NURSING As A Profession

The profession is a calling that requires special knowledge, skill, and preparation.

An occupation that requires advanced knowledge and skills and that grows out of society’s needs for special services.

Criteria of Profession:
To provide a needed service to society.
To advance knowledge in its field.
To protect its members and make it possible to practice effectively.

Characteristics of a Profession:
A basic profession requires an extended education of its members, as well as a basic liberal foundation.
A profession has a theoretical body of knowledge leading to defined skills, abilities, and norms.
A profession provides a specific service.
Members of a profession have autonomy in decision-making and practice.
The profession has a code of ethics for practice.

NURSING >is a discipline involved in the delivery of health care to society.
>is a helping profession
> and is service-oriented to maintain the health and well-being of people.
>is an art and a science.

NURSE - originated from a Latin word NUTRIX, meaning to nourish.

Characteristics of Nursing.
Nursing is caring.
Nursing involves close personal contact with the recipient of care.
Nursing is concerned with services that take humans into account as physiological, psychological, and sociological organisms.
Nursing is committed to promoting individual, family, community, and national health goals in its best manner possible.
Nursing is committed to personalized services for all persons without regard to color, creed, social or economic status.
Nursing is committed to involvement in ethical, legal, and political issues in the delivery of health care.


Personal Qualities of a Nurse:
Must have a Bachelor of Science degree in nursing.
Must be physically and mentally fit.
Must have a license to practice nursing in the country.
A professional nurse, therefore, is a person who has completed a basic nursing education program and is licensed in their country to practice professional nursing.

Roles of a Professional

1. Caregiver/ Care provider
The traditional and most essential role
functions as nurturer, comforter, provider
“Mothering actions” of the nurse
provides direct care and promotes the comfort of the client
activities involve knowledge and sensitivity to what matters and what is important to clients
show concern for client welfare and acceptance of the client as a person

2. Teacher
provides information and helps the client to learn or acquire new knowledge and technical skills
encourages compliance with prescribed therapy.
promotes healthy lifestyles
interprets information to the client

3. Counselor
helps client to recognize and cope with stressful psychological social problems; to develop and improve interpersonal relationships, and to promote personal growth
provides emotional, intellectual, and psychological support
Focuses on helping a client to develop new attitudes, feelings, and behaviors rather than promoting intellectual growth.Encourages the client to look at alternative behaviors, recognize the choices, and develop a sense of control.

4. Change agent
initiate changes or assist clients to make modifications in themselves or in the system of care.

5. Client advocate
Involves concern for and actions on behalf of the client to bring about a change.
Promotes what is best for the client, ensuring that the client’s needs are met and protecting the client’s rights.
Provides explanation in the client's language and supports the client's decisions.

6. Manager
makes decisions, coordinates activities of others, allocates resources
Evaluate care and personnel
plans, gives direction, develops staff, monitors operationsgiveshe rewards fairly, and represents both staff and administration as needed.

7. Researcher
participates in identifying significant researchable problems
participates in scientific investigation and must be a consumer of research findings
must be aware of the research process, language of research, a sensitive to issues related to protecting the rights of human subjects.

Expanded role of the nurse

1 Clinical Specialist- is a nurse who has completed a master’s degree in a specialty and has considerable clinical expertise in that specialty. She provides expert care to individuals, participates in educating health care professionals and ancillary staff, acts as a clinical consultant, and participates in research.


2. Nurse Practitioner- is a nurse who has completed either a certificate program or a master’s degree in a specialty and is also certified by the appropriate specialty organization. She is skilled at making nursing assessments, performing P. E., counseling, teaching, and treating minor self-limiting illnesses.


3. Nurse-midwife- a nurse who has completed a midwifery program; provides prenatal and postnatal care and delivers babies to women with uncomplicated pregnancies.


4. Nurse anesthetist- a nurse who completed the course of study in an anesthesia school and carries out the pre-operative status of clients.


5. Nurse Educator- A nurse, usually with an advanced degree, who works in clinical or educational settings, teaches theoretical knowledge, clinical skills, and conducts research.


6. Nurse Entrepreneur- a nurse who has an advanced degree and manages a health-related business.


7. Nurse administrator- a nurse who functions at various levels of management in health settings; responsible for the management and administration of resources and personnel involved in giving patient care.

Fields and Opportunities in Nursing

1. Hospital/Institutional Nursing – a nurse working in an institution with patients

Example: rehabilitation, lying-in, etc.

2. Public Health Nursing/Community Health Nursing – usually deals with families and communities. (no confinement, OPD only)

***Example: brgy. Health Center


3. Private Duty/Special Duty Nurse – privately hired


4. Industrial/Occupational Nursing – a nurse working in factories, offices, companies


5. Nursing Education – nurses working in a school, a review center, or in hospitals, a CI.

6. Military Nurse – nurses working in a military base.


7. Clinic Nurse – nurses working in a private and public clinic. A profession that requires special knowledge, skill, and preparation.

8. Independent Nursing Practice – private practice, BP monitoring, home service.

Additional Educational Material Resources

Career Nursing Paths, Role of a Nurse...

Nurse's Responsibility in Your Role 

What do Nurses Do ? 

Types of Nurses

NURSING As A Profession....#Nurse#NurseLife#RegisteredNurse#NursingCommunity#NursingCare#NursingEducation#FutureNurse#NurseAdvocate#HealthcareHeroes#NursingSkills#NurseHumor#CompassionateCare#ClinicalNurse#NurseSupport#NursingSpecialties

Use of Lidocaine Jelly (Urojet) for Foley Insertion

Central Line Dressing Change Demonstration

Cardiovascular Medications

How to Safely Take off PPE, Selected Equipment: PAPR and Gown

How to Safely Put on PPE, Selected Equipment: N95 and Gown

Critical Care Nursing: Basics of EKGs Module 1

Emergency Department Nursing: Initial Patient Assessment Module 1

Coffee, Conversation and Teachable Moments.....See Below...

NANDA International Blog: Coffee, Conversation and Teachable Moments

American Nurse's Association ......

Handle With Care Fact Sheet

ANA's Handle with Care campaign is intended to develop and implement a proactive, multi-faceted plan to promote the issue of safe patient handling and the prevention of musculoskeletal disorders among nurses in the U.S. Through partnerships and mobilization of ANA-related groups, nursing organizations, research experts, academic centers, and health care systems, the campaign seeks to educate, advocate, and facilitate change from traditional practices of manual patient handling to emerging, technology-oriented methods. The Handle with Care campaign seeks to reshape the professional and disciplinary dimensions of nursing, influence the mindset of the health care industry, and inform federal/state policy by highlighting how safe patient handling produces benefits to patients and the nursing workforce.

Nursing World Site....

Nursing Practice and Musculoskeletal Disorders (MSDs)

• Patient handling tasks are recognized as the primary cause for musculoskeletal disorders among the nursing workforce. Of primary concern are back injuries and shoulder strains which can both be severely debilitating.
• A variety of patient handling tasks exist within the context of nursing care, such as lifting, transferring, and repositioning patients, and, are typically performed manually.
• Patient handling tasks most frequently associated with low back pain: lifting and forceful movements.
• Continuous, repeated performance of these activities throughout one's working lifetime results in the development of musculoskeletal disorders.
• The physical environment of the health care setting also contributes to work-related musculoskeletal disorders. Configurations of and area within patient rooms and the placement of furniture and treatment equipment (e.g., critical care unit monitors, ventilator machines) can limit the space needed for patient handling situations.
• Proper body mechanics is a "myth." Traditionally taught to student nurses to counteract the physical stress of patient handling, such as lifting, so-called "proper" body mechanics do not translate well to nursing practice. Early findings of body mechanics studies were based on static loads (i.e., boxes with handles) and primarily focused on men. Further, body mechanic methods primarily concentrate on the lower back for lifting and do not account for other vulnerable body parts involved in other types of patient handling tasks, such as lateral transfers from gurney to bed along a horizontal plane

A Profession at Risk

• Compared to other occupations, nursing personnel are among the highest at risk for musculoskeletal disorders. The Bureau of Labor Statistics lists RNs sixth in a list of at-risk occupations for strains and sprains that included nursing personnel, with nurses aides, orderlies and attendants (first); truck drivers (second); laborers (third); stock handlers and baggers (seventh); and construction workers (eighth).
• Additional estimates for the year 2000 show that the incidence rate for back injuries involving lost work days was 181.6 per 10,000 full-time workers in nursing homes and 90.1 per 10,000 full-time workers in hospitals, whereas incidence rates were 98.4 for truck drivers, 70.0 for construction workers, 56.3 for miners, and 47.1 for agriculture workers.
• Lower back injuries are also the most costly musculoskeletal disorder affecting workers. Studies of back-related workers compensation claims reveal that nursing personnel have the highest claim rates of any occupation or industry.
• Research on the impact of musculoskeletal injuries among nurses:
  • 52 percent complain of chronic back pain 1;
  • 12 percent of nurses "leaving for good" because of back pain as main contributory factor 2;
  • 20% transferred to a different unit, position, or employment because of lower back pain, 12 percent considering leaving profession 3;
  • 38 percent suffered occupational-related back pain severe enough to require leave from work 4; and
  • 6 percent, 8 percent, and 11 percent of RNs reported even changing jobs for neck, shoulder and back problems, respectively. 5

Effectiveness of Safe Patient Handling Equipment & Devices

• The development of assistive patient handling equipment and devices has essentially rendered the act of strict "manual" patient handling unnecessary as a function of nursing care.
• Assistive patient handling equipment and devices control the ergonomic hazard associated with patient handling by technologically "engineering out" the energy/force imposed onto the nurse worker during the act of lifting, transferring or repositioning patients.
• Application of assistive patient handling technology fulfills an ergonomic approach within nursing practice by designing and fitting the job or workplace to match the capabilities and limitations of the human body.
• A growing number of health care facilities have incorporated patient handling technology and have reported positive results. Injuries among nursing staffs have dramatically declined since implementing patient handling equipment and devices along with an institutional commitment to the safest available methods. As a result, the number of lost work days secondary to injury and staff turnover has declined. Cost-benefit analyses have also shown that assistive patient handling technology successfully reduces workers' compensation costs for musculoskeletal disorders.

Patient Benefit

• The weight of adult patients requiring lifting averages 169 lbs. (range 91-387 lbs.). Weights and sizes of patients can vary significantly, particularly considering geriatric patient populations.
• The potential for patient injury, such as falls and skin tears, as a consequence of a manual handling mishap is reduced by using assistive equipment and devices. They provide a more secure process for lifting, transferring, or repositioning tasks. Patients are afforded a safer means to progress through their care. Moreover, any anxiety patients may feel with having a person susceptible to injury perform the task can be relieved and increase confidence with the use of assistive equipment.
• Using assistive patient handling equipment contributes to patient comfort. Patients are less subjected to awkward or forceful handling that can be experienced when lifting, transferring, or repositioning is done manually. Rather than manipulating a patient's body parts, equipment and device parts are manipulated.
• Patient dignity is protected by using assistive equipment and devices. A patient's self-esteem and privacy can be compromised during difficult patient handling situations when performed manually. The use of technology for such circumstances can offer a considerate way of completing patient handling tasks that respects a patient's sense of dignity.
• Assistive patient handling equipment can be selected to match a patient's ability to assist in their own movement, thereby promoting the expression of patient autonomy Read more here...

Regulation/Legislation

• The Occupational Safety and Health Administration (OSHA) promulgated a standard intended to protect workers from ergonomic hazards, such as patient handling. In March 2001, Congress repealed the OSHA standard and ordered that the agency cease all work related to the standard.
• In March 2003, federal OSHA released its "Guidelines for Nursing Homes - Ergonomics for the Prevention of Musculoskeletal Disorders." In these "Guidelines," which are not requirements, OSHA recommends that "manual lifting of patients be minimized in all cases and eliminated when feasible."
• Legislation was introduced in three states in 2003 but was not enacted. For the latest updates, seehttp://nursingworld.org/gova/state/2003/ergo.pdf

Resources

• ANA's Handle with Care Campaign Web site: Handle With Care
• ANA Position Statement - "Elimination of Manual Patient Handling to Prevent Work-Related Musculoskeletal Disorders"
  http://nursingworld.org/readroom/position/workplac/pathand.htm
• ANA Brochure - "Preventing Back Injuries: Safe Patient Handling and Movement" 
• Nelson, A., Fragala, G., Menzel, N. (2003). "Myths and Facts About Back Injuries in Nursing" American Journal of Nursing, 103: 2.
• Nelson, A. et al (2003). "Safe Patient Handling and Movement." American Journal of Nursing, 103: 3.
• Patient Safety Center of Inquiry, Tampa Veterans' Health Administrationwww.visn8.med.va.gov/patientsafetycenter
• OSHA's voluntary ergonomics guidelines for the prevention of musculoskeletal disorders in nursing homes www.osha.gov/ergonomics/guidelines/nursinghome/final_nh_guidelines.html

References

1. Nelson, A. State of the science in patient care ergonomics: Lessons learned and gaps in knowledge. Presented at the Third Annual Safe Patient Handling and Movement Conference. March 5, 2003, Clearwater Beach, FL.
2. Stubbs D.A., Buckle P.W., Hudson M.P., Rivers P.M., & Baty D. (1986). Backing out: nurse wastage associated with back pain. International Journal of Nursing Studies, 23, 4: 325-336.
3. Owen, B.D. (1989). The magnitude of low-back problem in nursing. Western Journal of Nursing Research, 11, 2: 234-242.
4. Owen, B.D. (2000). Preventing injuries using an ergonomic approach. AORN Journal, 72, 6: 1031-1036.
5. Trinkoff, A.M., Lipscomb, J.A., Geiger-Brown, J., Storr, C.L., Brady, B.A. (2003). Perceived physical demands and reported musculoskeletal problems in registered nurses. American Journal of Preventive Medicine, 24, 3: 270-275.

New Online Forum for Nurses.....

New Online Forum for Nurse Practitioners

Nurse Practitioner Head to Toe Assessment...Great Video!!

Knee Pain Illustration....

How to create focus in the chaos.....

While driving home today, I was distracted by the commotion outside my car. Tractor trailers were banging and clanging quickly past me. On the sidewalk, construction workers were shouting to one another. Radios and car horns were invading my quiet space. I was having a hard time concentrating and my mind was racing. Then I realized it: This reminded me of a busy day on a nursing unit!

We’ve all had experiences like these: getting interrupted while calculating medication dosages, being called to the telephone during patient teaching, or hearing a bed alarm and rushing away from talking to a family member about a loved one. And it can get a bit chaotic and stressful!

One way to decrease distraction is through positive affirmations. Stating positive declarations can create greater focus and concentration, and give you a sense of balance. Taking time out each day to sit quietly, breathe and state mantras to yourself can have a deep impact on your happiness, peace of mind and health.

Research has shown that stating mantras has positive effects on stress reduction. In a 2007 study conducted at Duke Medical Center, researchers found significant reductions in stress and negative emotions in participants who used meditation techniques that focused on mantras.

When you do this, you quiet the mind. You create a space that is free from disruption. And then, with practice, you can call upon this state of mind at any point during a busy shift.

Picture this: You have been running all day. Patient after patient needs you. The older gentleman in 312A fell down. Your chronic pain patient in 316B will not lay off the call bell. Any time you think you have five minutes to sit down and chart, another person is calling your name. This has been the longest shift of your life.

Instead of creating more stress, anxiety and disappointment by focusing on the hours ahead, try something different. Take a deep breath and say to yourself: “I have the strength and energy to see this through. I enjoy helping others.” Repeat this until you stand up, ready to give that final medication and discharge that last patient—feeling revitalized and ready to go!

Make time each day, either in the morning or the evening, to quietly state affirmations. Take a slow and deep breath in and out through your nose between each of the affirmations. Become aware of how you feel and start to notice any shifts in energy, mood or stress levels.

Here are some statements I use that can help you get started:

• I am exactly where I need to be as my journey in life reveals itself to me.
• I honor my mind, body and soul and treat each aspect of my being with respect.
• I am a confident, knowledgeable and successful role model as I inspire others to be the same.
• I know great joy and peace and therefore have wonderful energy.
• My speech is a form of love.
• I am limitless in my capacity for joy, healing and happiness.
• I will achieve perfect balance and be successful in all that I take on.
•  

You can add some of your own affirmations as you become comfortable with the process.

Taking the time to sit quietly with your own positive thoughts will greatly affect your life. You’ll create a way to cope with distraction during your busy days. You’ll generate a calmer presence by slowing down and breathing with yourself. You deserve great happiness, peace and love in your life. Make room for yourself!

 Source Link-How to create focus in the chaos....

Elizabeth Scala, MSN/MBA, RN, is a health and wellness coach who owns Living Sublime Wellness, a company that provides holistic coaching for mind, body and spirit. She coaches nurses and caregivers who are stressed, burned out and overwhelmed to make time for self-care and healthy balance in their busy lives. Scala offers a holistic newsletter and supportive monthly calls. Visit livingsublimewellness.com for more details.

Nursing Career Outlook for the next few years......

Keeping up with job market news in the nursing field can quickly make you wish you had a career advisor to untangle the mixed messages—a tough job market, yet understaffing at hospitals and clinics; a looming shortage, yet potential students being turned away from schools.

Here, we throw the word “crisis” out the window and provide some quick, simple facts and projections about the job market today and tomorrow, along with answers to the questions you’ve been asking.

What will the job market look like in 10 years?

The need for both RNs and LPNs is expected to grow like never before—by 21 to 22 percent between 2008 and 2018. What is particularly interesting is that these jobs will be in various fields, not just in long-term care and geriatrics. As medical procedures advance, nurses are needed to care for patients who are recovering from previously fatal diseases and conditions.

How does the current shortage compare to ones in the past?

The last time the United States experienced a significant nursing shortage was in 1965. It’s predicted that in 2025, there will be a shortage that rivals that of the one in 1965. In fact, it’s estimated that we will be short twice the amount.

How is the nursing field faring in the recession compared to other job markets?

Healthcare facilities across the U.S., including hospitals, long-term care and clinics, added 21,000 jobs in November 2009. In that same month, 85,000 people in other fields lost their jobs.

Why can’t some new nurses find jobs?

Currently there is a job vacancy rate of more than 8 percent, and yet some nurses can’t find jobs. One reason may be that these nurses are new and inexperienced. Will the powers-that-be invest money into orienting them and accepting them into the fold? Seems the smart ones will, considering these nurses are going to be an essential part of the team 15 years from now!

Why are people being turned away from nursing school when there’s a significant shortage looming?
Almost 50,000 potential nurses were refused entry into BSN and graduate nursing programs in the 2008-09 academic year due to the lack of resources


—instructors, space and clinical sites. If you’re a seasoned nurse, what this means is that if you’ve been harboring a secret desire to go into teaching, there’s no time like the present. Instructors are needed in the classrooms and in the clinical areas.


Can I still be a bedside nurse while teaching?
Some nurses work part-time as floor nurses and part-time as clinical instructors. These nurses get paid to help educate the next generation of nurses while maintaining the job they’ve always loved.
Why are some hospitals struggling with staffing problems?


The nurse staffing problem isn’t just the lack of new nurses, but the mobility of the new graduates. Apparently, 13 percent of new RNs change jobs after just one year and 37 percent would like to. Considering how much it costs to recruit nurses and to teach them the ropes, this could result in significant dings in the annual staffing budgets. According to a 2005 report, it costs almost $3,000 to hire a new nurse.

Why is it important to find the right job and stick with it when there are so many specialties to explore?
Above all else, it’s best for the patients. For example, good staffing increases a surgical patient’s chance of survival by 7 percent. There’s no better reason out there for nurses and administrators to work toward maintaining a good staff.



What can nurses do to help fill the ranks?
Don’t feel helpless—speak up. If you feel you would make a good teacher, don’t keep wondering if you should do it—do it! There are various ways to add to your education, from going to a traditional classroom to taking online courses. If you work in a hospital that doesn’t offer clinical space for nursing students, propose it. The more students we have out there, the better it will be for all of usReferences:
Originating Source and full owner of this article from:http://scrubsmag.com/
http://centerforamericannurses.org/displaycommon.cfm?an=1&subarticlenbr=20

Vasculitis-Prevention, Diagnosis, and Management....

 

 

  Vasculitis is an inflammation and necrosis of the blood vessels, leading to hemorrhage, ischemia, and infarction.. Treatment of the condition is entirely dependent on the extent of the disease. In many instances, cutaneous vasculitis is a self-limited condition, relieved by leg elevation, avoidance of standing, and therapy with non-steroidal anti-inflammatory drugs (NSAIDs). However, more extensive or severe disease can prove more difficult to manage.

Treatment of vasculitis should begin with a confirmatory diagnosis to eliminate conditions with a similar appearance. A tissue biopsy may confirm diagnosis of cutaneous vasculitis, and can sometimes be used to identify the type of immunoglobin involved. Once a diagnosis is confirmed histologically, other organ systems should be evaluated to identify potential causative factors.

The first and preferred treatment for cutaneous vasculitis should always be avoidance of triggers known to exacerbate the condition, such as excessive standing, infection, or drugs.  For mild recurrent or persistent disease, colchicine and dapsone are first-choice agents.

Severe cutaneous disease requires treatment with systemic corticosteroids or more potent immunosuppression (azathioprine, methotrexate, or cyclophosphamide are typical treatments). A combination of corticosteroids and cyclophosphamide is required therapy for systemic vasculitis, which is associated with a high risk of permanent organ damage or death. Intravenous immunoglobin or plasmapheresis may be useful in the treatment of severe, refractory vasculitis, or in patients who have contraindications to traditional immunosuppression.

New biologic therapies that act via cytokine blockade or lymphocyte depletion, such as the tumor necrosis factor-α inhibitor infliximab and the anti-B-cell antibody rituximab, respectively, appear to offer some benefit in certain settings, such as connective tissue disease and anti-neutrophil cytoplasmic antibody-associated vasculitis.

This is article 3 in a series of four articles pertaining to vasculitis.  To read the additional articles click title link, or  click here.

.
Vasculitis is the inflammation of blood vessels. There are many types of vasculitis. Diseases in which vasculitis is a primary process are called primary systemic vasculitides. Vasculitis may also occur as a secondary feature in other rheumatic diseases and syndromes
WHAT YOU NEED TO KNOW ABOUT VASCULITIS What is vasculitis? Vasculitis is a general term that refers to the inflammation of blood vessels. When blood vessels become inflamed, they can only react in limited ways. They may become weakened, stretch and increase in size, or become narrow – even to the point of closing off entirely. What are the consequences of vasculitis? In an extreme situation, when a segment of a blood vessel becomes weakened, it may then stretch and bulge (called an “aneurysm”). The wall of the blood vessel can become so weak that it ruptures and bleeds. Fortunately, this is a very rare event. If a blood vessel becomes inflamed and narrowed, blood supply to that area may be partially or completely eliminated. If collateral blood vessels (thought of as alternate routes of blood supply) are not available in sufficient quantity to carry the blood to such sites, the tissue supplied by the affected blood vessels will die. This is called infarction. Because vasculitis can occur in any part of the body, any tissue or organ can be at risk. Who is affected by vasculitis? Vasculitis can affect people of all ages from childhood to adulthood. There are some types of vasculitis that occur in certain age groups more than others. What are the causes of vasculitis? Vasculitis may occur secondary to an identified underlying disease or trigger. Occasionally, an allergic reaction to a medicine may trigger vasculitis. Vasculitis can sometimes develop in conjunction with an infection. Usually in these cases, the infection causes an abnormal response in the person’s immune system, damaging the blood vessels. Viral hepatitis (a type of liver infection), is a specific infection that can be associated with vasculitis. Vasculitis may also be related to other diseases of the immune system that the patient had for months or years. For example, vasculitis could be a complication of rheumatoid arthritis, systemic lupus erythematosus, or Sjögren’s syndrome. In many cases though, the causes of vasculitis are not known. These diseases are collectively sometimes referred to under the broad heading of primary forms of vasculitis. In such settings, the appearance and location of the vasculitis often behaves in a distinct way allowing it to be diagnosed as a unique type of vasculitis and is given a specific name. What are the types of primary vasculitis? There are many types of primary vasculitis including disease entities such as Wegener’s granulomatosis, microscopic polyangiitis, Henoch-Schönlein purpura, polyarteritis nodosa, Kawasaki disease, giant cell arteritis, Takayasu’s arteritis, and Behçet’s disease. Some are named after doctors (Wegener, Takayasu, Kawasaki) who were among those to provide the best original descriptions of the illness or are named based on features seen on biopsies (giant cell arteritis, angiitis, arteritis nodosa) of affected tissues or blood vessels. Although most of these are systemic (or generalized) vasculitides where the vasculitis may affect many organ systems at the same time, they often differ a great deal among each other. Some of the primary systemic vasculitic diseases may be quite mild and require little or even no treatment. Other forms may be severe, affecting critical organs and, if left untreated, may lead to death within days or months. Some forms of primary vasculitis may be restricted in their location to certain organs (these are called isolated forms of vasculitis). Examples include vasculitis that only occurs either in the skin, eye, brain (isolated CNS vasculitis) or certain internal organs. What are the symptoms of vasculitis? Because any organ system may be involved, an enormous number of symptoms are possible. If the skin is involved, there may be a rash. If nerves suffer loss of blood supply, there may initially be an abnormal sensation followed by a loss of sensation. Vasculitis in the brain may cause a stroke, or in the heart may result in a heart attack. Kidney inflammation usually is not associated with symptoms and is detected by the doctor by examination of the urine. This is important to recognize as inflammation in the kidneys can lead to kidney failure unless promptly detected. Sometimes the symptoms are nonspecific. When inflammation is present in the body, we tend to respond in ways that tell us that we are not well, but those responses may not be unique to vasculitis at all. For example, along with the symptoms mentioned previously, a person with vasculitis may also have a fever or experience loss of appetite, weight loss and loss of energy. How is vasculitis treated? Treatment depends entirely upon the diagnosis, the organs that are affected, and the severity of the vasculitis. When vasculitis represents an allergic reaction, it may be “self limiting,” or will go away on its own and not require treatment. There are other instances also where minimal to no treatment is required and the person can be closely observed. In instances where critical organs such as the lungs, brain or kidneys are involved, the outlook is less positive and aggressive and timely treatment is necessary. For most forms of systemic vasculitis, treatment generally includes corticosteroid medications (prednisone is the most commonly prescribed). For some forms of vasculitis, treatment must also include another immunosuppressive medication used in combination with the prednisone. Some of these medications are chemotherapy agents like those used to treat cancer, but are given in doses considerably lower than people with cancer may receive. The goal of this type of chemotherapy is to suppress the abnormal immune response that has led to blood vessel damage. What is the outlook for people with vasculitis? The outlook for a person who has vasculitis will vary with the type of vasculitis that is present, what organs are being affected, how severe the vasculitis is, and how the person responds to treatment. Knowing the type of vasculitis allows the doctor to predict the likelihood of illness severity and outcome. Prior to the time of available treatment, people with severe vasculitis may have had anticipated survival of only weeks to months. However, today with proper treatment, normal life spans are possible. The success of therapy is related to prompt diagnosis, aggressive treatment and careful follow-up to be sure that side effects from medications do not develop. Once vasculitis is under control (often referred to as “remission”), medications may be cautiously withdrawn, with the hope that the patient will sustain a long remission, independent of treatment. Because some forms of vasculitis can recur (referred to as a “relapse”) after a period of remission, it is very important for patients with vasculitis to remain under the care of a knowledgeable physician.

Diabetes Animation...Maintaining Blood Glucose Homeostasis.....

Adherence to Post MI Medications

Stroke Risk Associated With Diet Quality, Energy Intake Overall.....

 

Clinical Context...

Undernutrition before birth, as well as in infancy, childhood, and adulthood, is associated with an increased risk for stroke in later life. However, the mechanism of increased stroke risk is poorly understood.

In addition, overnutrition also increases stroke risk. The likely mechanism is by hastening the onset of obesity, hypertension, hyperlipidemia, and diabetes. The objective of this review by Hankey was to describe recent evidence regarding the effects of nutrition on stroke risk.

Study Synoposis and Perspective

The overall quality of a person’s diet and the balance between caloric intake and caloric expenditure appear to be more important determinants of stroke risk than the actual foods and nutrients consumed, according to a new review published in the January 2012 special issue of the Lancet Neurology.

In general, the 2 biggest threats to health and risk of stroke are overeating and excess salt, author Graeme J. Hankey, from Royal Perth Hospital, Perth, Western Australia, writes.

"These behaviors are a normal response by people to an abnormal environment," Dr. Hankey notes. "Our living environments have become more conducive to consumption of energy and less conducive to expenditure of energy in developed and increasingly in developing regions."

He writes that between 1970 and 2008, the incidence of stroke in high-income countries fell by 42%, probably as a result of increased public awareness about the dangers of high blood pressure, high cholesterol, and cigarette smoking.

But in poorer countries, the incidence of stroke increased by more than 100% during this period. This rise coincided with food and lifestyle changes associated with industrialization and urbanization.

Small Number of Trials

In his review, Dr. Hankey examines the evidence linking nutrition and diet to the risk of stroke. He searched PubMed articles published in English from 1970 to October 2011, using a variety of search terms.

The review included a small number of randomized trials and large observational and epidemiological studies.

He found that the findings from these studies were diverse, owing to the fact that most were epidemiological and therefore "prone to substantial methodological challenges of bias, confounding, and measurement error."

For example, one observational study found that a high intake of a healthy diet was associated with an increased risk of stroke, whereas another observational study found just the opposite.

Dr. Hankey's review also revealed the following effects of individual foods and beverages on the risk of stroke:

• Fish: 3 servings a day associated with a 6% lower risk of stroke
• Fruits and vegetables: >5 servings a day associated with a 26% lower risk of stroke
• Meat: Each daily serving associated with a 24% increased risk of stroke
• Reduced-fat milk: associated with a lower risk of stroke vs full-fat milk
• Chocolate: High consumption associated with a 29% lower risk of stroke
• Coffee: 3 to 4 cups per day associated with a 17% lower risk of stroke
• Tea: ≥3 cups per day associated with a 21% lower risk of stroke
• Sugar-sweetened beverages: high intake associated with increased obesity, diabetes, metabolic syndrome, and coronary heart disease
• Whole grains: high intake associated with a 21% lower incidence of cardiovascular events
• Rice: intake not associated with risk of stroke
•  

"Further research is needed to improve the quality of evidence relating to the association of many nutrients, foods, and dietary patterns with stroke risk," Dr. Hankey suggests.

This requires adequately powered, large randomized trials with carefully described patient populations and interventions. The outcomes of such trials should also distinguish first-ever and recurrent stroke, as well as ischemic and hemorrhagic stroke, and their different etiologies.

Dr. Hankey also suggests that population-wide salt reduction programs led by governments and with industry cooperation could be highly cost effective.

"In the USA, modest, population-wide reductions in dietary salt of up to 3 g per day…are projected to reduce the annual number of new cases of stroke by 32,000 to 66,000, similar to the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels," he writes.

Dr. Hankey told Medscape Medical News that he hopes his study will stimulate conclusive studies "by means of large, randomized controlled trials of the effect of dietary nutrients, foods, and patterns on stroke and its pathological and etiological subtypes."

The current evidence associating dietary nutrients, foods, and patterns with stroke is generally suboptimal for providing reliable conclusions about causality, he reiterated.

"The effect of only a few supplements on stroke risk have been studied by means of large, randomized controlled trials, and all of those have shown no benefit of antioxidant vitamins, B-vitamins, and calcium supplements in preventing stroke, despite large, more suboptimal, epidemiological studies claiming they should be beneficial," he said.

Best Diet Still Uncertain

Commenting on this study for Medscape Medical News, Eugene Storozynsky, MD, a cardiologist from the University of Rochester Medical Center, Rochester, New York, said that he agrees with Dr. Hankey's conclusions.

"This is a good review of the literature as to what role diets and their components would have on reducing stroke, and what it tells us is that there still is a lot of uncertainty about the best diet. One study suggests benefit of a certain food or strategy, the other may come to the opposite conclusion," Dr. Storozynsky said.

The take-home message here is as Dr. Hankey notes, Dr. Storozynsky continued. "We need rigorously done randomized controlled trials to really monitor the long-term effects of diets and nutrients, rather than observation studies that look at individual factors, to see whether or not there is any benefit to adopting certain strategies."

Dr. Storozynsky also noted what he considers to be an important omission from Dr. Hankey's review.

"This review did not look at the effect of exercise and how it affects nutrition or stroke results. Does routine daily exercise mitigate the effect of intermittent poor eating? Exercise definitely needs to be part of the equation," he said.

Helmi L. Lutsep, MD, from the Oregon Stroke Center at Oregon Health Science University in Portland, added, "My quick read of the article suggests that it is a very nicely written, comprehensive review of our current knowledge regarding nutrition and stroke."

Dr. Lutsep, who is also a spokesperson for the American Academy of Neurology, added, "While I haven't seen all of these pieces summarized in one place before, I don't think that the article provides novel observations."

Dr. Hankey reports that he was the principal investigator of the VITAmins TO Prevent Stroke (VITATOPS) trial and has financial relationships with Sanofi-Aventis, Johnson & Johnson, Bristol-Myers Squibb, Boehringer Ingelheim, Bayer, and Pfizer Australia. Dr. Storozynsky and Dr. Lutsep have disclosed no relevant financial relationships. 

 

Lancet Neurol. 2012;11:66-81. Abstract

The National Stroke Association provides a comprehensive discussion for patients about stroke prevention.

Study Highlights

• On the basis of a literature review, the reviewer noted the following findings:
  • Vitamin A supplementation increases all-cause mortality risk.
  • β-carotene supplementation increases cardiovascular and all-cause mortality risks and does not prevent stroke.
  • Vitamin C supplementation does not prevent stroke.
  • Vitamin E supplementation increases all-cause mortality risk and does not prevent stroke.
  • Although folic acid supplementation does not prevent stroke in populations with high folate intake, deficiency in regions of low folate intake may be a causal and treatable risk factor for stroke.
  • Vitamin D deficiency is associated with hypertension, cardiovascular disease, and stroke, but to date, supplementation has not been shown to prevent cardiovascular events. Randomized trials are underway.
  • Salt supplementation by 5 g per day is linked to a 23% increase in stroke risk (95% confidence interval [CI], 6 - 43).
  • Although decreasing salt intake has not been shown to reduce stroke risk, lowering consumption by 2 g per day is associated with a 20% decrease in cardiovascular events (95% CI, 1 - 36), and lower salt intake is also linked to blood pressure reduction.
  • Potassium supplementation by 1 g per day is associated with an 11% reduction in the risk for stroke (95% CI, 3 - 17), but supplementation is not proven to prevent stroke.
  • Potassium supplementation by 0.8 g per day is associated with a decrease in blood pressure by 5/3 mm Hg.
  • Calcium supplementation exceeding 0.5 g per day is linked to a 31% increase in the risk for myocardial infarction (95% CI, 2 - 67), does not prevent stroke, and may actually increase stroke risk.
  • High intake of total fat, trans fats, and saturated fats is not associated with an increased risk for stroke, and reduced total fat intake does not lower stroke risk.
  • High intake of plant n-3 polyunsaturated fats is associated with a reduced risk for stroke.
  • Marine n-3 polyunsaturated fat supplementation lowers cardiovascular events and death by 8% (95% CI, 1 - 15), but in a randomized trial, it did not reduce stroke risk.
  • High intake of carbohydrates with high glycemic index and glycemic load is associated with increased blood glucose levels, body weight, and stroke mortality.
  • High fiber intake is linked to lower blood pressure, blood glucose levels, and low-density lipoprotein cholesterol levels.
  • High protein intake is not associated with stroke risk.
  • High intake of a healthy diet was linked to an increased risk for stroke in one observational study and a reduced risk for stroke in another observational study.
  • High intake of an unhealthy diet was linked to an increased risk for stroke and a population-attributable risk for stroke of 19% (99% CI, 11 - 30).
  • In women, a prudent diet or Dietary Approaches to Stop Hypertension (DASH)–style diet is associated with a lower risk for stroke, and a Western diet is linked with a higher risk for stroke.
  • In women, the Mediterranean diet is associated with lower risks for stroke, cardiovascular disease, cardiovascular mortality, and all-cause mortality.
  • The effects of a vegetarian diet and a Japanese diet on stroke risk are unknown.
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Clinical Implications

• Reliable evidence from randomized trials suggests that dietary supplementation with antioxidant vitamins, B vitamins, and calcium does not reduce the risk for stroke. However, methodologic limitations of studies to date preclude firm conclusions regarding the effect of many other nutrients on stroke risk.
• Less reliable evidence suggests that stroke can be prevented by prudent diets; Mediterranean or DASH-type diets; diets that are low in salt and added sugars and high in potassium; and diets that meet, but do not exceed, energy requirements. The overall quality of dietary pattern and the balance between energy intake and expenditure seem to affect stroke risk to a greater extent than individual nutrients and foods.

Borrowed from- Medscape Education Clinical Briefs

Organizing your Day:

An efficient nurse will fill her pockets like they are the drawers in her kitchen–everything has a place!

After it’s used–put it back in that place so you aren’t digging madly in your pockets when you need something!

As a Student:

0645-0715: Get report

Check labs, meds and orders (in that order)

0715-0830: Assessment

Chart assess. and vitals

0830: Accuchecks?

Breakfast

Meds with Breakfast?

Chart

Bath

Treatments

0900-1000: Meds passed

1130: Accuchecks?

1200: Lunch

1300-to end of clinical day: Finish charting, teaching,

treatments and help nurses

As a Nurse:

Come in early!

0630: Check kardex/chart/med card

0645: Get report, check orders while waiting, check meds and labs

0730: Vital signs done w/ aid beginning with most critical and those leaving the floor.

Assessments done (get as many done as you can before BK).

0845: Pass meds as breakfast 

comes around (remember insulin given 15 min before BK and after accucheck!)

1000: Chart and check for new orders, tell pt you will do treatments and bath AFTER lunch

1130: Accuchecks

1200: Meds

1300: Eat lunch or catch up on charting or both

1400-1500: Treatments (good time to play catch-up)

1600: Chart check, charting, accuchecks

1700: Insulin, dinner

1800: Wrap up, chart

1900: Report off after everything is done and cleaned up for night shift