nurse.rusari.com

Nursing Resume & Job Search Tips
Surgical Dressings
Nursing Interventions for Pericarditis
Acetabular Fractures for nurse
nursing care with Apendiksitis inflamation
ACUTE LIMPHOSITYC LEUCEMIA

Posted: 30 Apr 2011 07:10 AM PDT

Nursing Resume & Job Search Tips

It is broadly agreed upon in the employment sector that the need for Nursing positions will grow faster
than the national job average for the next few years. This is great news for all you interested in Nursing as a career.

Just like in any growing profession there is the inevitable competition for these very desirable nursing positions.

How do you get a head of the competition?

First…Know your stuff. You have to be good at your job. So learn your job well.

Second…Have confidence in yourself, be proud of what you do.

Third…You need an outstanding Resume built specifically for the Nursing Profession.

Remember you are competing for a job in a profession that is growing and you are competing in the
in the age of the email application process. (That means there are hundreds of resumes sent in by
email for each position advertised.)

Once your training is complete and you begin your job search you are stepping out of the world
of medicine and stepping into the world Of “Marketing and Sales”.

Your Resume has to have all the important Technical aspects of your training and all the applicable
experience that you also have to offer and every bit of relevant education. But your Resume also has
to stand out from the crowd, and it has to quickly grab the attention of the reader.

Another thing to be aware of, as a result of the volume of resumes generally received for an advertised position, Resumes are not typically read all the way through, they are quickly “scanned”.

Did you know that the typical resume is looked at for only about 7 to 8 seconds! Now you see what I mean when I say you have to GRAB the ATTENTION of the READER FAST!

An Outstanding Resume is just as important to your job search as making sure that a patient’s Meds are administered correctly o the patients.

Every situation has it’s challenges whether you are entry level an RN, BSN, whatever your level of education and experience, there is a need to be thorough and yet maintain a quality of Interest in your resume.

Most hiring managers hire nurses based on their experience or knowledge (education if you are new) in a specific area of the nursing profession. Make this stand out when writing your resume.

While detailing your License Qualifications, grants, academic honors, fellowships, scholarships, GPA, your clinical rotations, or your nursing mentorships is an important thing to do while writing your resume, remember also that your resume format, layout, structure, phrasing, and design are just as important!

In many many cases it is a smart thing to have a professional resume prepared for you. A certified resume writer with experience in the Nursing Field can help you get a better job with higher pay much faster than if you wrote it on your own.

If you go with a professional resume here are a couple of things to look out for:

1: Don’t go with a Resume Template. (They don’t work)

2. Go with a Professional Certified Resume Writer, experienced in Nursing,
that will guarantee their product. (if it is good it will be guaranteed)

3. Don’t skimp on your Resume. This is your career. It is important. Treat it like it is
important and don’t go to the $.99 Resume Service. (A cheap resume isn’t worth the price.)

Surgical Dressings

Posted: 29 Apr 2011 08:22 PM PDT

Rapid covering and healing of both acute skin defects and chronic skin defects are important objectives for wound healing. The best way to heal a wound is to close it according to surgical standards as quickly as possible after injury. However, this procedure is limited to those wounds and those anatomical regions that allow both excision and adaptation of wound borders to close the wound by primary intention or per primam (Latin term meaning to close the wound by suturing [or equivalent method] and restructuring of the skin continuity).

In large-surface and deep wounds in which the primary wound closure is not possible or not practicable, the most important issue is to dress the wound with appropriate materials to allow the following: (1) to keep the wound free of infection, (2) to reduce or eliminate pain, (3) to reduce or eliminate all potential factors inhibiting natural healing (eg, dead tissue in burns, superficial fibrosis, necrotic tissue), and (4) to replace or substitute the missing tissue as much as possible.
Wound repair

Wound repair involves the timed and balanced activity of inflammatory, vascular, connective tissue, and epithelial cells. All of these components need an extracellular matrix to balance the healing process. Skin wounds heal by the formation of epithelialized scars of different contraction ability rather than by the regeneration of a true full-thickness tissue. To minimize scar formation and to accelerate healing time, different wound dressings and different techniques of skin substitution have been introduced in the last decades.

Autologous skin grafting in the form of split- or full-thickness skin is still a criterion standard. However, in many patients, this technique may not be practicable for a variety of reasons, and the wound must be allowed to heal by second intention. Moreover, in cases in which skin grafts are used, a new wound is created on the donor side. Thus, eliminating a new wound to close the old one and to close as many tissue defects as possible without the risk of large area infection, necrosis, tissue hypertrophy, and contraction, as well as deformation of wound borders, is a necessity. The next important problem is to reduce or eliminate scar formation, particularly in the field of large-surface wounds.

Traditional management of large-surface or deep wounds involves open and closed methods. In the open method, the wounds are left in a warm, dry environment to crust over, whereas, in the closed method, wounds are covered with different kinds of temporary dressings and topical treatment, including antibiotics, until healing by secondary intention. The early removal of the dead tissue (eg, in burns) reduced pain, the number of surgical procedures, and the length of the hospital stay.

The surgical intervention (ie, tangential excision of partial- or full-thickness wound) followed by wound closure with autografts or temporary dressings is one of the currently used methods. In large-surface, full-thickness wounds, the wound can be excised down to the fat or the fascia, particularly if infection is present. Excision to the fat induces the removal of the subdermal plexus of blood vessels and decreases the take of autografts because this tissue is less vascularized. Excision down to the fascia induces better take of the autografts but has aesthetic disadvantages.

Wound debridement can also be achieved by enzyme digestion of the dead tissues. Proteolytic enzymes (eg, collagenases used topically) allow a more specific destruction of necrotic tissues, while preserving viable dermis and avoiding blood loss, but the treatment can be painful and can increase the risk of local infection. In addition, it takes a long time to achieve a clean wound bed.
Wound coverings

Currently available wound coverings can be divided into 2 categories: (1) permanent coverings, such as autografts, and (2) temporary coverings, such as allografts (including de-epidermized cadaver skin and in vitro reconstructed epidermal sheets), xenografts (ie, conserved pig skin), and synthetic dressings.

Conventional autograft (epidermis and a significant amount of dermis) obtained from healthy skin areas is considered the optimum wound cover in that its viability yields immediate take (incorporation into the wound bed) and resistance to wound infection. However, harvesting of autograft creates a second wound in the healthy tissue, a donor wound. This open wound increases the risk of infection and fluid/electrolyte imbalance. Repeated conventional harvests of autograft from a donor wound site can result in contour defects or scarring. Optimizing the healing of both main wounds and donor wounds becomes a later goal of patient management and the development of different surgical dressings, which can be used based on the principle of phase-adapted wound healing.

Most recently, developed wound dressings are in use only as temporary dressings because of their synthetic or chemical components, limited persistence on the wound surface, and foreign body character.

Primary closure versus second-intention treatment of skin punch biopsy sites was evaluated in a randomized trial.[1] Punch biopsy sites healed by second intention appear at least as good as biopsy sites closed primarily with sutures. Volunteers preferred suturing for 8-mm biopsy sites and had no preference for 4-mm sites. Elimination of suturing of punch biopsy wounds results in personnel efficiency and economic savings for both patients and medical institutions.

The wounds had been dressed with petroleum jelly under an occlusive dressing that consisted of gauze covered by a transparent dressing (Tegaderm; 3M, St Paul, Minn) and were left in place for 3 days. After that time, the gel foam was removed from the second-intention site and both biopsy sites were cleansed with water to remove any exudate. Then, an occlusive transparent dressing was reapplied to both sites. After this initial dressing change, dressings were changed weekly or more often at the volunteers’ discretion until the biopsy sites were completely healed or reepithelialized. Efficient wound dressings can be important for both small and large wounds.

Some of the currently available surgical dressings used in dermatologic and dermatosurgical practice are discussed.
source Surgical Dressings : http://emedicine.medscape.com/article/1127868-overview

Nursing Interventions for Pericarditis

Posted: 29 Apr 2011 08:16 PM PDT

Nursing Interventions for Pericarditis

Pericarditis is a condition in which the sac-like covering around the heart (pericardium) becomes inflamed.

Nursing Interventions: Pericarditis

1. Stress the importance of bed rest,
2. Assist the patient with bathing if necessary.
3. Provide a bedside commode because this method puts less stress on the heart rather than using a bed pan.
4. Place the patient in upright position to relieve dyspnea and chest pain.
5. Provide analgesics to relieve pain and oxygen to prevent tissue hypoxia.
6. Assess the patient's cardiovascular status frequently, watching for signs of cardiac tamponade.
7. Monitor the patient's pain level and the effectiveness of analgesics.
8. Explain all tests and treatments to the patient.
9. Before giving antibiotics, obtain a patient history for allergy.
10. Tell the patient to resume his daily activities slowly and to schedule rest periods into his daily routine for a while.

Acetabular Fractures for nurse

Posted: 29 Apr 2011 08:08 PM PDT

Acetabular Fractures for nurse

* Usually caused by force applied to the femur which is translated to the acetabulum.
* In young adults, acetabular fractures are due to high energy injuries, primarily motor vehicle accidents.
* The majority of patients are evaluated for and have associated injuries that require initial evaluation of the multiple trauma patient.
* There are also minority of patients, which are elderly, and suffer relatively minor trauma causing acetabular fractures.

Pathophysiology

* Fractures maybe caused by direct trauma to the bone.
* Disruption of blood vessel in cortex periostrum.
* Soft tissue bleeding from damage end of bone.
* Hematoma formation
* Bone tissue death
* Necrosis
* Stimulation of inflammatory response vasodilation
* Exudation of plasma
* Increase leukocytes and infiltration of wbc

Signs and Symptoms

* Crepitus
* Deformity
* Pain
* Tenderness at the site
* Swelling
* Loss of function
* Discoloration
* Dislocation of bone
* Bleeding from an open wound with protrusion of bone ends.
* Fever
* Dysfunction
* Hematoma on the site
* Abnormal or decrease sensation of the affected extremity
* Change in size
* Moderate or severe edema joint point
* Dyspnea
* Rapid weal pulse
* Mental confusion apprehension due to hypoxia
* Mental aberration before signs of infection
* Metabolic disturbance

Assessment

1. Remove clothing so that entire extremity may be visualized. Cut clothing along seems when necessary.
2. Assess for neurovascular changes distal to fracture.
3. Assess for change in length, shape or alignment.
4. Support joint extremity at all times; including joints above and below the suspected injury.
5. If fracture is impacted the patient may be able to bear weight and walk for a short period of time after the initial injury.
6. History of simple fall.
7. Decrease range of motion.
8. Affected limb shortened abducted and externally rotated.
9. Greater thochanter may be displaced into the buttock.

Complications

1. Pulmonary embolism
2. Fat embolism
3. Gas gangrene
4. Tetanus
5. Loss of bone substance
6. Soft tissue interposed between bone ends.
7. Infection
8. Loss of circulation
9. Interrupted or improper immobilization
10. Inadequate fixation
11. Necrosis due to fixation devices
12. Metabolic disturbance

Nursing Diagnoses

1. Altered health maintenance
2. Risk for infection
3. Risk for injury
4. Impaired skin integrity
5. Impaired tissue integrity
6. Self-care deficit
7. Impaired physical mobility
8. Activity intolerance
9. Anxiety
10. Pain
11. Fear
12. Disturbed body image

Nursing Interventions

1. Assist the patient or significant others to identify self-care deficits.
2. Develop plan with patient for self-care, adapting, and organizing care as necessary.
3. Assist the patient to maintain and manage usual health practices during period of wellness or when progressive illness.
4. Provide for communication and coordination between the healthcare facility team.
5. Monitor lesion or wound daily for changes.
6. Promote good nutrition with increase protein intake to facilitate healing.
7. Encourage adequate period of rest and sleep.
8. Provide devices that aid in comfort or healing.
9. Discuss importance of early detection and reporting of changes in condition or any unusual physical discomforts and changes.
10. Identify required changes in lifestyle.
11. Encourage verbalization of feeling about pain.
12. Provide comfort measure like backrubbing.
13. Encourage patient to do deep breathing exercises during pain.
source Acetabular Fractures for nurse

nursing care with Apendiksitis inflamation

Posted: 29 Apr 2011 05:32 PM PDT

DEFINITIONS
Apendiksitis is an inflammation that often occurs in the appendix which is a serious case of abdominal surgery that most often occurs.

Aetiology
Apendiksitis a bacterial infection caused by obstruction or blockage due to:

1. Hyperplasia of lymphoid follicles
2. The presence in the lumen of the appendix fekalit
3. Tumors of the appendix
4. The presence of foreign objects such as worms Ascariasis
5. Erosion of the mucosa of the appendix due to parasites such as E. Histilitica.
According to research, epidemiology shows eating low-fiber foods will lead to constipation which can cause apendiksitis. This will increase intra sekal pressure, causing a functional obstruction of the appendix and improve the growth of bacteria flora in the colon.

SIGNS AND SYMPTOMS

Pain felt in the lower quadrant of the abdomen and is usually accompanied by mild fever, nausea, vomiting and loss of appetite. Local tenderness at the point of Mc. Burney pressure when done. Tenderness may be found out.
Degree of tenderness, muscle spasm, and if there is constipation or diarrhea does not depend on the severity of infection and location of the appendix. If the appendix at the back of the caecal circular, pain and tenderness can be felt in the lumbar region; when the tip is in the pelvis, these signs can only diketahuipada rectal examination. Pain at defecation shows that the tip of the appendix close to the bladder or ureter. Kekeakuan existence at the bottom right of the rectum muscle may occur.
Tand Rovsing may arise by the left lower quadrant palpation, which is paradoxical causes pain felt in the lower right quadrant. If the appendix has ruptured, the pain and can be more diffuse; abdominal distension caused by ileus paralitikdan client’s condition deteriorated

COMPLICATIONS
The main complication is apendiksitis perforated appendix, which can progress to peritonitis, or abscess. Incidence of perforation was 105 to 32%. Higher incidence in small children and the elderly. Perforation generally occurs 24 hours after awitan pain. Symptoms include fever with a temperature of 37.7 o C or higher, abdominal tenderness kontinue.

Management

In acute apendiksitis, the best treatment is surgery of the appendix. Within 48 hours must be done. Patients in obsevarsi, rest in Fowler’s position, given antibiotics and are given food that does not stimulate persitaltik, if there is perforated drain given the lower right stomach.
a. Pre operative action, including the hospitalized patients, given antibiotics and compress to reduce the temperature of the patient, the patient was asked to tirabaring and dipuasakan
b. Operative actions; apendiktomi
c. Post operative actions, one day post-surgical clients are encouraged to sit up in bed for 2 x 30 minutes, soft foods the next day and stood upright outside the room, the seventh day of stitches removed, clients go home

ACUTE LIMPHOSITYC LEUCEMIA

Posted: 28 Apr 2011 07:43 PM PDT

ACUTE LIMPHOSITYC LEUCEMIA

A. DEFINITIONS ACUTE LIMPHOSITYC LEUCEMIA

Acute limphosityc leukemia is the proliferation of malignant / malignant limphoblast in bone marrow cells caused by a single core that can be systemic. (Ngastiyah, 1997; Smeltzer & Bare, 2002; Tucker, 1997; Reeves & Lockart, 2002).

B. CAUSE ACUTE LIMPHOSITYC LEUCEMIA

The cause of leukemia acute limphosityc until now not yet clear, probably due to suspected virus (oncogenic viruses) and other factors that may play a role, namely:

1. Exogenous factors

a. X-rays, radioactive rays.

b. Hormone.

c. Chemicals such as benzene, arsenic, sulfate preparations, chloramphinecol, anti-neoplastic agent).

2. Endogenous factors

a. Race (the Jews is more easily affected than black people)

b. Congenital (chromosomal abnormalities, particularly in children with Down syndrome).

c. Hereditary (or twin sisters one egg).

(Ngastiyah, 1997)

C. Pathophysiology ACUTE LIMPHOSITYC LEUCEMIA

Cancer cells produce immature leukocytes / abnormal excessive amounts. This immature leukocytes infiltrated into various organs, including bone marrow and replace the elements of normal cells. Immature lymphocytes proliferate in the bone marrow and peripheral tissue that interfere with normal cell growth. This causes the normal haemopoesis inhibited, resulting in decrease in the number of leucosit, red blood cells and platelets. Cancer cell infiltration into various organs causing pembersaran liver, spleen, limfodenopati, headache, vomiting, and pain in bones and joints. Decrease in the number of red blood cells cause anemia, decrease in the number of platelets facilitate the occurrence of bleeding (echimosis, bleeding gums, etc. epistaksis.). The presence of cancer cells also affect retikuloendotelial system that can cause the body’s defense system, thus susceptible to infection. Existence kaker cells that also interfere with cell metabolism of food shortages. (Ngastiyah, 1997; & Bare Smeltzer, 2002; Suriadi and Rita Yuliani, 2001, Betz & Sowden, 2002).

D. SIGNS AND SYMPTOMS ACUTE LIMPHOSITYC LEUCEMIA

Clinical manifestations of leukemia acute limphosityc include:

1. Colds do not heal

2. Pale, listless, easily stimulated

3. Fever, anorexia, nausea, vomiting

4. Weight loss

5. Ptechiae, epistaksis, bleeding gums, bruising for no reason

6. Bone and joint pain

7. Abdominal pain

8. Hepatosplenomegaly, lymphadenopathy

9. WBC abnormalities

10. Headache

E. DIAGNOSTIC EXAMINATION IN ACUTE LIMPHOSITYC LEUCEMIA

Diagnostic tests are commonly done in children with leukemia acute limphosityc are:

1. Bone marrow examination (BMP / Bone Marrow Punction):

a. Found excessive blast cells

b. Increased protein

2. Peripheral blood examination

a. Pansitopenia (anemia, lekopenia, trombositopneia)

b. Increased serum uric acid

c. Increased copper (Cu) serum

d. Decreased levels of Zinc (Zn)

e. Increased leukocytes can occur (from 20,000 to 200,000 / ?l), but in the form of blast cells / primitive cell

3. Biopsy liver, spleen, kidney, bone to examine the involvement / infiltration of cancer cells to these organs

4. Fotothorax to assess the involvement of the mediastinum

5. Sitogenik:

50-60% of ALL and AML patients have abnormalities in the form:

a. Number of chromosome abnormalities, such as the diploid (2n), haploid (2n-a), hiperploid (2n + a)

b. Increases or loss of chromosomes (delection partial)

c. There are marker chromosomes, which are morphological elements that are not normal components of chromosomes that form a very large to very small

TREATMENT AT ALL

1. Blood transfusion, is usually given when the Hb levels less than 6 g%. In severe thrombocytopenia and massive bleeding, platelet transfusions can be given and if there are signs DIC can be given heparin.

2. Corticosteroids (prednisone, cortisone, dexamethasone, etc.). Achieved remission after the dose is reduced gradually and eventually discontinued.

3. Sitostatika. In addition to the long sitostatika (6 merkaptopurin or 6 mp, methotrexate, or MTX) was used at the same time new and more potent as vinkristin (oncovin), rubidomisin (daunorubycine), cytosine, arabinosid, L asparaginase, cyclophosphamide, or CPA, adriamycin and the like . Sitostatika generally given in combination with prednisone joint. In giving this drug there is often a side effect alopecia, stomatitis, leukopenia, infection or secondary kandidiagis. Berhziti should be more caution when jumiah less than 2.000/mm3 leukocytes.

4. Secondary infection avoided (if possible the patient was isolated in a sterile room).

5. Immunotherapy is the newest way of treatment. Having achieved remission and the number of leukemia cells was low (105 106), Immunotherapy began to be given. Treatment is done by assigning aspesifik immunization with BCG or Corynae bacterium and is intended to form antibodies that can strengthen the immune system. Specific treatment is done by injecting the leukemia cells that have been irradiated. In this way are expected to form specific antibodies against leukemia cells, so that all the pathological cells will be destroyed so that leukemia patients can expect a complete recovery.

6. Treatments.

Each clinic has its own way depending on experience. Generally, treatment directed toward the prevention of relapse and obtain a longer remission. To achieve that state, in principle, the basic pattern of medication use as follows:

a. Induction

Intended to achieve remission, namely the provision of various drugs mentioned above, both systemic and intrathecal until blast cells in bone marrow less than 5%.

b. Consolidation

Namely that the remaining cells no longer multiply rapidly.

c. Rumat (maintenance)

To maintain the remission, as far as dapatnya a long period of remission. Usually done by giving a half dose sitostatika ordinary.

d. Reinduksi

Intended to prevent relapse. Reinduksi usually done every 6 months to 3 drug delivery such as the induction drug for 10 14 days.

e. Prevent the occurrence of central nervous system leukemia.

For this intrathecal MTX was given at the time of induction to prevent meningeal leukemia and cranial radiation as much 2.4002.500 rad. to prevent meningeal leukemia and cerebral leukemia. This radiation is not repeated in reinduksi.

f. Medical imunologik

It is expected that all leukemia cells in the body will vanish altogether, and thus patients can expect a complete recovery.