always think twice: Mei 2011

Selasa, 17 Mei 2011

nurse.rusari.com

Posted: 17 May 2011 03:55 AM PDT

Defibrillation Overview

Defibrillation is the therapeutic use of a significant electrical current delivered over about 6-10 milliseconds to depolarize the heart for the purpose of terminating pulseless VF and VT. Hopefully, the return of a perfusing rhythm occurs thereafter.
The rationale for early defibrillation has been well established. For patients experiencing sudden cardiac death, the chances of a successful defibrillation decreases by 7-10% each minute that the arrest continues. On a more positive note, defibrillation within 2-3 minutes of a sudden cardiac death can resuscitate the majority of victims.
Defibrillation is delivered by either a monitor defibrillator or an AED. The AED is an automatic device, equipped with defibrillator pads, a speaker, removable batteries, and operational buttons (on/off, analyze and shock). A display screen for viewing rhythms is only rarely included in an AED. The AED is a portable light-weight device designed
to be operated with minimal training.

Typically, hand-held paddles and/or hands free pads are standard features of any monitor defibrillator. The monitor defibrillator is able to display and print rhythms, deliver electrical current – synchronous and asynchronous – and often pace transcutaneously.
The standard monitor defibrillator does not analyze rhythms although newer models can have an integrated AED function. Electrical current is adjusted via energy select buttons on the main monitor and/or on the hand-held paddles. Unlike the AED, charging of the paddles is initiated by a charge button on the monitor defibrillator
and/or the paddles.

Causes Of Social Anxiety

Posted: 17 May 2011 02:12 AM PDT

Social anxiety or social phobia has many varied causes, including biological, psychological and social. However, each one may be intertwined so it is hard to specify exacting ones. Though it is not yet known if social anxiety is caused by a genetic disposition or something learned through family social conditioning, it does appear that it can run in the family.

The first group of causes include environmental and social. It is believed by some social phobia experts that it is possible to learn this from the environment in which you are in. It has been suggested that simply interacting and watching others with similar tendencies can be influential. Also, it is possible that overprotective and controlling parents may develop this in their children and fail to recognize the disorder in them because they too suffer from it and consider it to be perfectly normal. Others think that people may develop social phobias based on a negative childhood event, including bullying, public embarrassment and teasing. Such indicators include disfigurement, abuse (sexual and physical), neglect, speech impediments or conflicts within a family.

The second group of causes of social anxiety is thought to be due to psychological or emotional trauma experienced in childhood. The subsequent symptoms may be the direct result of unresolved traumatic experiences such as car accidents, abuse, relationship breakdowns, humiliation or even a natural disaster. The key elements of that are common amongst all people suffering anxiety as a result of traumas include an event or experience that was not expected, the person was not prepared for, and there was little if anything that the person could have done to have pretended it from occurring. However, such traumas can also run deeper, including a poor bonding between the major caregiver and the person during childhood. The person may well have not learned the skills needed to regulate calmness, self-soothing and focus during stressful events.

The third social anxiety cause is biological in nature, including biochemical reactions, the structure of the brain and the possibility of the disorder having been inherited genetically. In genetical inheritance, most researchers believe that the main part of the disorder is born out of inhibited behavior. Young babies with such a disposition are quick to show stress and fear of unfamiliar situations and people, and as they grow into teenagers and adults, their risk for getting social phobia increases. Also, studies have shown that it may also have something do with the section of your brain that controls fears (amygdale). Through CAT scans, doctors have found that people with this disorder have an excess amount of activity in the amygdale and too little in the prefrontal brain cortex. Biochemically speaking, more studies indicate that an imbalance in the serotonin levels in the brain, dopamine, GABA and neurotransmitters may be to blame.

The most common group that social anxiety disorder sufferers fall into is the second. Each and everyday, many people, young and old, experience traumas, some of which they may well put behind them for many years, or at least they believe, but somewhere inside of them, they have not learned to cope with the resulting trauma, but in fact pushed the emotional side 'under the carpet' or so to speak. When this happens it is essential to get medical support and treatment. Such traumas as abuse, rape and other experiences can develop from social anxiety to include even post-traumatic shock disorder, which can attack any person at any time in their lives. It may manifest itself many years later, even after the trauma has since been apparently forgotten.
Though there are many cause of social anxiety phobias, the bottom line is that the result is an unnatural fear of social interaction and a lowered self-esteem that can not only hinder a person's ability to function in everyday situations, but in some cases hinder the person's ability to simply live a normal existence outside of their home. Sometimes the disorder is so debilitating that the person cannot even carry on regular daytime activities. If you or anyone you suspect may have this disorder, there is no shame in asking for medical help. This does not have to be a lifelong affliction, nor is it normal because someone else you know is dealing with it by pushing it away. Your family doctor is your best source of relief in this regard.

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Senin, 16 Mei 2011

nurse.rusari.com

Low Salt Diets And Your Health Problems
Anxiety Attacks: How an International Pharmacy Can Help
Acknowledge Your Depression

Low Salt Diets And Your Health Problems

Posted: 16 May 2011 02:20 AM PDT

In my opinion salt free diets are amongst the worst type of diets there are. I like my food to be properly salted and spiced before I eat. This doesn't mean that I liberally shake the salt shaker over my food every time I sit down to a meal. It just means that when I cook I add the right amount of salt for my food to taste good. If I go to a restaurant I taste my food first to see whether I need a little added salt, I don't go and start shaking the salt over my dish the minute it's put in front of me. Now that's a bad habit and will ruin even the most glorious dishes.

Unfortunately, for people who suffer from certain medical conditions they have no choice but to stick with these salt free diets. These conditions can include high blood pressure or hypertension as it can be called, kidney disease, impaired liver functions, and also people with heart problems.

People who are overweight should also stay away from too much salt intake. But if you suffer from something like a hypothyroid condition, or cystic fibrosis should not reduce your salt intake and therefore salt reduced diets would not be good for you. In the case of people with a hypothyroid condition iodized salt may be their only form of iodine and should not be stopped.

If you sweat a lot, or live in a hot and humid place then you shouldn't really reduce your salt intake as your body will lose salt through your sweat. In actuality you really shouldn't go on any salt free diets unless you're instructed to by your doctor.

However if you are required to go on salt free diets there is still some hope left as it is mainly table salts that are bad for you. Salts, otherwise known as sodium, which don't contain chloride like MSG, or baking soda are good for you.

You should also be able to include in your diet such foods as pastas, rice, oats, and fresh fruits and vegetables Additionally, although you should ideally stay away from pre-packaged and processed foods, you can look into the ones that are labeled "salt free", or "low sodium". These can fit very nicely into your salt free diets although you should always ask your doctor first before changing your diet.

If you are on low salt diets though there are some foods that you should really avoid and these can include processed meats, butter, most processed and pre-packaged foods, along with cereals, ketchup and cheese. Table salt is naturally, a no-no. You really wouldn't want to blow your low salt diets by including this item into your meals!

Anxiety Attacks: How an International Pharmacy Can Help

Posted: 16 May 2011 02:09 AM PDT

At some point in life, almost everyone experiences anxiety. Perhaps you feel uncomfortable in the moments leading up to an important test, maybe you get the jitters the night before your wedding, or perhaps you have a case of the butterflies before you get up to speak in front of a group. This transient anxiety is simply a part of life, and while it is sometimes exacerbated by stress, it always goes away.

This kind of normal social anxiety is very different from the anxiety experienced by those with an anxiety disorder. According to the National Institute of Mental Health (NIMH), “Anxiety disorders affect about 40 million American adults age 18 years and older (about 18%) in a given year.” Anxiety disorders can be debilitating for those who suffer from them, as well as to family members and loved ones.

What Are Anxiety Disorders?

In a sense, “anxiety disorder” is an umbrella phrase for a number of more specific psychiatric disorders. According to the NIMH, anxiety disorders include panic disorder, post-traumatic stress disorder, social anxiety disorder, obsessive-compulsive disorder, specific phobias, and generalized anxiety disorder. Although these are distinct conditions, the one thing they have in common is a sense of fear and dread that is disproportionate to the actual events taking place.

The symptoms of an anxiety attack can depend upon the type of disorder. According to the NIMH, panic disorder is “characterized by sudden attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain, or smothering sensations.”

Treatment for Anxiety Disorders

Some anxiety disorders respond well to a type of psychotherapy called cognitive-behavioral therapy. This can help alleviate the “self-talk” that contributes to the escalation of an anxiety attack. Systematic desensitization therapy often works well for people with phobias, as it gradually exposes them to that which they fear and lessens their negative reactions.

Virtually all anxiety disorders can be treated with pharmaceuticals, either alone or in conjunction with psychotherapy. Antidepressants are often useful in treating panic disorder and generalized anxiety disorder, particularly those that are selective serotonin reuptake inhibitors (SSRIs). Brand name drugs like Prozac, Zoloft, and Paxil are examples of SSRIs.

There are also pharmaceuticals specifically for anxiety, such as the generic drugs buspiron, diazepam, and lorazepam. Brand name pharmaceuticals include Klonopin, Buspar, and Ativan.

The Role of an International Pharmacy

Although an online pharmacy isn’t meant to replace a mental health professional’s diagnosis and treatment of anxiety attacks, it can serve a much-needed purpose: access to the pharmaceuticals that can make life bearable for those who suffer. Those with anxiety disorders often can’t go out of the house or are ashamed of their condition. They often end up self-medicating with illicit drugs or alcohol. With skilled doctors and licensed pharmacists, an international pharmacy can help those in need get the help they deserve.

Acknowledge Your Depression

Posted: 16 May 2011 02:05 AM PDT

Depression is an illness and needs to be acknowledged as such. It is not a reason to be ashamed. The reason so many people fail to seek help for their depression is that they are ashamed. Unfortunately, this is one of the feelings associated with depression anyway and makes the illness difficult to acknowledge.

If you are constantly feeling particularly low, well-meaning friends might tell you to "snap out of it" or even start to get irritated by your mood. Your depression will feed off this negativity and you start to wonder why you can't just "snap out of it". You then start to feel that there's something wrong with you because it should be so easy and it's just "not right" that you feel so bad all the time. Well, it's not right and there is something wrong with you. You have a medical condition and you deserve treatment in the same way as any other patient. If you had a cold for six months would you ignore it and hope it would pass? No, you would dose yourself up with anything you could find and maybe see a doctor to find out if there's an underlying reason for it to last so long.

Depression is sadness that lasts too long. Everyone is sad at some point in their lives but depression is more than that. It is a feeling that you can't bring yourself up from the bottom. In the end you give up trying. People start to avoid you. You feel worse. You need to find external help to treat the problem in the same way as you would if you had a long-lasting cold. You could try herbal remedies – there are some in your pharmacy – or you could see your doctor. There may be an underlying physical cause for your depression.

If your doctor cannot help you they may refer you for counselling. Don't be embarrassed to go for counselling but do make sure you are comfortable with your counsellor. If not, try another one. Counselling should not be discounted because you don't feel comfortable with your first choice of practitioner. In everyday life you will naturally find that you get on with some people and clash with others. You cannot afford to have a personality clash with your counsellor. On the other hand you must be sure that it is a personality clash and not just that you don't agree with what they are saying. A general rule is to go with your instincts. If you like the person and seemed to get on well in the first couple of sessions then stick with it because they might just have touched on the root cause of your problem.

In some cases, acknowledging depression may be difficult because you have lived with it so long that you don't know whether it is depression or not. If you have grown up with depression it is possible not to realise that you are actually depressed because you have no concept of how normal people should feel. You may feel angry all the time or you may feel like going to the middle of an empty field and simply screaming. You may feel anxious, have trouble sleeping or even sleep too much. You may think that your family would be better off without you (and actually believe that to be true) and may have considered running away or suicide. You may worry about death all the time (yours or someone else's) and not let yourself be happy just in case…… (or even "I must enjoy this now in case……….."). If you are feeling any or all of the above then you need to consider talking to someone. Even if it is just a friend or family member to start with, they may be able to advise you and encourage you to seek professional help.

Once you have acknowledged that you have depression please remember that it is a medical condition and can be cured. You don't have to feel this way for ever. Nobody actually thinks of you the way you think they do. Talk to someone. Seek and accept help and you will find that there is a different way of seeing life.

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Kamis, 05 Mei 2011

nurse.rusari.com

NURSING DIAGNOSIS VS. MEDICAL DIAGNOSIS

Posted: 04 May 2011 06:22 PM PDT

NURSING DIAGNOSIS VS. MEDICAL DIAGNOSIS

What is the difference between a medical diagnosis and a nursing diagnosis?
A medical diagnosis deals with disease or medical condition. A nursing diagnosis deals with human response to actual or potential health problems and life processes. For example, a medical diagnosis of Cerebrovascular Attack (CVA or Stroke) provides information about the patient's pathology. The complimentary nursing diagnoses of Impaired verbal communication, risk for falls, interrupted family processes and powerlessness provide a more holistic understanding of the impact of that stroke on this particular patient and his family – they also direct nursing interventions to obtain patient-specific outcomes.

What is the best nursing diagnosis to use for my patient with congestive heart failure (or any other) medical diagnosis?
Using a medical diagnosis alone does not provide enough information to accurately diagnosis a patient from a nursing perspective. A holistic nursing assessment is critical for you to identify the potential nursing diagnoses. A medical diagnosis may be a related (or etiologic) factor for a nursing diagnosis, but you must identify defining characteristics of a nursing diagnosis during your assessment; it is impossible to make an accurate nursing diagnosis strictly from a medical diagnosis.

Does NANDA-I provide a list of nursing diagnoses that go along with the most common medical diagnoses?
There are several books that use this format. However, we believe the individual nursing assessment is critical to the accurate nursing diagnosis for a patient. It can be helpful to consider nursing diagnoses that tend to cluster with a particular medical diagnosis. However, if nurses only use a "list" of nursing diagnoses with a particular medical diagnosis, they are missing the uniqueness of the patient for whom they are providing care – that is the risk of this approach. A nursing diagnosis must always be related to each individual patient's nursing assessment, or we risk misdiagnosis and inappropriate interventions. Remember that patient safety demands accurate nursing diagnosis!
click here for view source NURSING DIAGNOSIS VS. MEDICAL DIAGNOSIS

NURSING DIAGNOSIS BASICS

Posted: 04 May 2011 06:08 PM PDT

NURSING DIAGNOSIS BASICS

What is a nursing diagnosis?
A nursing diagnosis is a clinical judgment about individual, family, or community experiences and responses to actual or potential health problems and life processes.

Why use nursing diagnosis?
A nursing diagnosis is used to determine the appropriate plan of care for the patient. The nursing diagnosis drives interventions and patient outcomes, enabling the nurse to develop the patient care plan. Nursing diagnoses also provide a standard nomenclature for use in the Electronic Health Record, enabling clear communication among care team members and the collection of data for continuous improvement in patient care.

Why doesn't NANDA International provide a list of its diagnoses on its website?
There is no real use for simply providing a list of terms – to do so defeats the purpose of a standardized language. Unless the definition, defining characteristics, related and/or risk factors are known, the label itself is meaningless. Therefore, we do not believe it is in the interest of patient safety to produce simple lists of terms that could be misunderstood or used inappropriately in a clinical context.
Should all of nursing practice related to patient care be named with nursing diagnoses?

Not all nursing interventions or actions are based on nursing diagnosis. Nurses intervene on conditions described by medical diagnoses as well as nursing diagnoses. We do not rename medical diagnoses or terms to create actual nursing diagnosis.
How specific should each nursing diagnosis be?
Specificity – or granularity – differs by concept. It is important to look at each diagnosis based on the level of evidence available in the literature and to stay clinically focused in decision-making.
click here for more question about NURSING DIAGNOSIS BASICS

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Minggu, 01 Mei 2011

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The Cardiac Cycle

Posted: 01 May 2011 05:49 AM PDT

The Cardiac Cycle

A complete cardiac cycle occurs with each audible 'lub-dub' that is heard with a
stethoscope. During this heartbeat, both atria simultaneously contract followed soon
after by the contraction of the ventricles. Systole is the contractile phase of each
chamber while diastole is the relaxation phase. During the cardiac cycle, the atria and
the ventricles each have periods of both systole and diastole.
The purpose of the cardiac cycle is to effectively pump blood. The right heart delivers
deoxygenated blood to the lungs. Here oxygen is picked up and carbon dioxide is
breathed off. The left heart delivers oxygenated blood to the body. Normally, the
volume of blood ejected by the right ventricle to the lungs is about the same as the
volume ejected by the left ventricle. A mismatch in volumes ejected by the ventricles
(i.e. right ventricle pumps more blood than the left ventricle) can result in heart failure.

De-oxygenated blood enters the right side of the heart via the vena cava and is ejected through
to the lungs where oxygen is replenished and carbon dioxide diffuses out to the lungs.
Oxygenated blood enters the left side of the heart and is subsequently delivered to the body.
The synchronized actions of the atria and the ventricles are coordinated to maximize
pumping efficiency. This sequence of events is worth considering. Rhythm
disturbances can greatly impair this synchrony, resulting in a less effective cardiac cycle.
For simplicity, we'll consider the events that lead to the ejection of blood from the right
ventricle into the lungs beginning at the end of atrial diastole. These events mirror
those of the left heart.
The tricuspid valve closes during ventricular systole – otherwise, it remains open. At
end atrial diastole and ventricular diastole, an open tricuspid valve provides a channel
between the right atrium and the right ventricle. As a result, blood flows into both the
right atrium and the right ventricle simultaneously. The ventricle receives up to 85% of
its blood volume during this period.
Prior to ventricular systole, the atrium contracts. Since the atrium is about 1/3 the size
of the ventricle, an atrial contraction only contributes an additional15-35% of blood
volume to the ventricle. This 'topping up' of the ventricle by the atrium is called atrial
kick. Note that the conclusion of atrial systole coincides with the end of ventricular
diastole.
After ventricular end-diastole, the ventricle enters systole and contracts forcefully, . As
the pressure within the ventricle increases, the tricuspid valve closes to ensure forward
blood flow. Very soon after, the pulmonic valve opens as pressure within the ventricle
becomes greater than pulmonary artery pressure. Blood is then ejected into the
pulmonary arteries.
As blood is ejected, ventricular pressure falls. When ventricular pressure is below the
pulmonary artery pressure, the pulmonic valve closes to prevent back flow of blood
into the right ventricle. As mentioned in chapter one, the closure of the AV valves
(tricuspid and mitral valves) normally produces the S1 heart sound. The closure of the
semilunar valves (pulmonic and aortic valves) produces the S2 heart sound.
While ventricular systole ejects blood into either the pulmonary or systemic vascular
systems, ventricular diastole is at least as important. Without a sufficient period of
diastole, systole is ineffective. During diastole, the ventricles relax. But in relaxing, the
ventricles open to regain their pre-contractile size, effectively dropping the chamber
pressure below that of the vena cava. As a result, blood is drawn into the ventricle
during ventricular (and atrial) diastole. Then the cardiac cycle begins again.
And this cardiac cycle is repeated over 100,000 times daily! Remarkable.

source The Cardiac Cycle http://www.skillstat.com/mce.htm

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