebulizer, as appropriate, and instruct in its use in collaboration with respiratory therapist. * Refer to home health services for nursing care or oxygen management as appropriate. source Nursing Diagnosis: Impaired Gas Exchange Ventilation or Perfusion Imbalance

Corneal ulcers and infections Posted: 18 Jan 2011 04:28 AM PST The cornea is the transparent area at the front of the eyeball. A corneal ulcer is an erosion or open sore in the outer layer of the cornea. It is associated with infection. Bacterial keratitis; Fungal keratitis; Acanthamoeba keratitis; Herpes simplex keratitis Causes Corneal ulcers are most commonly caused by an infection with bacteria, viruses, fungi, or parasite. Other causes include: * Abrasions (scratches) * Foreign bodies in the eye * Inadequate eyelid closure * Severely dry eyes * Severe allergic eye disease * Various inflammatory disorders Contact lens wear, especially soft contact lenses worn overnight, may cause a corneal ulcer. Herpes simplex keratitis is a serious viral infection. It may cause repeated attacks that are triggered by stress, exposure to sunlight, or any condition that impairs the immune system. Fungal keratitis can occur after a corneal injury involving plant material, or in immunosuppressed people. Acanthamoeba keratitis occurs in contact lens users, especially those who attempt to make their own homemade cleaning solutions. Risk factors are dry eyes, severe allergies, history of inflammatory disorders, contact lens wear, immunosuppression, trauma, and generalized infection. Symptoms * Eye burning, itching and discharge * Eye pain * Eye redness * Impaired vision * Sensitivity to light (photophobia) * Watery eyes * White patch on the cornea Exams and Tests * Examination of scrapings from the ulcer * Fluorescein stain of the cornea * Keratometry (measurement of the cornea) * Pupillary reflex response * Refraction test * Slit-lamp examination * Tear test * Visual acuity Blood tests to check for inflammatory disorders may also be needed. Treatment Treating corneal ulcers and infections depends on the cause. They should be treated as soon as possible to prevent further injury to the cornea. Patients usually start treatment with an antibiotic that is effective against many bacteria. More specific antibiotic, antiviral, or antifungal eye drops are prescribed as soon as the cause of the ulcer has been identified. Corticosteroid eye drops may be used to reduce inflammation in certain conditions. Severe ulcers may need to be treated with corneal transplantation. Outlook (Prognosis) Untreated, a corneal ulcer or infection can permanently damage the cornea. Untreated corneal ulcers may also perforate the eye (cause holes), resulting in spread of the infection inside, increasing the risk of permanent visual problems. Possible Complications * Loss of the eye * Severe vision loss * Scars on the cornear When to Contact a Medical Professional Call your health care provider if you develop impaired vision, severe light sensitivity, or eye pain. Prevention Prompt, early attention by an ophthalmologist for an eye infection may prevent ulcers from forming. Wash hands and pay very close attention to cleanliness while handling contact lenses. Avoid wearing contact lenses overnight. References Butler FK. The eye in the wilderness. In: Auerbach PS, ed. Wilderness Medicine. 5th ed. St. Louis, Mo: Mosby; 2007:chap 25. source Corneal ulcers and infections

Low blood pressure or hypotension Posted: 18 Jan 2011 04:24 AM PST Definition Low blood pressure or hypotension Low blood pressure, or hypotension, occurs when blood pressure during and after each heartbeat is much lower than usual. This means the heart, brain, and other parts of the body do not get enough blood. See also: Blood pressure Alternative Names Low blood pressure; Blood pressure – low; Postprandial hypotension; Orthostatic hypotension; Neurally mediated hypotension; NMH Causes Blood pressure that is borderline low for one person may be normal for another. The most important factor is how the blood pressure changes from the normal condition. Most normal blood pressures fall in the range of 90/60 millimeters of mercury (mm Hg) to 130/80 mm Hg. But a significant drop, even as little as 20 mm Hg, can cause problems for some people. There are three main types of hypotension: * Orthostatic hypotension, including postprandial orthostatic hypotension * Neurally mediated hypotension (NMH) * Severe hypotension brought on by a sudden loss of blood (shock) Orthostatic hypotension is brought on by a sudden change in body position, usually when shifting from lying down to standing. This type of hypotension usually lasts only a few seconds or minutes. If this type of hypotension occurs after eating, it is called postprandial orthostatic hypotension. This form most commonly affects older adults, those with high blood pressure, and persons with Parkinson’s disease. NMH most often affects young adults and children. It occurs when a person has been standing for a long time. Children usually outgrow this type of hypotension. Low blood pressure is commonly caused by drugs such as: * Alcohol * Anti-anxiety medications * Certain antidepressants * Diuretics * Heart medicines, including those used to treat high blood pressure and coronary heart disease * Medications used for surgery * Painkillers Other causes of low blood pressure include: * Advanced diabetes * Anaphylaxis (a life-threatening allergic response) * Changes in heart rhythm (arrhythmias) * Dehydration * Fainting * Heart attack * Heart failure * Shock (from severe infection, stroke, anaphylaxis, major trauma, or heart attack) Symptoms Symptoms may include: * Blurry vision * Confusion * Dizziness * Fainting (syncope) * Light-headedness * Sleepiness * Weakness Exams and Tests The health care provider will examine you and try to determine what is causing the low blood pressure. Your vital signs (temperature, pulse, rate of breathing, blood pressure) will be checked frequently. You may need to stay in the hospital for a while. The doctor will ask questions, including: * What is your normal blood pressure? * What medications do you take? * Have you been eating and drinking normally? * Have you had any recent illness, accident, or injury? * What other symptoms do you have? * Did you faint or become less alert? * Do you feel dizzy or light-headed when standing or sitting after lying down? The following tests may be done: * Blood cultures to check for infection * Complete blood count (CBC) and other blood tests, including blood differential * ECG * Urinalysis * X-ray of the abdomen * X-ray of the chest Treatment Hypotension in a healthy person that does not cause any problems usually doesn’t require treatment. If you have signs or symptoms of low blood pressure, you may need treatment. Treatment depends on the cause of your low blood pressure. Severe hypotension caused by shock is a medical emergency. You may be given blood through a needle (IV), medicines to increase blood pressure and improve heart strength, and other medicines, such as antibiotics. For more details, see the article on shock. If you have orthostatic hypotension caused by medicines, your doctor may change the dose or switch you to a different drug. DO NOT stop taking any medicine before talking to your doctor. Other treatments for orthostatic hypotension include increasing fluids to treat dehydration or wearing elastic hose to boost blood pressure in the lower part of the body. Those with NMH should avoid triggers, such as standing for a long period of time. Other treatments involve drinking plenty of fluids and increasing the amount of salt in your diet. (Ask your doctor about specific recommendations.) In severe cases, medicines such as fludrocortisone may be prescribed. Outlook (Prognosis) Low blood pressure can usually be treated with success. Possible Complications * Shock * Injury from falls due to fainting Falls are particularly dangerous for older adults. Fall-related injuries, such as a broken hip, can dramatically impact a person’s quality of life. Severe hypotension starves your body of oxygen, which can damage the heart, brain, and other organs. This type of hypotension can be life threatening if not immediately treated. When to Contact a Medical Professional When you have symptoms from a drop in blood pressure, you should immediately sit or lie down and raise your feet above heart level. If low blood pressure causes a person to pass out (become unconscious), seek immediate medical treatment or call the local emergency number (such as 911). If the person is not breathing or has no pulse, begin CPR. Call your doctor immediately if you have any of the following symptoms: * Black or maroon stools * Chest pain * Dizziness, lightheadedness * Fainting * Fever higher than 101 degrees * Irregular heartbeat * Shortness of breath Also call your doctor if you have: * Burning with urination or other urinary symptoms * Cough with phlegm * Inability to eat or drink * Prolonged diarrhea or vomiting Prevention If you have low blood pressure, your doctor may recommend certain steps to prevent or reduce your symptoms. This may include: * Avoiding alcohol * Avoiding standing for a long time (if you have NMH) * Drinking plenty of fluids * Getting up slowly after sitting or lying down * Using compression stockings to increase blood pressure in the legs References Calkins H, Zipes DP. Hypotension and syncope. In: Libby P, Bonow RO, Mann DL, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 37. source Low blood pressure or hypotension

Addison’s disease,Symptoms,Risk factors, treatment Addison’s disease Posted: 18 Jan 2011 04:21 AM PST Definition Addison’s disease Addison’s disease is a disorder that occurs when the adrenal glands do not produce enough of their hormones. Alternative Names Adrenocortical hypofunction; Chronic adrenocortical insufficiency; Primary adrenal insufficiency Causes The adrenal glands are small hormone-secreting organs located on top of each kidney. They consist of the outer portion (called the cortex) and the inner portion (called the medulla). The cortex produces three types of hormones: * The glucocorticoid hormones (such as cortisol) maintain sugar (glucose) control, decrease (suppress) immune response, and help the body respond to stress. * The mineralocorticoid hormones (such as aldosterone) regulate sodium and potassium balance. * The sex hormones, androgens (male) and estrogens (female), affect sexual development and sex drive. Addison’s disease results from damage to the adrenal cortex. The damage causes the cortex to produce less of its hormones. This damage may be caused by the following: * The immune system mistakenly attacking the gland (autoimmune disease) * Infections such as tuberculosis, HIV, or fungal infections * Hemorrhage, blood loss * Tumors * Use of blood-thinning drugs (anticoagulants) Risk factors for the autoimmune type of Addison’s disease include other autoimmune diseases: * Chronic thyroiditis * Dermatis herpetiformis * Graves’ disease * Hypoparathyroidism * Hypopituitarism * Myasthenia gravis * Pernicious anemia * Testicular dysfunction * Type I diabetes * Vitiligo Certain genetic defects may cause these conditions. Symptoms * Changes in blood pressure or heart rate * Chronic diarrhea * Darkening of the skin – patchy skin color * Unnaturally dark color in some places * Paleness * Extreme weakness * Fatigue * Loss of appetite * Mouth lesions on the inside of a cheek (buccal mucosa) * Nausea and vomiting * Salt craving * Slow, sluggish movement * Unintentional weight loss Exams and Tests Tests may show: * Increased potassium * Low blood pressure * Low cortisol level * Low serum sodium * Normal sex hormone levels Other tests may include: * Abdominal x-ray * Abdominal CT scan This disease may also change the results of the following tests: * 17-hydroxycorticosteroids * 17-ketosteroids * 24-hour urinary aldosterone excretion rate * ACTH * Aldosterone * Blood eosinophil count * CO2 * Cortrosyn stimulation test * Potassium test * Renin * Urine cortisol Treatment Treatment with replacement corticosteroids will control the symptoms of this disease. However, you will usually need to take these drugs for life. People often receive a combination of glucocorticoids (cortisone or hydrocortisone) and mineralocorticoids (fludrocortisone). Never skip doses of your medication for this condition, because life-threatening reactions may occur. The health care provider may increase the medication dose in times of: * Infection * Injury * Stress During an extreme form of adrenal insufficiency, adrenal crisis, you must inject hydrocortisone immediately. Supportive treatment for low blood pressure is usually needed as well. Some people with Addison’s disease are taught to give themselves an emergency injection of hydrocortisone during stressful situations. It is important for you to always carry a medical identification card that states the type of medication and the proper dose needed in case of an emergency. Additionally, your health care provider may advise you to always wear a Medic-Alert tag (such as a bracelet) alerting health care professionals that you have this condition in case of emergency. Outlook (Prognosis) With hormone replacement therapy, most people with Addison’s disease are able to lead normal lives. Possible Complications Complications can occur if you take too little or too much adrenal hormone supplement. Complications also may result from the following related illnesses: * Diabetes * Hashimoto’s thyroiditis (chronic thyroiditis) * Hypoparathyroidism * Ovarian hypofunction or testicular failure * Pernicious anemia * Thyrotoxicosis When to Contact a Medical Professional Call your health care provider if: * You are unable to keep your medication down due to vomiting. * You have been diagnosed with Addison’s disease, and you have stress such as infection, injury, trauma, or dehydration. You may need to have your medication adjusted. * Your weight increases over time. * Your ankles begin to swell. * You develop other new symptoms. If you have symptoms of adrenal crisis, give yourself an emergency injection of your prescribed medication. If it is not available, go to the nearest emergency room or call 911. Symptoms of adrenal crisis include: * Abdominal pain * Difficulty breathing * Low blood pressure * Reduced consciousness References Stewart PM. The adrenal cortex. In: Kronenberg H, Melmed S, Polonsky K, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, PA: Saunders Elsevier; 2008:chap 14. source Addison’s disease

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Nurse Jobs: Nurse (Research Nurse / Sr. Research Nurse) Posted: 17 Jan 2011 05:44 AM PST Nurse (Research Nurse / Sr. Research Nurse) Research Nurse - In this role, you will coordinate and conduct research projects and related activities. You may also recruit, screen, and enroll potential survey participants. Sr. Research Nurse - In this role, you will coordinate, direct and implement the nurse care functions within a research project. You may also provide direction to assure optimal compliance with research protocols. Changing the World… Through Discovery, Education and Care Organizational Requirements - Current Registered Nurse licensure - Graduation from an accredited nursing program Research Nurse role requires a minimum of 1 year related experience. Sr. Research Nurse role requires a minimum of 3 years related experience. Job Location Texas Medical Center Department Neurosurgery more information about this jobs Nurse (Research Nurse / Sr. Research Nurse) click here

Childhood Disorders • Signs & Symptoms • Treatments Posted: 17 Jan 2011 05:40 AM PST Types of Childhood Disorders Recognizing and understanding some of the disorders common in children is the first step. Mood Disorders Major depression, manic depressive disorder (also called bipolar disorder) and mania are disorders which cause change in a child’s mood. Depression is considered to be the most common mental disorder. It is often mistaken for “the blues” and therefore goes untreated. Depression is caused by a number of factors, from chemical imbalances to environmental influences to genetics. Major depression causes people to feel hopeless, exhausted and useless. More than changes in mood, major depression can cause problems with sleep, appetite, self-esteem, daily activities and physical health. Manic depressive disorder (bipolar disorder) causes swings from deep depression to abnormal elation or “highs.” Hyperactivity, scattered ideas, easy distraction, irritability and recklessness also occur in bipolar disorder during manic episodes. Anxiety Disorders Certain fears are common in children. But when they don’t go away with time, they may be a sign of anxiety disorders. Anxiety disorders come in many forms and may be experienced differently in each person. However, their common factor is a feeling of constant terror, dread or worry beyond one’s normal reactions to danger. Phobias are irrational fears of objects or situations which cannot be overcome with reasonable explanations or actions. Not to be confused with simple childhood fears that go away with time, like a fear of the dark, phobias are so extreme that they cause major disruption to the victim’s life. Specific phobias are typically fears of particular objects or situations. The most common are fears of animals, fears of heights, fears of enclosed spaces and fears of flying. Social phobias cause people to dread being watched or humiliated while doing something of a social nature, such as eating a meal or giving a speech, due to expectation of negative evaluation. Some people with social phobias fear and avoid any contact with others. People with agoraphobia often have panic attacks and fear being in situations in which they cannot get help or escape. Often, this paralyzing fear causes its sufferers to remain isolated in their homes. Separation anxiety disorder is marked by intense anxiety or panic when separated from parents or other loved ones. This disorder can be so extreme that it disrupts normal activities. Often children with separation anxiety disorder will cling to their parents or stay close wherever they go. They may refuse to play outside, spend the night with a friend, or even go on errands. This disorder is also characterized by physical ailments, such as headaches, nausea and vomiting, and even heart palpitations and dizziness. Separation anxiety can explain why many children refuse to attend school. Conduct disorders are thought to be the single largest group of psychiatric illnesses in young people. Often beginning before teen years, the symptoms of these problems are frequently mistaken for juvenile delinquency or the turmoil of growing up. Some common behaviors include stealing, consistent lying, cruelty, deliberate destruction of property, fighting with or without weapons, or even rape. There are many studies into the biological, psychological and sociological causes of conduct disorders, but like many other disorders, conduct disorders are probably caused by a number of factors. Conduct disorders will not go away with age, and therefore treatment is critical. Attention-Deficit Disorder Attention-deficit disorder (ADD) affects a child’s ability to concentrate, learn and maintain a normal level of activity. Excessive activity, impatience, constant distraction, shifting from one activity to another and restless sleeping are common to ADD. But these behaviors may develop as a result of other problems, like an inability to see or hear adequately, or another physical or emotional illness. A physician should conduct a thorough medical examination to diagnose ADD and/or rule out other possible problems. Autism Autism is the most disabling of pervasive development disorders, a series of disorders that affect intellectual skills; responses to senses; and the ability to communicate. Autistic children fail to develop normal relationships with anyone, including parents. As infants, they may resist affection or consistently cling to someone. As they grow older, they may not seek comfort if they are hurt, and they generally like to play alone. Autistic children have difficulty communicating because they don’t develop language skills. They may not use words correctly, or they may develop a language all their own. Sometimes autistic children go through repetitive body movements. They may become preoccupied with or extremely attached to particular objects. Autistic children usually require order in their environment and usually follow strict routines. Signs and Symptoms Children who suffer from mental or emotional disorders may display one or more of the following behaviors: *Talk of suicide or threats to others *Prolonged feelings of intense tension or anxiety *Sudden changes in eating and/or sleeping habits *Atypical thoughts and speech *Sudden and/or extreme changes in mood and behavior *Withdrawal from friends and family *Loss of interest in favorite activities Loss of energy *Physical ailments that occur seemingly without cause Treatments Mental health professionals offer a wide range of effective therapies and treatments, drawing on significant advances in procedures and technologies. Like mental illnesses in adults, childhood disorders usually require a combination of medication and supportive psychological therapies either in the hospital or on an outpatient basis. Medication is commonly prescribed for childhood disorders and has been proved an increasingly effective tool. This type of treatment requires careful supervision by a physician and is targeted at the chemical imbalances associated with these disorders. Like any drugs, these medications may have side effects. Psychotherapy addresses the emotional response to childhood disorders. Coping with life’s stressful events is especially difficult for children with mental or emotional illness. Psychotherapists help children understand their emotions and deal with their problems in a more confident, healthy way. Supportive therapies include a number of related activities designed to enhance treatment of childhood disorders. The most successful treatments of medication, psychotherapy and supportive therapies are tailored to the individual child’s needs under the close supervision of a psychiatrist – a physician who specializes in childhood disorders. source Childhood Disorders • Signs & Symptoms • Treatments click here

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REACTION TO STRESS AND HOSPITALIZATION Posted: 08 Jan 2011 05:12 PM PST 1-21. “INTRODUCTION” INTRODUCTION The patient who is entering a hospital is under many emotional pressures. Fear of death, disfigurement, pain, or a prolonged illness, and loss of control of the surrounding environment are just a few of the emotional concerns being faced. People react to stress in many ways. The Practical Nurse must be able to recognize the signs and symptoms of stress and identify the coping mechanisms being utilized by the patient in order to provide effective nursing care. 1-22.”FACTORS INFLUENCING WHETHER A PERSON WILL SEEK OR AVOID PROFESSIONAL HELP” FACTORS INFLUENCING WHETHER A PERSON WILL SEEK OR AVOID PROFESSIONAL HELP Some of the factors that influence a person seeking or avoiding professional help are: The degree and extent of symptom distress. Expectation of return to health if treatment is instituted. Fear of diagnostic and treatment procedures. Fear of discovery of serious illness. The self-concept that one is always healthy. “FACTORS CAUSING STRESS IN THE HOSPITAL” FACTORS CAUSING STRESS IN THE HOSPITAL Some of the factors that cause stress in the hospital are: Unfamiliarity of surroundings. Having strangers sleep in the same room. Having to eat cold or tasteless food. Being awakened in the night by the nurse. Loss of independence. Having to eat at different times than usual. Having to wear a hospital gown. Not having the call light answered. Separation from spouse. Separation from family. Financial problems. Isolation from other people. Having an unfriendly roommate. Not having friends visit. Having staff in too much of a hurry to talk, or more importantly, listen. Lack of information. Not having questions answered by staff members. Having nurses or doctors who talk too fast. Nervousness and preoccupation often make it difficult to fully concentrate on what is being said. Needless to say, patients often have plenty on their minds, so it is crucial that you explain things patiently and slowly and be prepared to repeat instructions and explanations. Do not assume that because you have explained something once, your job is done. Not knowing the reasons for (or the results of) treatments. Threat of severe illness. Fear that appearance will be changed after hospitalization. Being hospitalized after an accident and suspecting the worst. Thinking he/she may have cancer. Problems with medications. Having medications cause discomfort (that is., chemotherapy). Not getting relief from pain. Not getting pain medication when needed. “STAGES OF THE ILLNESS EXPERIENCE” STAGES OF THE ILLNESS EXPERIENCE Denial or Disbelief in Being Ill. Patient may avoid, refuse, or even forget needed care. Patient may appear to flee toward health in trying to escape illness. Acceptance of Being Ill. Becomes dependent on health care personnel. Focuses attention on symptoms and the illness. Gradually becomes less dependent. Recovery, Rehabilitation, or Convalescence. May be a short or long period, depending on how much the patient’s life-style must change as a result of the illness. Patient goes through a process of resolving his/her perceived loss or impairment of function. 1-25. “EMOTIONAL RESPONSES TO ILLNESS AND HOSPITALIZATION” EMOTIONAL RESPONSES TO ILLNESS AND HOSPITALIZATION Fear. An emotional response characterized by an expectation of harm or unpleasantness. Usually associated with behavior that attempts to avoid or flee a threatening situation. Patient is usually aware of the specific danger and has some understanding into the reasons for the fear. Common indications of fear include: Tachycardia (rapid heart rate). Dry mouth. Constipation. Hypertension. Increased perspiration. The “fight or flight” reaction (alertness and readiness for action in order to avoid or escape harm). Anxiety. An emotional response characterized by feelings of uneasiness and apprehension of a probable danger or misfortune. Patient who is anxious usually is unaware of the cause of the anxiety. Behaviors are similar to those seen with the fear, but are not usually as dramatic. Because the patient does not know its specific cause, he/she usually focuses on the physiologic symptoms of anxiety, to include: Fatigue. Insomnia. Diarrhea or constipation. Urgency. Nausea. Anorexia. Excessive perspiration. Stress. A state of strain or tension. Occurs in situations, which require an increased and often prolonged effort to adjust. Any factor that disturbs the physical, psychological, or physiological homeostasis of the body may be stressful. As with fear, the body tries to rid itself of the factor causing the stress. Physical signs of stress include: Ulcers. Hair loss. Insomnia. Over Dependency or Feelings of Helplessness. Over dependency is a response characterized by feelings of helplessness while trying to search for help and understanding (to an extent beyond what is considered normal). Helplessness is a response characterized by feelings of being unable to avoid an unpleasant experience. While healthy people may show some degree of dependence on others during illness, this dependence often increases to the point of being harmful to the patient. The over dependent patient may be fearful or angry. 1-26. “CLOSING”>CLOSING There are as many reactions to illness as there are patients. Your kindness and understanding will help your patient to go through the hospitalization experience with a minimum of stress and anxiety. source http://www.brooksidepress.org/Products/Nursing_Fundamentals_1/lesson_1_Section_3.htm#FACTORS%20CAUSING%20STRESS%20IN%20THE%20HOSPITAL

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• Equipment in the NICU
• Travel Nurse Informatics Job
• If your baby had reflux in the NICU,Reflux in infants
• Common conditions treated in the NICU
• Procedure:Urine Collection, 24-Hour Specimen
• Antioxidants and Cancer Prevention: Fact Sheet

Equipment in the NICU Posted: 06 Jan 2011 05:30 AM PST equipment and procedures in the neonatal intensive care unit. Seeing your baby hooked up to machines and covered with wires can be scary, but the equipment is all there to help your baby get well. Monitoring equipment Infants in special care nurseries are continuously monitored to make sure they are healthy. Monitors commonly used include: * Cardiac monitors: These use stickers on the chest connected to wires (called leads) that hook up to a monitor to make sure that baby’s heart is beating at the correct speed and with the correct rhythm. * Respiratory monitors: Often part of the cardiac monitors, these use leads to monitor baby’s breathing rate and pattern. * Pulse oximeters: These wrap around your baby’s wrist or foot and have a red light that monitors the amount of oxygen in the blood. IV Equipment You may be familiar with IVs, or thin tubes that go into the veins to allow staff to infuse fluids or medicines directly into the veins. As part of regular NICU procedures, babies in the NICU may have several types of IV lines. * Peripheral IVs: These are the “regular” IVs that go into a vein for medications or fluids. Peripheral IVs may be in the feet, hands, arms, or scalps of premature babies. Although scalp IVs look scary to parents, they are very common in the NICU since premature babies don’t always have good veins for IVs in their hands and feet. * PICC lines: Percutaneously inserted central catheters, or PICC lines for short, look like regular IVs. They have longer catheters, or tubes, than regular IVs, and travel through the vein into the large veins that empty into the heart. Insertion of these lines is one of the procedures NICU babies commonly undergo. * Umbilical catheters: These are inserted into the umbilical cord stump and travel to the large veins and arteries near the heart. Umbilical lines may be inserted into an artery in the umbilical cord, a vein in the umbilical cord, or both, to allow fluid and medication administration, blood pressure monitoring, painless blood sampling, and other procedures. Respiratory equipment Infants in the NICU may need help to breathe or to keep their blood oxygenated. Respiratory equipment in the NICU may include: * Nasal cannulas: A nasal cannula is a set of small nasal prongs may provide a higher concentration of oxygen than room air. They may also deliver room air at a higher flow, which helps to keep airways open and encourage babies to breathe on their own. * CPAP: Continuous positive airway pressure, or CPAP, is a mask or a special set of nasal prongs placed firmly on baby’s nose to constantly blow air. The constant pressure encourages open airways and reminds babies to breathe, and higher concentrations of oxygen may be used. * Ventilators: If a baby is put on a ventilator, then procedure called intubation will be used to place a special tube called an endotracheal tube in the airway through the mouth or nose. The ventilator, or respirator, is the machine that delivers breaths to babies who cannot breathe on their own or who don’t breathe well. * ECMO: Extracorporeal membrane oxygenation is a highly specialized procedure to oxygenate baby’s blood. ECMO is used only in very sick babies at highly advanced NICUs. With ECMO, the baby’s blood is pumped out of the body so that oxygen can be added and carbon dioxide removed. The blood is then returned to the body. Other equipment While in the NICU, your baby may require additional equipment as well. * Feeding tubes: A feeding tube travels from the mouth (orogastric- called OG) or from the nose (nasogastric- called NG) to the stomach. Infants who are too sick or weak to eat from the breast or from a bottle receive food through these tubes. Inserting the tubes and giving feedings through them are common procedures among premature babies. * Incubators: Premature infants have trouble keeping themselves warm, so incubators are used to provide a warm place for baby to rest. Skin probes constantly measure the baby’s temperature, so he or she doesn’t get too warm or too cold. * Phototherapy: Preemies are more likely to have problems from jaundice. Phototherapy lights, also called bili lights, are special lights that help the baby’s body break down bilirubin, the chemical that causes jaundice. Sources: American Academy of Pediatrics. "Levels of Neonatal Care" Pediatrics 2004 114:1341-1347. Children’s Hospital of Pittsburgh. "Procedures and Equipment in NICU." Accessed November 22, 2008. http://www.chp.edu/CHP/P02358 Children’s Hospital West. "Our Caring NICU Staff." 2008. Accessed November 22, 2008. http://www.memorialwest.com/neonatal/staff.aspx March of Dimes. "Glossary: Common NICU Equipment." October 2008. Accessed November 22, 2008. Nemours Foundation. "When Your Baby’s In the NICU." Accessed November 22, 2008. http://kidshealth.org/parent/system/ill/nicu_caring.html http://preemies.about.com/od/allaboutthenicu/a/NICU2.htm?once=true&

Travel Nurse Informatics Job Posted: 06 Jan 2011 05:17 AM PST Position Description for this Travel Nurse Informatics Job : Nurse Informatics contract assignment. Position is located in the Mid Atlantic region and the project length varies. This is a great opportunity outside of a true clinical setting. Work along with clinicians and analysts to develop and test clinical applications. You’ll serve a project advisor, proposal developer and end user liason. RN Required and Cerner Millennium experience preferred. A great location with lots of history and sites to see when you are not working. Soliant offers a great benefits including health care plans with Blue Cross Blue Shield, 401k, disability and life insurance. In addition you’ll receive a strong compensation plan. For more information contact: Kevin Morris at 800.947.8233 Benefits Travel Nurse Informatics Job : Competitive Salaries. We’re proud to offer some of the most competitive compensation packages in the industry. We’ll even create a custom package to meet your unique needs. Weekly Pay. If you’re tired of the typical long wait between paychecks, you’ll welcome Soliant’s weekly pay system. You’ll be paid every Friday during your assignment and we’ll be glad to deposit your check directly for you. Healthcare Benefits for this Travel Nurse Informatics Job Our health and dental program is not a bare-bones version. You’ll receive the same complete benefits from Blue Cross Blue Shield that all our internal employees enjoy. Matching 401(K). Our 401(k) retirement plan with matching from Merrill Lynch will make investing for your future easy. Paid Personal Housing. Privacy is important to everyone. We understand. That’s why we offer the finest in paid personal housing. Referral Bonus. Earn cash for each new healthcare professional you refer that becomes a part of the Soliant Health family Facility Description Travel Nurse Informatics Job : At Soliant Health, we don’t just fill healthcare jobs, we fulfill dreams. Thousands of dreams every year, for professionals just like you. As a Soliant healthcare professional, you’ll enjoy a personal relationship with a recruiter who is as passionate about your career as you are. Your recruiter works tirelessly to match your personal goals, interests, strengths and professional aspirations with the right job, in the right place. But it doesn’t stop there. Your recruiter is always with you, available for assistance, advice or simply an understanding ear on which you can always count. It’s this consistent, one-on-one attention that sets Soliant Health apart from other healthcare staffing agencies. Well, this and the fact that we go the distance for our healthcare professionals, taking care of every last detail – travel plans, housing and scheduling – so you can focus on your job, and yourself! Location Travel Nurse Informatics Job : Mid Atlantic, Maryland Note: Click the location link above to see a map of this location. The best available map will be displayed depending on if a real City name and Zip Code are posted. Job Title: Travel Nurse Informatics Job Category: Professional: Information Systems/Computers Position Is For: A Travel Assignment Position Posted By: A Facility, Registry, or Staffing Company Posting Expires: February 21, 2011 Contact: Please tell this company you saw their job posting at Absolutely Health Care. (info@soliant.com) Phone: 800.849.5502 for further information Travel Nurse Informatics Job <font size=”1″>http://www.healthjobsusa.com/cgi-bin/search.cgi?action=display&ID=82266036&source=web</font>

If your baby had reflux in the NICU,Reflux in infants Posted: 06 Jan 2011 05:05 AM PST If your baby had reflux in the NICU All babies spit up or throw up now and then. But some do so more often than usual. This is called reflux. Reflux is short for gastroesophageal reflux or GER. Reflux is common among premature babies. Most babies outgrow it after a few months. Only 1 percent of babies are still spitting up after their first birthday. Here’s what happens with reflux: * Food first passes through the mouth and the esophagus into the stomach. (The esophagus is the tube that connects the mouth and the stomach.) * Once the food is in the stomach, it comes back up the esophagus and out of the mouth. Most babies with reflux are less bothered by it than their parents. They grow and develop normally. But for a few babies, reflux is more serious. The baby needs medication to make sure reflux is not dangerous. Feeding tips If your baby had reflux in the NICU, the nurses may have shown you how to feed and position your baby to minimize spit up. These tips may help: * Hold your baby upright during feeding. * Try smaller, more frequent feedings. * Burp your baby often, especially if you are feeding him with a bottle. * Try a different nipple on your baby’s bottle so he swallows less air. * Ask your baby’s health care provider if you can thicken the formula or expressed breastmilk with a small amount of rice cereal. * Keep your baby still after feeding. * Raise the head of your baby’s bed 30 degrees or so. * Keep a stack of cloth diapers or burp cloths handy. Use them to protect your clothes, your baby’s clothes and your furniture. When to call your baby’s health care provider These symptoms may mean that your baby has other problems digesting food: * The spit-up is bright yellow or green. * There is a large amount of spit-up. * Your baby arches his back or cries during feeding. * Your baby vomits with great force (projectile vomiting). source If your baby had reflux in the NICU,Reflux in infants http://www.marchofdimes.com/advocacy/premature_reflux.html

Common conditions treated in the NICU Posted: 06 Jan 2011 04:57 AM PST Conditions treated in the NICU Premature babies and other very sick newborns face some of the same medical issues. Listed below are some medical conditions that may be seen in the NICU. The conditions listed may not be relevant to your baby’s situation. We encourage you to read only what you feel would be helpful to you and your child’s particular circumstances. To find out more information about specific conditions, ask our health experts. Additional information and support for families with babies in the NICU can be found at Share Your Story, the March of Dimes Web site for NICU families. Anemia Premature babies are often anemic. This means that they do not have enough red blood cells. Normally, the fetus stores iron during the latter months of pregnancy and uses it after birth to make red blood cells. Infants born too soon may not have had enough time to store iron. Loss of blood from frequent blood tests also can contribute to anemia. Anemic infants may be treated with dietary iron supplements, drugs that increase red blood cell production or, in some cases, a blood transfusion. Breathing problems Premature babies often have breathing problems because their lungs are not fully developed. Full-term babies also can develop breathing problems due to complications of labor and delivery, birth defects and infections. An infant with breathing problems may be given medicines, a mechanical ventilator to help him breathe, or a combination of these two treatments. Apnea: Premature babies sometimes do not breathe regularly. A baby may take a long breath, then a short one, then pause for 5 to 10 seconds before starting to breathe normally. This is called periodic breathing. It usually is not harmful, and the baby will outgrow it. Premature and sick babies also may stop breathing for 15 to 20 seconds or more. This interruption in breathing is called apnea. It may be accompanied by a slow heart rate called bradycardia. Babies in the NICU are constantly monitored for apnea and bradycardia (often called "A’s and B’s"). Sensors on the baby’s chest send information about his breathing and heart rate to a machine located near the incubator. If a baby stops breathing, an alarm will begin beeping. A nurse will stimulate the baby to start breathing by patting him or touching the soles of his feet. The neonatologist might consider giving the baby medicine or using equipment, such as C-PAP (continuous positive airway pressure; delivery of air to a baby’s lungs through either small tubes in the baby’s nose or through a tube inserted into the windpipe). Bronchopulmonary dysplasia (BPD): This chronic lung disease is most common in premature babies who have been treated for respiratory distress syndromre (RDS) (see below). Babies with RDS have immature lungs. They sometimes need a mechanical ventilator to help them breathe. Some babies treated for RDS may develop symptoms of BPD, including fluid in the lungs, scarring and lung damage. Babies with BPD are treated with medications to help make breathing easier. They are slowly weaned from the mechanical ventilator. Their lungs usually improve over the first two years of life. But some children develop a chronic lung disease resembling asthma. BPD also occasionally occurs in full-term newborns after they have had pneumonia or other infections. Persistent pulmonary hypertension of the newborn (PPHN): Babies with PPHN cannot breathe properly because they have high blood pressure in their lungs. At birth, in response to the first minutes of breathing air, the blood vessels in the lungs normally relax and allow blood to flow through them. This is how the blood picks up oxygen. In babies with PPHN, this response does not occur. This leads to a lack of oxygen in the blood, and sometimes to other complications including brain damage. Babies with PPHN often have birth defects (such as heart defects) or have suffered from birth complications. Babies with PPHN often need a mechanical ventilator to help them breathe. They may be given a gas called nitric oxide through a tube in the windpipe. This treatment may help the blood vessels in the lungs to relax and improve breathing. Pneumonia: This lung infection is common in premature and other sick newborns. A baby’s doctors may suspect pneumonia if the baby has difficulty breathing, if her rate of breathing changes, or if the baby has an increased number of apnea episodes. The doctor will listen to the baby’s lungs with a stethoscope and then do an X-ray to see if there is excess fluid in the lungs. Sometimes the doctor may insert a tube into the lungs to take a sample of the lung fluid. The fluid is then tested to see what type of bacterium or virus is causing the infection, so that the doctor can choose the most effective drug to treat it. Babies with pneumonia are generally treated with antibiotics. They also may need additional oxygen until the infection clears up. Respiratory distress syndrome (RDS): Babies born before 34 weeks of pregnancy often develop this serious breathing problem. RDS is sometimes called hyaline membrane disease. Babies with RDS lack a chemical mixture called surfactant, which keeps the small air sacs in the lungs from collapsing. Treatment with surfactant helps affected babies breathe more easily. Babies with RDS also may receive a treatment called C-PAP (continuous positive airway pressure). The air may be delivered through small tubes in the baby’s nose, or through a tube that has been inserted into his windpipe. As with surfactant treatment, C-PAP helps keep small air sacs from collapsing. C-PAP helps your baby breathe, but does not breathe for him. The sickest babies may temporarily need the help of a mechanical ventilator to breathe for them while their lungs recover. Respiratory syncytial virus (RSV): If your baby was premature, you may be advised to get your baby immunized against respiratory syncytial virus. RSV is a common virus that affects virtually all children before the age of 2. Many babies get only a slight cold from RSV. But RSV can be more serious. Babies who were born prematurely, or who have heart or lung problems, may benefit from medication that helps prevent a severe RSV infection. This medication is called palivizumab (Synagis). It is given in monthly shots usually from fall through spring. Ask your baby’s health care provider if your baby should receive this medication. Congenital heart defects These heart defects are present at birth. They originate in the early part of pregnancy when the heart is forming. Coarctation of the aorta: The aorta is the large artery that sends blood from the heart to the rest of the body. In this condition, the aorta may be too narrow for the blood to flow evenly. A surgeon can cut away the narrow part and sew the open ends together, replace the constricted section with man-made material, or patch it with part of a blood vessel taken from elsewhere in the body. Sometimes, this narrowed area can be widened by inflating a balloon on the tip of a catheter inserted through an artery. Heart valve abnormalities: Some babies are born with heart valves that are narrowed, closed or blocked and prevent blood from flowing smoothly. Some babies may require placement of a shunt (artificial graft) to allow blood to bypass the blockage until the baby is big enough to have the valve repaired or replaced. Patent ductus arteriosus (PDA): PDA is the most common heart problem in premature babies. Before birth, much of a fetus’s blood goes through a passageway (ductus arteriosus) from one blood vessel to another, instead of through the lungs, because the lungs are not yet in use. This passageway should close soon after birth, so the blood can take the normal route from heart to lungs and back. If it doesn’t close, blood doesn’t flow correctly. In some cases, drug treatment can help close the passageway. If that doesn’t work, surgery can also close it. Septal defects: A septal defect refers to a hole in the wall (septum) that divides the two upper or lower chambers of the heart. Because of this hole, the blood cannot circulate as it should, and the heart has to work extra hard. A surgeon can close the hole by sewing or patching it. Small holes may heal by themselves and not need repair at all. Tetralogy of Fallot: In this condition, a combination of four heart defects keeps some blood from getting to the lungs. As a result, the baby has episodes of cyanosis (the skin looks blue due to lack of oxygen) and may grow poorly. New surgical techniques allow early repair of this complex heart defect. Transposition of the great arteries: Here, the positions of the two major arteries leaving the heart are reversed. Each artery arises from the wrong pumping chamber. Surgical advances have enabled correction of this defect in the newborn period. Feeding Experts agree that breast milk provides many wonderful and vital health benefits for newborns, especially premature or sick babies. And it is something only a mom can give her baby. A baby needs good nutrition to grow and become stronger. But she may need to be fed a different way for a while, before she is ready for breast or bottle. Babies who are very small or sick are often fed intravenously (through a vein). A tiny needle is placed in a vein in the baby’s hand, foot, scalp or belly button. She will receive sugar (glucose) and essential nutrients through the vein. As soon as she is strong enough, the baby will be fed breast milk or formula through a tube that is placed through the nose or mouth into the stomach or intestines. This is called gavage feeding. In gavage feeding, the tube may be left in place or inserted at each feeding. Inserting the tube should not bother the baby too much because babies this small generally do not gag. When the baby can suck and swallow effectively, gavage feedings will be stopped, and the baby will be able to breast or bottle-feed. Many babies in NICUs start trophic (minimal) feeds shortly after birth. This is done to stimulate the baby’s intestine until the baby is strong enough to tolerate larger feedings. Hypoglycemia Hypoglycemia is low blood sugar (glucose). It is usually diagnosed in a baby shortly after birth. Babies born to mothers with diabetes have their glucose levels checked regularly to assess for hypoglycemia. Early feeding and an intravenous glucose solution help to prevent and treat hypoglycemia. Intrauterine Growth Restriction (IUGR) A baby with this condition grows more slowly than usual in utero, and is smaller than normal for his gestational age at birth. IUGR is ordinarily diagnosed during pregnancy through an ultrasound. It usually is due to fetal or maternal complications. Upon admission to the NICU, babies are tested to determine possible causes, although this can’t always be determined. Intraventricular Hemorrhage (IVH) IVH refers to bleeding in the brain and is most common in the smallest premature babies (those weighing less than 3 1/3 pounds). The bleeds usually occur in the first four days of life. Bleeding generally occurs near the fluid-filled spaces (ventricles) in the center of the brain. An ultrasound examination can show whether a baby has had a brain bleed and how severe it is. Brain bleeds usually are given a number from 1 to 4, with 4 being the most severe. Most brain bleeds are mild (grades 1 and 2) and resolve themselves with no or few lasting problems. More severe bleeds can cause difficulties for the baby during the hospitalization and possible problems in the future. Some will require careful monitoring of the baby’s development throughout infancy and childhood. Jaundice Babies with jaundice have a yellowish color to their skin and eyes. Jaundice occurs when the liver is too immature or sick to remove a waste product called bilirubin from the blood. Bilirubin is formed when old red blood cells break down. Jaundice is especially common in premature babies and in babies who have blood type incompatibilities with their mothers (such as Rh disease, ABO incompatibility or G6PD disease) Jaundice itself does not usually cause harm to a baby. But if the bilirubin level gets too high, it can cause more serious problems. For this reason, the baby’s bilirubin level is checked frequently. If it gets too high, he is treated with special blue lights (phototherapy) that help the body break down and eliminate bilirubin. Occasionally, a baby will need a special type of blood transfusion called an exchange transfusion to reduce very high bilirubin levels. In this procedure, some of the baby’s blood is removed and replaced with blood from a donor. Keeping warm Babies who are born too small and too soon often have trouble controlling their body temperature. Unlike healthy, full-term babies, they don’t have enough body fat to prevent the loss of heat from their bodies. Babies in the NICU are placed in an incubator or warmer right after birth to help control their temperature. A tiny thermometer taped to the baby’s stomach senses her body temperature and regulates the heat in the incubator. A baby will grow faster if she maintains a normal body temperature (98.6 degrees F.). Macrosomia A condition in which a baby is born with excessive birth weight, that is, 4,500 grams (9 pounds, 14 ounces) or more. This is commonly due to maternal diabetes and may require delivery by cesarean section. These babies are also monitored for hypoglycemia. Necrotizing Enterocolitis (NEC) This potentially dangerous intestinal problem most commonly affects premature babies. The bowel may become damaged when its blood supply is decreased. Bacteria that are normally present in the bowel invade the damaged area, causing more damage. Babies with NEC develop feeding problems, abdominal swelling and other complications. If tests show that a baby has NEC, he will be fed intravenously while his bowel heals. Sometimes damaged sections of intestine must be surgically removed. Retinopathy of Prematurity (ROP) ROP is an abnormal growth of blood vessels in the eye. It occurs only in babies born before 32 weeks of pregnancy. ROP can lead to bleeding and scarring that can damage the eye’s retina (the lining at the rear of the eye that relays messages to the brain). This can result in vision loss. An ophthalmologist (eye doctor) will examine the baby’s eyes for signs of ROP. Most mild cases heal without treatment, with little or no vision loss. In more severe cases, the ophthalmologist may perform laser therapy or do a procedure called cryotherapy (freezing) to eliminate abnormal blood vessels and scars. Both treatments help protect the retina. Sepsis Some babies are admitted to the NICU to determine if they have this potentially dangerous infection of the bloodstream. The infection is caused by a germ which the baby has had difficulty fighting off. Certain lab tests, cultures, and X-rays can help diagnose this condition. These tests may be recommended if your baby has symptoms such as temperature instability, high or low blood sugar levels, breathing problems or low blood pressure. The condition is treated with antibiotics, and the baby is monitored closely for an improvement in symptoms. source Common conditions treated in the NICU http://www.marchofdimes.com/advocacy/inthenicu_conditions.html

Procedure:Urine Collection, 24-Hour Specimen Posted: 06 Jan 2011 04:49 AM PST All 24-hour urine collections shall be collected in the same manner to ensure consistency, safety and non-contamination. Procedure: The order for a 24-hour urine collection shall be entered into Sunrise: The nursing staff shall: · Obtain the appropriate collection container(s) (with or without preservative) · Place the patient’s name on the container(s) (use patient addressograph imprinted labels) · Place the container(s) on ice in a locked area as designated · Obtain the appropriate urine collection device (collection container will be labeled with the patient’s name) – Males will use urinals – Females will use “Fireman’s Caps” · Instruct the patient in use of the urine collection device · Assign a specific nursing staff member to assist with the collection of the urine All collections shall be started at 6:00 a.m., Sunday through Thursday. The assigned nurse shall assure that: · The patient shall void into his/her own device. · The urine shall be emptied into the 24-hour container. · The containers shall remain iced at all times. · Assess output and notify Physician as appropriate. Upon completion of the 24-hour urine collection, the requisitions shall be completed and sent to the laboratory. source Procedure:Urine Collection, 24-Hour Specimen http://www.uth.tmc.edu/uth_orgs/hcpc/procedures/alpha/nur/uc.htm

Antioxidants and Cancer Prevention: Fact Sheet Posted: 06 Jan 2011 04:06 AM PST What are antioxidants?Antioxidants are substances that may protect cells from the damage caused by unstable molecules known as free radicals. Free radical damage may lead to cancer. Antioxidants interact with and stabilize free radicals and may prevent some of the damage free radicals might otherwise cause. Examples of antioxidants include beta-carotene, lycopene, vitamins C, E, and A, and other substances. Can antioxidants prevent cancer?Considerable laboratory evidence from chemical, cell culture, and animal studies indicates that antioxidants may slow or possibly prevent the development of cancer. However, information from recent clinical trials is less clear. In recent years, large-scale, randomized clinical trials reached inconsistent conclusions. What was shown in previously published large-scale clinical trials?Five large-scale clinical trials published in the 1990s reached differing conclusions about the effect of antioxidants on cancer. The studies examined the effect of beta-carotene and other antioxidants on cancer in different patient groups. However, beta-carotene appeared to have different effects depending upon the patient population. The conclusions of each study are summarized below. The first large randomized trial on antioxidants and cancer risk was the Chinese Cancer Prevention Study, published in 1993. This trial investigated the effect of a combination of beta-carotene, vitamin E, and selenium on cancer in healthy Chinese men and women at high risk for gastric cancer. The study showed a combination of beta-carotene, vitamin E, and selenium significantly reduced incidence of both gastric cancer and cancer overall (1). A 1994 cancer prevention study entitled the Alpha-Tocopherol (vitamin E)/ Beta-Carotene Cancer Prevention Study (ATBC) demonstrated that lung cancer rates of Finnish male smokers increased significantly with beta-carotene and were not affected by vitamin E (2). Another 1994 study, the Beta-Carotene and Retinol (vitamin A) Efficacy Trial (CARET), also demonstrated a possible increase in lung cancer associated with antioxidants (3). The 1996 Physicians' Health Study I (PHS) found no change in cancer rates associated with beta-carotene and aspirin taken by U.S. male physicians (4). The 1999 Women’s Health Study (WHS) tested effects of vitamin E and beta-carotene in the prevention of cancer and cardiovascular disease among women age 45 years or older. Among apparently healthy women, there was no benefit or harm from beta-carotene supplementation. Investigation of the effect of vitamin E is ongoing (5). Are antioxidants under investigation in current large-scale clinical trials?Three large-scale clinical trials continue to investigate the effect of antioxidants on cancer. The objective of each of these studies is described below. More information about clinical trials can be obtained using http://www.cancer.gov/clinicaltrials, http://www.clinicaltrials.gov, or the RePORT Expenditures and Results (RePORTER) query tool at http://projectreporter.nih.gov/reporter.cfm on the Internet. The Women's Health Study (WHS) is currently evaluating the effect of vitamin E in the primary prevention of cancer among U.S. female health professionals age 45 and older. The WHS is expected to conclude in August 2004. The Selenium and Vitamin E Cancer Prevention Trial (SELECT) is taking place in the United States, Puerto Rico, and Canada. SELECT is trying to find out if taking selenium and/or vitamin E supplements can prevent prostate cancer in men age 50 or older. The SELECT trial is expected to stop recruiting patients in May 2006. The Physicians’ Health Study II (PHS II) is a follow up to the earlier clinical trial by the same name. The study is investigating the effects of vitamin E, C, and multivitamins on prostate cancer and total cancer incidence. The PHS II is expected to conclude in August 2007. Will the National Cancer Institute (NCI) continue to investigate the effect of beta-carotene on cancer?Given the unexpected results of ATBC and CARET, and the finding of no effect of beta-carotene in the PHS and WHS, NCI will follow the people who participated in these studies and will examine the long-term health effects of beta-carotene supplements. Post-trial follow-up has already been funded by NCI for CARET, ATBC, the Chinese Cancer Prevention Study, and the two smaller trials of skin cancer and colon polyps. Post-trial follow-up results have been published for ATBC, and as of July 2004 are in press for CARET and are in progress for the Chinese Cancer Prevention Study. How might antioxidants prevent cancer?Antioxidants neutralize free radicals as the natural by-product of normal cell processes. Free radicals are molecules with incomplete electron shells which make them more chemically reactive than those with complete electron shells. Exposure to various environmental factors, including tobacco smoke and radiation, can also lead to free radical formation. In humans, the most common form of free radicals is oxygen. When an oxygen molecule (O2) becomes electrically charged or "radicalized" it tries to steal electrons from other molecules, causing damage to the DNA and other molecules. Over time, such damage may become irreversible and lead to disease including cancer. Antioxidants are often described as "mopping up" free radicals, meaning they neutralize the electrical charge and prevent the free radical from taking electrons from other molecules. Which foods are rich in antioxidants?Antioxidants are abundant in fruits and vegetables, as well as in other foods including nuts, grains, and some meats, poultry, and fish. The list below describes food sources of common antioxidants. Beta-carotene is found in many foods that are orange in color, including sweet potatoes, carrots, cantaloupe, squash, apricots, pumpkin, and mangos. Some green, leafy vegetables, including collard greens, spinach, and kale, are also rich in beta-carotene. Lutein, best known for its association with healthy eyes, is abundant in green, leafy vegetables such as collard greens, spinach, and kale. Lycopene is a potent antioxidant found in tomatoes, watermelon, guava, papaya, apricots, pink grapefruit, blood oranges, and other foods. Estimates suggest 85 percent of American dietary intake of lycopene comes from tomatoes and tomato products. Selenium is a mineral, not an antioxidant nutrient. However, it is a component of antioxidant enzymes. Plant foods like rice and wheat are the major dietary sources of selenium in most countries. The amount of selenium in soil, which varies by region, determines the amount of selenium in the foods grown in that soil. Animals that eat grains or plants grown in selenium-rich soil have higher levels of selenium in their muscle. In the United States, meats and bread are common sources of dietary selenium. Brazil nuts also contain large quantities of selenium. Vitamin A is found in three main forms: retinol (Vitamin A1), 3,4-didehydroretinol (Vitamin A2), and 3-hydroxy-retinol (Vitamin A3). Foods rich in vitamin A include liver, sweet potatoes, carrots, milk, egg yolks, and mozzarella cheese. Vitamin C is also called ascorbic acid, and can be found in high abundance in many fruits and vegetables and is also found in cereals, beef, poultry, and fish. Vitamin E, also known as alpha-tocopherol, is found in almonds, in many oils including wheat germ, safflower, corn, and soybean oils, and is also found in mangos, nuts, broccoli, and other foods. Selected References Blot WJ, Li JY, Taylor PR, et al. Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population. J Natl Cancer Inst 1993;85:1483–91. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. The effects of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 1994;330:1029–35. Omenn GS, Goodman G, Thomquist M, et al. The beta-carotene and retinol efficacy trial (CARET) for chemoprevention of lung cancer in high risk populations: smokers and asbestos-exposed workers. Cancer Res 1994;54(7 Suppl):2038s–43s. Hennekens CH, Buring JE, Manson JE, Stampfer M, Rosner B, Cook NR, et al. Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease. N Engl J Med 1996;334:1145–9. Lee IM, Cook NR, Manson JE. Beta-carotene supplementation and incidence of cancer and cardiovascular disease: Women's Health Study. J Natl Cancer Inst 1999;91:2102–6. source Antioxidants and Cancer Prevention: Fact Sheet http://www.cancer.gov/cancertopics/factsheet/prevention/antioxidants

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