Urinary Tract Infection UTI

Urinary Tract Infection UTI occurs when bacteria enter and multiply in tne normally sterile urinary tract. This causes inflammation, which can result in small amounts of blood, pus (white blood cells that fight infection), and bacteria in the urine. This can also cause pain with urination (called dysuria), a sense of needing to urinate frequently, a feeling of urgency, and sometimes cramping in the lower abdomen. The infection can involve the urethra (the short tube from the bladder to the outside of the body), the bladder, sometimes the ureters (longer tubes connecting the bladder and kidneys), and occasionally the kidneys. If the kidneys are involved you may have flank pain, fever, and chills.

What causes Urinary Tract Infection UTI?

Most of these infections-85-95%-are causes by bacteria that are normally present in the intestine. The vaginal area also has certain bacteria present normally. Because women have a short urethra which opens near the vagina, bacteria can enter the bladder relatively easily.

Urine needs to be examined under a microscope for white blood cells, red blood cells, and bacteria. Sometimes with recurrent infections, a culture is grown to determine which organisms are causing the infection. Sensitivity studies determine which antibiotics are effective for those organisms. After treatment, a urinalysis or a colony count is often done to make sure the infection is cleared. This can decrease the possibility of a mild, undetected infection which can lead to an early recurrence of a more severe bladder infection or might spread to the kidneys.

Treatment For Urinary Tract Infection UTI

• Urinary tract infections are treated with antibiotics.
• Drinking a lot of liquids (an eight-ounce glass per hour) helps wash out the urinary tract.
• Cranberry juice, plums, or apricot juice can help by creating a more acid environment in which bacteria cannot grow as easily. NOTE: This is not a substitute for treatment with antibiotics.
• Avoid caffeine (common in coffee, tea, and cola drinks), because it irritates the bladder.
• Hot baths can alleviate discomfort.
• Rest helps conserve energy for healing the infection.

Prevention For Urinary Tract Infection UTI?

• Drink plenty of liquids to keep the urinary tract flushed. Concentrated, stagnant urine can allow bacteria to multiply.
• Always urinate when you feel the need. Overfilling the bladder can cause irritation and microscopic tears in the bladder wall,which lead to infection.
• Wash your hands before you urinate, as well as after. To avoid spreading bacteria, wipe from front to back after urination or bowel movements.
• Urinate before and after sexual intercourse to flush bacteria away.
• Caffeine and alcohol are irritating to the bladder and should be avoided.
• Keeping the vaginal area dry will make it harder for bacteria to grow. Wearing cotton underwear and avoid confining clothes can help keep the area dry.

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Postpartum Complications

Despite the normalcy of childbirth, complications may arise that will have detrimental effects on the postpartum client. These include postpartum hemorrhage, thrombophlebitis, infections (including mastitis, endometritis, and urinary tract infections), and postpartum depression. Healthcare providers working with postpartum clients must have a clear understanding of these complications, including the symptoms, nursing interventions, and treatment.

Postpartum Hemorrhage (PPH)

Postpartum hemorrhage is one of the leading causes of death among postpartum clients. Postpartum hemorrhage refers to a blood loss of more than 500 mL after a vaginal birth and more than 1000 mL after a C-section. Postpartum hemorrhage is categorized as early or late. Early refers to a hemorrhage occurring within the first 24 hours after birth, while late refers to a hemorrhage occurring after 24 hours.

RISK FACTORS

Every postpartum client has the potential to hemorrhage after delivery. However, some clients have attributes that place them at higher risk for postpartum hemorrhage. These risk factors include:

• Multiple parity
• Multi-fetal pregnancy
• Macrosomia
• Prolonged or precipitous labor
• Labor induction
• Vacuum or forceps delivery
• Lacerations
• Stillbirth
• Placenta previa
• Use of certain medications (eg, magnesium sulfate)
• Mechanical factors, such as a full bladder

CAUSES AND INTERVENTIONS

Early postpartum hemorrhage is often caused by uterine atony. With uterine atony, there is a failure of the uterine muscles to contract properly, thereby inhibiting the healing of blood vessels at the site of placental attachment. The blood vessels continue to bleed until the uterine muscles contract. Signs of uterine atony include a boggy uterus, a fundus that is higher than expected upon palpation, and excessive lochia.

If the fundus is not firm (boggy), there are several nursing interventions that can alleviate the problem:

• Massage the uterine fundus.
• Express blood clots only if the uterus is firmly contracted, otherwise, uterine inversion and severe hemorrhage can occur.
• Encourage the client to void, or catheterize as needed.
• Administer prescribed medications, such as Pitocin, Ergonovine, Methergine, or Hemabate to assist the uterus in contracting. (Methergine can cause an elevation in blood pressure and should not be used with hypertensive clients.)

The nurse must report a PPH immediately and prepare for the insertion of a large-bore intravenous catheter, if one is not already present, and the administration of intravenous fluids and oxygen. A large-bore intravenous catheter is inserted to allow possible administration of blood products. The nurse should assess continually for bleeding, changes in vital signs, and oxygen saturation. The client's legs may also be elevated "to a 20° to 30° angle to increase venous return" (Leifer, 2005). Clients and their families will need nursing support during a PPH as it can be quite a disconcerting experience.

Early postpartum hemorrhage can also be caused by damage to the birth canal during labor and birth. If an early PPH is due to trauma to the birth canal, such as a hematoma, an extension of a perineal incision, or an improperly sutured laceration, clients may exhibit one or more of the following symptoms: a contracted uterus with excessive lochia, bright red lochia, a constant trickle of blood from the vagina, severe pain (possibly from a hematoma), or shock.

In the case of an early PPH caused by damage to the birth canal, surgical repair is usually necessary. In the case of hematoma formation, surgical incision, evacuation of blood clots, and ligation of the bleeding blood vessel may be necessary. However, in the case of a small hematoma, observation and application of ice or alternating hot and cold applications may be all that is necessary (Leifer, 2005).

Late postpartum hemorrhage is often caused by subinvolution of the uterus or by retained placental fragments that prevent the uterus from contracting. In the case of retained placental fragments, clots develop around the retained fragments and hemorrhaging can occur days later when the clots are shed. The certified nurse-midwife or physician is responsible for examining the placenta after delivery and ensuring that it is intact; therefore, a late PPH is usually preventable. Clients with placenta accreta (an abnormally deep attachment of the placenta) or when providers attempt to extract the placenta prior to uterine wall separation are at higher risk for a late PPH.

Assessment and manual expression of placental fragments by the physician or nurse-midwife can often alleviate the problem; however, surgical intervention, such as a dilation and evacuation (D&E) may be necessary. With subinvolution and a late PPH, fundal massage, in addition to medications (Pitocin, Ergonovine) and the previously mentioned interventions for early PPH, may be used to minimize bleeding.

HYPOVOLEMIC SHOCK

A sequela of PPH is hypovolemic shock. Under normal circumstances, postpartal clients are able to withstand blood loss during the postpartum period as a result of increased blood volume during pregnancy. However, in the presence of a PPH, hypovolemic shock can occur and cause severe organ damage and even death if untreated. Often tachycardia is the first sign of hypovolemic shock. The blood pressure usually decreases and the respiratory rate increases. The skin becomes cool and pale initially and then cold and clammy. Clients may also become anxious, agitated, and restless as blood loss starts to affect the brain. Hypovolemic shock can be stopped by stopping blood loss. These clients will also require oxygen (usually 8–10 mL via face mask), IV fluids, and possibly blood products. This is a very serious situation and nurses must be prepared to assist in this life-threatening emergency.

Thrombophlebitis

Clients can suffer from thrombophlebitis as a result of venous stasis and the normal hypercoagulability state of the postpartum period. Thrombophlebitis is an inflammation of the blood vessel wall in which a blood clot forms and causes problems in the superficial or deep veins of the lower extremities or pelvis. All postpartum clients are at risk. However, certain risk factors predispose some clients to developing thrombophlebitis. These risk factors include varicose veins, clotting disorders, delivering via C-section, diabetes mellitus, smoking, obesity, prolonged sitting or standing, and advanced maternal age.

The blood clot that develops in thrombophlebitis can lead to a life-threatening pulmonary embolism as a result of the clot detaching from the vein wall and blocking the pulmonary artery. The major signs of pulmonary embolism include dyspnea and chest pain.In monitoring postpartum clients for the development or presence of thrombophlebitis, nurses should assess for the presence of hot, red, painful, or edematous areas on the lower extremities or groin area. An elevated temperature may also be present. As previously mentioned, it is currently contraindicated to assess for a thrombophlebitis by eliciting a Homan's sign.

Interventions to treat thrombophlebitis depend on the severity of the thrombosis. Usually, for superficial thrombosis, analgesics, bed rest, and elevation of the affected limb is enough to alleviate the problem. However, in the presence of a DVT, anticoagulants may be necessary. In addition to use of compression stockings and warm, moist heat applications, clients should be instructed to keep their legs elevated and uncrossed. These clients are typically allowed to ambulate only after symptoms subside.

Infections

Postpartum infections are infections accompanied by a temperature of 38° C or higher on two separate occasions where no other explanation is responsible for the elevation in temperature. Postpartum clients should be carefully monitored for signs and symptoms of infection during this period. Common infections that may occur during the postpartum period include mastitis, endometritis, wound infections, and urinary tract infections.

MASTITIS

Mastitis is a breast infection caused by Staphylococcus aureus. S. aureus is found on the hands and can also be in the mouths of infants. Bacteria can enter through cracked nipples caused by improper latch-on during breastfeeding. Mastitis can develop due to blocked milk ducts and milk stasis in the breastfeeding clients. Blocked milk ducts and milk stasis occurs as a result of improper latching and inadequate breast emptying.

It is crucial that postpartum nurses teach breastfeeding clients proper latch techniques. Additionally, nurses must stress that clients feed infants regularly and allow the breast to empty completely. Breastfeeding clients should also be encouraged to avoid missing feedings and allowing the breast to become engorged.The classic symptom of mastitis is a unilateral mass in the breast accompanied by pain and redness. Often these clients experience a low-grade fever, chills, and general malaise. If untreated, a breast abscess may develop. Treatment for mastitis typically involves antibiotic therapy and regular breastfeeding or pumping the breast. Nurses can encourage these clients to apply cold or warm compresses to ease discomfort and to take analgesics as needed. Mastitis usually resolves quickly as long as clients continue to breastfeed or pump regularly.

ENDOMETRITIS

Endometritis is an infection of the uterus characterized by uterine subinvolution, infection, abdominal cramps, and purulent, foul-smelling lochia. It is caused by the bacteria normally present in the uterus and cervix, such as E. coli and group B streptococcus. Manual removal of the placenta, multiple vaginal examinations during labor, C-sections, premature rupture of members, and internal fetal and/or uterine monitoring predispose clients to developing endometritis.

In addition to cramping and foul-smelling lochia, clients with endometritis typically have a fever, chills, general malaise, and may exhibit tachycardia. Blood cultures to identify the causative organism are typically done and white blood cell (WBC) counts are monitored. However, it is important to remember that the white blood cell count is normally elevated after delivery for a short period; continued monitoring of the WBC count is required in identifying endometritis. Endometritis is usually treated with intravenous antibiotics and rest.

WOUNDS

Wound infections are infections that occur at wound sites. Commonly affected wound sites during the postpartum period include the perineum, where lacerations and episiotomies occur, and C-section incisions. As with all infections, every client is at risk.

Postpartum clients with wound infections typically have wounds that exhibit redness, warmth, poor wound approximation, tenderness, and pain. If untreated, these clients may develop a fever and other symptoms of an infection, such as malaise. As with endometritis, blood cultures may be obtained to isolate the causative organism. Antibiotics will typically be administered and drainage of the wound may be necessary.

Dressing changes using normal saline will aid in the healing process. Clients should be taught about proper handwashing and encouraged to maintain adequate fluid intake and increase protein intake to assist in wound healing. Wound infections can be intensely painful, especially in the perineum. Therefore, the nurse should assist these clients in managing pain through the use of analgesics and positioning.

URINARY TRACT INFECTIONS (UTIs)

Urinary tract infections are common during the postpartum period. The client's urethra and bladder is often traumatized during labor and birth due to intermittent catheterizations and the pressure of the infant as it passes through the birth canal. Additionally, the bladder and urethra loose tone after delivery, making the retention of urine and urinary stasis common. The risk of developing a UTI is high. Clients may also develop a UTI due to frequent catheterization while in labor or the placement of a Foley catheter, which frequently remains in place for several hours or days after delivery.

Clients with urinary tract infections often complain of frequent and/or painful urination as well as flank pain. A low-grade fever and hematuria may also be present. Urinary tract infections are treated with antibiotics, but it is important that these clients drink adequate fluids to flush bacteria out of the system. (Additionally, it has been suggested that cranberry juice is useful in preventing urinary tract infections due to acidifying the urine and preventing bacteria from attaching to the bladder walls; however, there is great debate over this issue.)

Postpartum Depression

Postpartum depression is a serious and debilitating depression that affects many women throughout the world. According to Blum (2007), "There are no specific, generally accepted criteria for time after delivery for a depression to be considered a postpartum depression, but typically these depressions occur within the first nine months after the baby's birth, often within the initial weeks or months." Symptoms typically include sadness, crying, insomnia, decreased appetite, withdrawal, and sometimes suicidal ideation or the desire to harm the infant. Additionally, clients may present with somatic symptoms, such as "headaches, diarrhea, constipation, severe anxiety, feeling as though they are jumping out of their skin, and/or just not feeling like themselves" (Driscoll, 2006).

It is the responsibility of nurses to assess postpartum clients for signs and symptoms of postpartum depression. Various assessment tools are available, including the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Depression Screening Scale (PDSS). These tools are quick and provide a simple way to assess clients while at the hospital, at home during postpartum home visits, and during postpartum follow-up visits. These tools can also be used to assess maternal clients at pediatric follow-up visits.

After screening and assessment, clients who are at risk for developing (or who are suffering from) postpartum depression can be referred to the appropriate healthcare provider for follow-up and treatment. According to Lowdermilk and Perry (2006), symptoms of postpartum depression rarely disappear without outside help; therefore, it is imperative to appropriately assess and refer clients suffering from this type of depression.

Postpartum depression is usually treated with counseling and medication. Nurses can support these clients in the healing process at follow-up appointments and during home visits. Driscoll (2006) recommends that nurses help clients and their families understand postpartum depression and assist them in exploring the spiritual aspects of their suffering as an aid in the healing process. Additionally, nurses should encourage these clients to get adequate nutrition, rest, relaxation, and exercise (Driscoll, 2006).

DISCHARGE INSTRUCTIONS

Postpartum clients and their families should be instructed to call the healthcare provider if the client has any of the following:

• Fever
• Foul-smelling lochia
• Large blood clots or bleeding that saturates a pad in one hour
• Discharge or severe pain from incisions
• Hot, red, painful areas on the breasts or legs
• Bleeding and/or severe pain in the nipples
• Severe headaches and/or blurred vision
• Chest pain and/or dyspnea without exertion
• Frequent, painful urination
• Signs of depression

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Nurses Role in Proper Care and Prevention of Wound Infection

In the mature population, chronic wounds and pressure ulcers are a significant cause of mortality (McGuiness & Rice, 2009). Over 32,000 adult patients die annually in the United States because of improper wound treatments in the hospital (Cohen, 2007); consequently, costing hospitals to up to $9.3 billion in added expenses (Franz, Steed, & Robson, 2007). When a client receives a wound and it is not treated properly, infection may become a complication and can increase the risk of mortality in an individual up to 55% (Salcido, 2009). As a result of the increasing rates of death due to improper wound management and infections, nurses must be knowledgeable about wound care and pressure ulcers, and how to prevent infection.

Why are nurses having trouble with providing the appropriate care for client’s chronic wounds? Contributing factors to delayed wound healing is due to lack of knowledge on caring for wounds, inadequate supervision by the nurse, and due to the client’s socioeconomic status. According to McGuiness in The Management of Chronic Wounds, “Inappropriate product selection [and]...extended periods of time between assessments… delay healing” (2009, p. 37). If the nurse is unable to take care of the client’s wounds appropriately, the client’s wounds do not heal accordingly.

Prevention

When the nurse receives the client, two main steps need to always be applied. First, the nurse needs to identify and evaluate the risks of the client to gain pressure ulcers or worsening of treatable wounds. At admission, a head to toe assessment should be instigated. Inspect and palpate for changes in skin integrity, texture, temperature, turgor, moisture, color changes, and edema (Blaney, 2010). Document the observation and reassess skin integrity and changes in condition every shift or according to facility policies to track the progress of the injury.

The next step is when evidence-based practices are put into place. Start by minimizing pressure to decrease the start of pressure ulcers. A turning schedule should be implemented (normally every two hours), and using pillows to minimize pressure on bony prominences. According to research, if the turning schedule is used correctly than there could be an 87% reduction of pressure sores (Lyder, & Ayaller, 2008). By using a turning schedule and by continually monitoring the wounds, the nurse will help decrease the incidence of pressure sores.

Adequate hydration and nutrition should also be kept up. Offering small, frequent meals of high-protein, high calorie diet with zinc and vitamin C should be encouraged. Having a proper diet will increase the wound’s healing time. If the patient eats foods that are high in fat, sugar, and salts the healing time of the wounds will decrease. Therefore, it is important that the patient is encouraged to eat a nutritious meal.

As the client lies in bed, the head of the bed should be no more than 30 degrees, unless contraindicated. If the client needs to turn, and can do so without assistance, encourage the client to lift themselves when they are moving instead of sliding around on the bed. When the patient slides on the bed, it produces friction and can create chronic wounds and pressure ulcers (Blaney, 2010). By encouraging the client to lift themselves, the decrease of sliding on the bed will prevent wounds from getting worst and may increase the chance of faster healing. Any potential barrier that could hinder the client would be their socioeconomic status and the deficient knowledge and lack of teaching skills.

Protective Dressings

For each wound, whether it is from pressure ulcers, surgeries, or accidents, the appropriate choice of dressing or therapy and skin protectant must be used. There are many non-adherent dressings available for wound management. They include Urgotul™ and Tegapore ™ (McGuiness, 2009), which can all be used safely with no trauma or pain. They also do not need to be changed regularly. For wounds with high levels of discharge absorbent foam dressings will be required. Nurses need to make sure that “care must be taken… that dressings are adequately sealed preferably without adherence to friable skin to prevent leakage…” (McGuiness, 2009). When the proper dressings and healing techniques are used this helps decrease the wound healing time. However, if the client is unable to pay or have the proper insurances then they might not get the assistance they need. Also, if the nurse does not know how to properly address wounds or pressure ulcers, their lack of knowledge could decrease the chances of the wound to heal.

Preventing Infection

The environment of a wound is an ideal home for bacterial invasion which makes it necessary for the client to take antibiotics. The nurse needs to emphasize to the client the importance of taking the antibiotic as instructed by the doctor. There have been many concerns of antibiotic resistance by the bacteria due to prolonged illnesses and deaths. This antibiotic resistant bacterium is also popularly known as MRSA. By having the client finish the antibiotic the chances of creating antibiotic resistant bacteria diminishes.

Because of the risk of new infections, different hygiene measures should also be considered for the various transmission routes. Not only should dressings and antiseptics should be used, but another way to slow down the spread of infection is for the nurse and other care providers to wash their hands or use hand sanitizers. “At the University of Geneva, a hospital-wide program promoting hand hygiene helped lower the hospital-acquired infection rate from 17 percent to 10 percent between 1994 and 1998” (Jain, 2008). These important steps are key components to be done after contact with an infected client or before caring for a vulnerable one. Any problems that would hinder the client are the lack of knowledge and teachings of the nurse to teach the importance of finishing the antibiotic and the client’s socioeconomic status where they might not be able to afford to buy the medication to prevent infection.

Potential Barriers

Two potential barriers for all these problems is socioeconomic and insufficient knowledge by the nurse. The client’s socioeconomic status may prohibit them from getting the proper help due to lack of income, transportation, or unable to find or obtain adequate health insurance. However, the nurse can help prevent high costs by having sufficient knowledge in prevention and educating the client about wound care and prevention.

To give thorough care for the wound, nurses need to make sure they are doing proper cleansing of the wound, controlling any signs and symptoms of infection, and ensuring the treatment of the underlying condition (McGuiness & Rice, 2009). When the nurse is incapable to properly address the wound and unable to assess the damaged area appropriately and within reasonable time, the damaged area is unable to continue through the normal stages of healing. Once wounds become infected, they are incapable to heal and are caught in a constant inflammatory condition because of a breakdown of the healing process in the tissues (Menke, Menke, Boardman, & Diegelmann, 2008). When there is a breakdown of the healing process, McGuiness (2009) asserts, the “result is often an increased shear and friction on wounds, inappropriate exudates control and the facilitation of infection” (p. 37). It is for these reasons that it is essential for nurses to gain an education and understanding in prevention of pressure ulcers and knowledge in wound management to decrease the occurrence of chronic wounds.

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Arterial Blood Gases ABG

Arterial Blood Gases ABG. Blood Gases Also known as: Arterial blood gases; ABGs; pH; PO2; PCO2; Bicarbonate; HCO3-; Oxygen saturation Formal name: Blood Gases

Blood gases are a group of tests that are performed together to measure the pH and the amount of oxygen (O2) and carbon dioxide (CO2) present in a sample of blood (usually from the arteries). The body carefully regulates blood pH, maintaining it within a narrow range of 7.35-7.45, not too acidic (acidosis) or too alkaline/basic (alkalosis).

There are a wide range of acute and chronic conditions that can affect kidney function, acid production, or lung function, and that have the potential to cause a pH, carbon dioxide/oxygen, or electrolyte imbalance. Examples include uncontrolled diabetes, which can lead to ketoacidosis and metabolic acidosis, and severe lung diseases that can affect carbon dioxide/oxygen gas exchanges. Even temporary conditions such as shock, anxiety, pain, prolonged vomiting, and severe diarrhea can sometimes lead to acidosis or alkalosis.

Blood gas tests give a snapshot of the blood's pH and oxygen and carbon dioxide content. They directly measure:

• pH - a measure of the balance of acid and bases in the blood. Blood pH decreases, becoming more acidic, with increased amounts of carbon dioxide (PCO2) and other acids. Blood pH increases, becoming more alkaline, with decreased carbon dioxide or increased amounts of bases like bicarbonate (HCO3-).
• Partial pressure of O2 (PO2) - the amount of oxygen gas in blood.
• Partial pressure of CO2 (PCO2) - the amount of carbon dioxide gas in the blood. As PCO2 levels rise, blood pH levels decrease, becoming more acidic; as PCO2 decreases, pH levels rise, making the blood more basic (alkaline).

Arterial blood is almost always used for blood gas analysis, but in some cases, such as for babies, whole blood from heelsticks is used. Blood may also be taken from the umbilical cord of a newborn. Since arterial blood carries oxygen to the body and venous blood carries waste products to the lungs and kidneys, the gas and pH levels will not be the same in both.

An arterial blood sample is usually collected from the radial artery in the wrist, located on the inside of the wrist, below the thumb, where the pulse can be felt. A circulation test called an Allen test will be done before the collection to make sure that there is adequate circulation in your wrist. The test involves compressing both the radial and the ulnar wrist arteries, then releasing each in turn to watch for "flushing," the pinking of the skin as blood returns to your hand. If one hand does not flush, then the other wrist will be tested. Blood can also be collected from the brachial artery in the elbow or the femoral artery in the groin. These sample locations require special training to properly access, so the collection is often performed by a doctor. In newborns that experience difficulty in breathing right after birth, blood may be collected from both the umbilical artery and vein and tested separately.

After an arterial blood draw, pressure must be firmly applied to the site for at least 5 minutes. Since blood pumps through the artery, the puncture will take awhile to stop bleeding. If you are taking blood thinners or aspirin, it may take as long as ten to fifteen minutes to stop bleeding. The person collecting the sample will verify that the bleeding has stopped and will put a wrap around your wrist, which should be left in place for an hour or so.

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Positions Available Master of Science in Nursing Cardinal Stritch University

Positions Available Master of Science in Nursing Cardinal Stritch University. Cardinal Stritch University is a private Franciscan Catholic institution of higher learning in Milwaukee, Wis. consisting of four colleges serving undergraduate and graduate programs of study. The Ruth S. Coleman College of Nursing is the only accredited Wisconsin nursing program offering all three-degree programs, ADN, BSN-C and MSN. Within the framework of Franciscan values, we provide innovative, flexible programs that integrate nursing theory and practice to meet the emerging health needs of all clients.

The Ruth S. Coleman College of Nursing at Cardinal Stritch University seeks applicants for the position of MSN program chair. This full-time administrative and leadership position reports directly to the dean of the college and is responsible for the development, management and evaluation of the NLNAC accredited MSN program.
Qualifications:

• The ideal candidate will have a earned doctorate degree in nursing or a related field and a master’s degree in nursing
• Current RN license in Wisconsin
• Experience and expertise with curriculum development, adult education and instruction
• Three or more years experience in formal nursing education
• Experience in graduate program development, administration, assessment and accreditation
• Relevant experience in teaching graduate nursing students
• Demonstrated leadership in professional nursing
• Excellent organizational, time management and interpersonal skills
• Computer literacy and familiarity with e-learning
• Grant writing experience

Satisfactory completion of a criminal background check is required prior to employment. Review of candidates continues until appointment is made. Applicants should submit letter of interest, curriculum vitae and three references with contact information by mail or email to:

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Faculty Recruitment University Hodgson Woodruff School of Nursing

Current Faculty Positions Available

• Acute Care Nurse Practitioner Specialty Coordinator
• Faculty Position in International Health

Tenure and Tenure-Track Positions
The Nell Hodgson Woodruff School of Nursing is seeking applications for a number of tenure and tenure-track positions. We invite inquiries from doctoral prepared scholars from a variety of research backgrounds and areas of specialization, particularly in (but not limited to) the following areas:

• Acute Care
• Psychiatry and Mental Health
• Geriatrics and Gerontology
• Pediatric Health

As an integral part of the Woodruff Health Sciences Center at Emory University, the School of Nursing maintains and seeks to extend research leadership and collaborative relationships with Emory’s strong interdisciplinary initiatives in:

• Neuroscience
• Palliative Care
• Critical Care
• Transplant Surgery
• Cardiovascular Health
• Comprehensive Cancer Care

In addition to submitting current Curriculum Vitae, applicants should attach a cover letter of interest and accomplishments. Please submit application materials to:

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Jobs at University Hodgson Woodruff School of Nursing

Nursing Faculty Position Acute Care Nurse Practitioner Specialty Coordinator. Emory University Nell Hodgson Woodruff School of Nursing is seeking a qualified individual to teach and provide leadership for the Acute Care Nurse Practitioner specialty area within the masters program. The Coordinator is responsible for planning, specialty marketing, implementation, updating, evaluation, daily management, and acquisition of clinical sites. The Coordinator is also responsible for advising students in the program and supervising faculty. Additional duties include responsibility for the viability, quality, legal, and professional compliance of the specialty program and for the achievement of specialty goals, enrollment targets and teaching external support for the programs.
Candidates for this position should have an earned doctorate in nursing or a related field.

• Be certified by AACN as an Acute Care Nurse Practitioner.
• Applicants are required to have current experience based on their area of certification as a nurse practitioner and scholar.
• As a scholar, the applicant should have teaching experience and a program of research that may focus on basic science or evidence-based practice.
• As a nurse practitioner, the applicant needs to remain active in practice.
• The applicant will be required to obtain a Georgia RN license and approval to practice as an advanced practice nurse in Georgia. A joint appointment with Emory Healthcare is possible.
• Experience advancing scholarship of an acute care program and designing a residency program is desired.
• Demonstrate successful leadership experience.

In addition to submitting a current Curriculum Vita, applicants should attach a cover letter of interest and accomplishments. Please submit application materials to:

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Jobs at UMMC Baltimore Cardiac Nursing

As a Cardiac Nursing professional, it’s unbelievable how much you will grow at UMMC. Every day, you’ll find new opportunities to take your skills and knowledge to the next level. No other single facility can offer you the variety of specialties…progressive technologies…invigorating pace…and opportunities for advancement. Most importantly, you’ll find a level of collaboration and camaraderie you won’t find anywhere else. Explore Baltimore Cardiac Nursing jobs at UMMC.

Why Pursue Baltimore Cardiac Nursing Jobs at UMMC?

We’re a team at UMMC. Nurses and doctors, specialists and therapists, we work shoulder-to-shoulder to give our patients the care they deserve. We take time to celebrate each other’s contributions. We treat each other with respect. We value each other’s ideas and opinions. We support each other’s growth. Together, we form a world-class team dedicated to furthering the practice of patient care. Apply for Cardiac Nursing Jobs in Baltimore with the University of Maryland Medical Center

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Maggots Medicine video

Maggots Medicine video. Maggots are fly larvae. When they mature in a few days, they become blow flies. The same flies we don’t want on our foods and beverages because they are pretty dirty and can cause many diseases. Maggot debridement (cleaning) therapy is used in cleaning wounds that won’t heal. Not all maggots can be used in medicine. Modern medicinal maggots are farmed in a sterile environment to ensure safety for medical use In many cases, doctors find that MDT is more efficient in cleaning wounds than any doctor or antibiotics can.

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Stop hiring Filipino nurses

Here’s how things work all too often in our "post-racial" society: one of California’s largest medical systems, Sutter Health/CPMC, has apparently enacted a ban on the hiring of Filipino registered nurses at a major San Francisco hospital.

The California Nurses Association, which is part of National Nurses United, today filed a demand for an investigation by the San Francisco Human Rights Commission, as well as filed a class-action grievance on behalf of the nurses denied employment because of their race, ethnicity, and national origin. It is unknown how many Filipinos were turned away from Sutter’s St. Luke’s Hospital, but we will find out and demand restitution on their behalf.

Nearly 100 Filipino community members and their allies joined nurses this morning at a press conference to express their outrage at this stunning turn of events.

At the press conference, CNA provided testimony by former nursing supervisors at Sutter Health and its San Francisco affiliate and nurses who have faced the discriminatory practices – and hiring data documenting the results. Chris Hanks, a former director of Critical Care Services at CPMC, said in a declaration that Karner, told him point blank, on a number of occasions, "you are not to hire any Filipinos."

Another former nurse supervisor Ronald Villanueva said in a declaration that he also heard Karner tell another supervisor, "do not hire foreign graduate nurses" – an unambiguous reference to Filipinos.

The hiring data bears that out. A review by CNA of active employee lists provided by CPMC demonstrates that in early 2008 there was a major demographic shift among the nurses being hired at St Luke’s. Before February 2008, 65% of St Luke’s RNs were Filipino. After February 2008, only 10% of RNs hired were Filipino.

These are stunning figures. And there is only one possible excuse: retaliation. On or around February of 2008, the nurses of St. Luke’s secured a major political victory, in forcing the hospital chain to keep their facility open, and to continue serving the medically-indigent patients who rely upon it. These Filipino nurses showed solidarity, and saved their hospital. Sutter’s response? Stop hiring Filipino nurses.

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Nurses’ union responds to violent cases against staff

Devoting concern to possible violence against nurses is not a new cause for the Pennsylvania Association of Staff Nurses and Allied Professionals, but the union has not specifically devoted attention to it since the summer. To remedy this, PASNAP hosted a recent conference to address violence against health care professionals in the workplace, specifically against nurses.

“This issue has the fastest response from members,” PASNAP Communications Specialist Emily Randle said. Randle recounted the most serious incident in recent months when a nurse, Jill Messler, was “assaulted by a psychiatric patient” and suffered severe injuries that left her hospitalized. “We called other hospitals with union members and found similar problems,” Randle said, recalling the attack on Messler.

“It doesn’t matter where the hospital is or who is treated – it happens everywhere,” said Donna Lee, the president of the PASNAP local at Jeanes Hospital, a branch of Temple University Health System.

While most attacks are committed by patients who are admitted to the emergency room and psychiatric wards, people under the influence of drugs and alcohol may also pose a risk. Violence can manifest in direct assault or in the form of threats.

PASNAP President Patricia Eakin, who said she’s had nurses leave for safety reasons, spoke of one disgruntled patient who threatened a nurse.

“He said that he was ‘going to blow your F-ing head off after work,’” Eakin said.

Representatives of PASNAP and TUHS agreed the biggest challenge is changing the misconception that nurses must ignore violent behavior by patients and accept it as a part of their job.

Randle said hospitals have a blanket response method to address workplace violence, but no sufficient new security measures have been put in place.

Allied Barton, the company that provides security personnel at Main Campus, recently extended its service to Temple University Hospital, most prominently in the emergency room.

“It makes the hospital more amenable,” Eakin said.

Eakin said the Nov. 10 conference, which gathered approximately 200 nurses statewide, was the first in a series of educational courses intended to encourage nurses to report violent persons to hospital security.

District Attorney Seth Williams and Delaware County District Attorney Michael Green were also present at the conference. Each supported a proposition to establish a regional and statewide task force that would evaluate legislation to protect nurses, develop a model contract language for health care workers, raise public awareness and extend support to hospitals not represented by the union.

Eakin said both Williams and Green would help with the task force.

Jeanes Hospital also secured a new nurses contract with hospital management on Nov. 8. The four-year contract includes the creation of a PASNAP board-appointed “work group” of union members from different hospital specialties to discuss security needs.

Lee said the nurses and managers selected for the work group will be those who best represent the people in their division.

The contract specifies that the findings will go to the hospital CEO, who will report to union members every 30 days. The group will meet as needed.

“It’s about changing attitudes,” Lee said, “and that’s a step our management has been good about.”

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Malaria In Africa Video

Malaria In Africa Video

Malaria in Africa Video. Malaria is caused by Plasmodium vivax, P. malaria, P. falciparum, and P. ovale, all of which are transmitted to humans by mosquito vectors. Malaria has been eradicated from North America, Europe, and Russia but continues to flourish in parts of the tropics despite efforts to eradicate it completely. Falciparum malaria is the most severe form of the disease. When treated, malaria seldom is fatal; untreated, it's fatal in 10% of victims, usually as a result of complications

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Practical Nursing program

The Practical Nurse program prepares the student to take the NCLEX-PN examination required for employment as an entry-level Licensed Practical Nurse (LPN). The Practical Nurse program includes theoretical instruction and clinical experience in medical, surgical, obstetric, pediatric, and geriatric nursing and clinical experience in both acute and long-term care situations. Theoretical instruction of the clinical application of vocational role and function and personal, family and community health concepts, nutrition, human growth and development over the lifespan, body structure and function, interpersonal relationship skills, mental health concepts, pharmacology and administration of medications, legal aspects of practice, Health Careers Core, Basic Life Support (BLS and CPR) for health-care providers, and current issues in nursing are all components of the program. Clinical experience comprises 50% of the total program. Areas of employment for Practical Nurses include hospitals, ambulatory care settings, long-term care facilities, home health agencies, private duty, and other appropriate medical areas. The PN program has provisional approval by the Florida Board of Nursing. Upon program completion, graduates are eligible to take NCLEX-PN credentialing examination.

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Top 10 America’s Nursing College

Below is our ranking of rankings that shows who the best nursing school

1. University of Washington Seattle, WA, PO Box 357260 Seattle, WA 98195Admissions Phone: (206) 543-8736. http://www.son.washington.edu
2. University of California--San Francisco School of Nursing 2 Koret Way, #N-319XSan Francisco, CA 94143-0602 Admissions Phone: (415) 476-1435 http://nurseweb.ucsf.edu/
3. University of Pennsylvania School of Nursing. 420 Guardian Drive Philadelphia, PA 19104-6096 Admissions Phone : (215) 898-8281.  Admissions E-Mail: admissions@nursing.upenn.edu.  http://www.nursing.upenn.edu/academic_programs/grad/
4. Johns Hopkins University School of Nursing .  525 N. Wolfe Street Baltimore, MD 21205-2100.  Admissions Phone: (410) 955-7548.  Admissions E-Mail: jhuson@son.jhmi.edu http://www.son.jhmi.edu/academics/academic_programs/doctoral/
5. University of Michigan Ann Arbor School of Nursing 400 N. Ingalls Ann Arbors, MI 48109-0482.  Admissions Phone: (734) 763-5985. Admissions E-Mail: umnursing@umich.edu. http://www.nursing.umich.edu/academics/index.html
6. University of North Carolina--Chapel Hill School of Nursing  Carrington Hall, CB #7460Chapel Hill, NC 27599-7460  Admissions Phone: (919) 966-4260  Admissions E-Mail: nursing_applications@unc.edu. http://nursing.unc.edu/
7. Oregon Health and Science University School of Nursing  3455 S.W. U.S. Veterans Hospital Road  Portland, OR 97239-2941  Admissions Phone: (503) 494-7725  Admissions E-Mail: proginfo@ohsu.edu  http://www.ohsu.edu/son
8. University of Illinois Chicago College of Nursing  845 South Damen Avenue MC 802Chicago, IL 60612  Admissions Phone: (312) 996-7800  Admissions E-Mail: con@uic.edu  http://www.uic.edu/nursing/
9. University of Maryland—Baltimore School of Nursing   Suite 516Baltimore, MD 21201-1579  Admissions Phone: (410) 706-3147  Admissions E-Mail: janar001@son.umaryland.edu  http://nursing.umaryland.edu/programs/phd/index.htm
10. University of Pittsburgh School of Nursing  Victoria BuildingPittsburgh, PA 15261  Admissions Phone: (412) 624-4586  Admissions E-Mail: sao50@pitt.edu  http://www.nursing.pitt.edu/

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Tracts and Sources of Pain

Pain Pathways, The ascending pathways that mediate pain consist of three different tracts: the neospinothalamic tract, the paleospinothalamic tract and the archispinothalamic tract. The first-order neurons are located in the dorsal root ganglion (DRG) for all three pathways. Each pain tract originates in different spinal cord regions and ascends to terminate in different areas in the CNS

Neospinothalamic Tract

The neospinothalamic tract has few synapses and constitutes the classical lateral spinothalamic tract (LST). The first-order nociceptive neurons (in the DRG) make synaptic connections in Rexed layer I neurons (marginal zone). Axons from layer I neurons decussate in the anterior white commissure, at approximately the same level they enter the cord, and ascend in the contralateral anterolateral quadrant. Most of the pain fibers from the lower extremity and the body below the neck terminate in the ventroposterolateral (VPL) nucleus and ventroposteroinferior (VPI) nucleus of the thalamus, which serves as a relay station that sends the signals to the primary cortex. The VPL is thought to mainly be concerned with discriminatory functions. The VPL sends axons to the primary somatosensory cortex (SCI).

The first-order nociceptive neurons from the head, face and intraoral structures have somata in the trigeminal ganglion. Trigeminal fibers enter the pons, descend to the medulla and make synaptic connections in the spinal trigeminal nucleus, cross the midline and ascend as trigeminothalamic tract. The A delta fibers terminate in the ventroposteromedial (VPM) thalamus, and the C fibers terminate in the parafasciculus (PF) and centromedian (CM) thalamus (PF-CM complex). The PF-CM complex is located within the intralaminar thalamus and are known as IL. All of the neospinothalamic fibers terminating in VPL and VPM are somatotopically oriented and from there send axons that synapse on the primary somatosensory cortex (SC I - Brodman areas 1 & 2). This pathway is responsible for the immediate awareness of a painful sensation and for awareness of the exact location of the painful stimulus.

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Benefits Nursing Outcomes Classification (NOC)

Values of Standardized Nursing Language-NOC in Managed Care

• Labels and provides measures for comprehensive outcomes that respond to nursing intervention.
• Defines outcomes that focus on the patient and can be used by both nurses and other disciplines.
• Provides more specific outcome information than global health status measures. This allows providers to identify problems when global health status measures are not in an acceptable range.
• Provides outcomes that are intermediate to the achievement of longer range desired outcomes.
• Uses a scale to measure outcomes which provides quantifiable information about patient outcomes achieved in an organization or managed care system.
• Facilitates the identification of risk adjustment factors for population groups. This is a necessary step in the assessment of outcome variance.

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Nursing Outcomes Classification (NOC)

The Nursing Outcomes Classification (NOC) is a comprehensive, standardized classification of patient/client outcomes developed to evaluate the effects of nursing interventions. Standardized outcomes are necessary for documentation in electronic records, for use in clinical information systems, for the development of nursing knowledge and the education of professional nurses. An outcome is a measurable individual, family, or community state, behavior or perception that is measured along a continuum and is responsive to nursing interventions. The outcomes are developed for use in all settings and with all patient populations. Clinical sites used to test the NOC included tertiary care hospitals, community hospitals, community agencies, nursing centers, and a nursing home. The outcomes are developed for use in all settings and can be used across the care continuum to follow patient outcomes throughout an illness episode or over an extended period of care. Since the outcomes describe patient/client status, other disciplines may find them useful for the evaluation of their interventions.

The 330 NOC outcomes in Nursing Outcomes Classification (NOC) (third ed.) are listed in alphabetical order. Each outcome has a definition, a list of indicators that can be used to evaluate patient status in relation to the outcome, a target outcome rating, place to identify the source of data, a five-point Likert scale to measure patient status, and a short list of references used in the development of the outcome. For 76 of the outcomes an additional measurement scale was added to the outcome based on feedback from our research in 10 clinical sites. Examples of scales used with the outcomes are 1=Extremely compromised to 5= Not compromised and 1=Never demonstrated to 5=Consistently demonstrated. The NOC (third ed.) includes 311 individual level outcomes, 10 family and 9 community level outcomes. The NOC outcomes are grouped in a coded taxonomy that organizes the outcomes within a conceptual framework to facilitate locating an outcome. The 330 outcomes are grouped into thirty-one classes and seven domains for ease of use. The seven domains are Functional Health, Physiologic Health, Psychosocial Health, Health Knowledge & Behavior, Perceived Health, Family Health, and Community Health. Each outcome has a unique code number that facilitates its use in computerized clinical information systems and allows manipulation of data to answer questions about nursing care quality and effectiveness. The classification is continually updated to include new outcomes and to revise older outcomes based on new research or user feedback and is published on a 4 year cycle.

The research to develop NOC began with the formation of the outcomes research team in 1991 and has progressed through the following phases.

• Phase I - Pilot Work to Test Methodology (1992-1993)
• Phase II - Construction of the Outcomes (1993-1996)
• Phase III - Construction of the Taxonomy and Clinical Testing (1996-1997)
• Phase IV - Evaluation of Measurement Scales (1998-2002)
• Phase V - Refinement and Clinical Use (1997 - Present)

Funding for Phase I was received from Sigma Theta Tau International and funding for Phases II through V from the National Institutes of Health, National Institute of Nursing. Multiple research methods have been used in the development of NOC. An inductive approach was used to develop the outcomes based on current practice and research. Concept analysis and research team review were used in the construction of the outcomes. Questionnaire surveys of expert nurses were used to assess the content validity and nursing sensitivity of the outcomes. The taxonomy was constructed using similarity/dis-similarity analysis and hierarchical clustering techniques. Feedback from clinical test sites and other sites implementing NOC have been used to identify new outcomes for development and refine current outcomes. Currently, inter-rater reliability, criterion measures and other methods are being used to evaluate the reliability, validity, and sensitivity of the outcome measures in clinical sites. This data is included in the third edition.

The outcomes have been linked to NANDA International diagnosis, to Gordon's functional patterns, to the Taxonomy of Nursing Practice, to Omaha System problems, to resident admission protocols (RAPs) used in nursing homes, to the OASIS System used in home care and to NIC interventions. A more in depth look at the linkage between NANDA, NIC and NOC is available in a separate book Nursing diagnoses, outcomes, & interventions: NANDA, NOC, and NIC Linkages. This publication is also available in a CD-ROM.

NOC is one of the standardized languages recognized by the American Nurses' Association (ANA). As a recognized language it meets the language guideline standards set by ANA's Nursing Information and Data Set Evaluation Center (NIDSEC) for information system vendors. NOC is included in the National Library of Medicine's Metathesaurus for a Unified Medical Language and in The Cumulative Index to Nursing Literature (CINAHL) and has been approved for use by Health Level 7 Terminology (HL7). NOC is currently being mapped into SNOMED (Systemized Nomenclature of Medicine). The use of NOC in practice, nursing education, and research is the most accurate indicator of NOC's usefulness. NOC is being adopted in a number of clinical sites for the evaluation of nursing practice and is being used in educational settings to structure curricula and teach students clinical evaluation. Interest in NOC has been demonstrated in other countries. NOC has been translated into Dutch, Japanese, Korean, French, and Spanish and several other translations are in progress including German and Portuguese.

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Nursing Procedure Taking Temperatures

What is Body temperature? Body temperature is the difference between heat produced and heat lost. The hypothalamus acts as the body’s thermostat to maintain a constant body temperature. The balance is maintained between the body’s heat producing functions (metabolism, shivering, muscle contraction, exercise, and thyroid activity) and the heat-losing functions (radiation, convection, conduction, and evaporation). When one temperature becomes greater than the other, temperature changes are seen; greater heat-producing functions result in temperature elevations (fever/hyperthermia), and greater heat losing functions result in temperature decreases (hypothermia).
Sites of measurement of Body temperature:

• Core temperature true body temperature. Rectal, bladder, and tympanic temperatures are in general the most reliable sites for maesuring body temperature.
• Sublingual convenient site to measuring body temperature. Tachypnea and consumption of hot or cold substances affect result. Best for intermittent measurement.
• Axillary temperatures average 1.5° to 1.9°C lower than tympanic. The accuracy of axillary temperatures is affected by inability to maintain probe position.
• Tympanic measured with specifically designed thermometer. In theory, correlates well with core temperature. In practice, correlates poorly because of difficulty performing the technique and technical malfunctions, with a high degree of user dissatisfaction.
• Skin poor correlation with core temperature.

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Strengths of Nursing Interventions Classification (NIC)

Strengths of Nursing Interventions Classification (NIC)

1. Comprehensive Nursing Interventions Classification NIC includes the full range of nursing interventions from general practice and specialty areas. Interventions include physiological and psychosocial; illness treatment and prevention; health promotion; those for individuals, families and communities; and indirect care. Both independent and collaborative interventions are included; they can be used in any practice setting regardless of philosophical orientation.
2. Research based The research, begun in 1987, uses a multi-method approach; methods include content analysis, questionnaire survey to experts, focus group review, similarity analysis, hierarchical clustering, multidimensional scaling, and clinical field testing.
3. Developed inductively based on existing practice Original sources include current textbooks, care planning guides, and nursing information systems from clinical practice, augmented by clinical practice expertise of team members and experts in specialty areas of practice.
4. Reflects current clinical practice and research All interventions are accompanied by a list of background readings that support the development of the intervention. All interventions have been reviewed by experts in clinical practice and by relevant clinical practice specialty organizations. A feedback process is used to incorporate suggestions from users.
5. Has easy to use organizing structure (domains, classes, interventions, activities) all domains, classes and interventions have definitions; principles have been developed to maintain consistency and cohesion within the Classification; interventions are numerically coded.
6. Uses language that is clear and clinically meaningful Throughout the work, the language most useful in clinical practice has been selected; the language reflects clarity in conceptual issues (e.g. what's an intervention versus a diagnosis or an assessment to make a diagnosis, or an outcome).
7. Has established process and structure for continued refinement The Classification continues to be developed by researchers at the College of Nursing, the University of Iowa; commitment to the project is evident by years of work and continued involvement. The continued refinement of NIC is facilitated by the Center for Nursing Classification and Clinical Effectiveness, established in the College of Nursing at the University of Iowa in 1995 by the Iowa Board of Regents.
8. Has been field tested The process of implementation was studied in five field sites representing the various settings where nursing care takes place; hundreds of other clinical and educational agencies are also implementing the Classification. Steps for implementation have been developed to assist in the change process.
9. Accessible through numerous publications In addition to the classification itself, approximately five dozen articles and chapters have been published by members of the research team since 1990. Book and article reviews and publications by others about use and value of NIC attest to the significance of the work.
10. Linked to NANDA nursing diagnosis, Omaha system problems, NOC outcome, RAP in long term care, OASIS for home health A second edition book linking NOC outcomes and NIC interventions to NANDA diagnoses is available from Mosby. Other linkages are available in monograph form from the Center for Nursing Classification and Clinical Effectiveness.
11. Recipient of national recognition NIC is recognized by the American Nurses Association, is included in the National Library of Medicine’s Metathesaurus for a Unified Medical Language, is included in indexes of CINAHL, is listed by JCAHO as one classification that can be used to meet the standard on uniform data, is included in Alternative Link’s ABC codes for reimbursement by alternative providers, is registered in HL7, and included in SNOMED CT.
12. Developed at same site as outcomes classification The Nursing Outcomes Classification (NOC) of patient outcomes sensitive to nursing practice has also been developed at Iowa; both NIC and NOC are housed in the Center for Nursing Classification and Clinical Effectiveness and the work on the two classifications is coordinated.
13. Included in a growing number of vendor software clinical information systems  The Systematized Nomenclature of Medicine (SNOMED) has included NIC in its multidisciplinary record system. Several vendors have licensed NIC for inclusion in their software, targeted at both hospital and community settings, as well as practitioners in either general and specialty practice.
14. Translated into several languages Although NIC has been developed for applicability to nursing in the United States, nurses in several other countries are finding the Classification useful. Translations are complete or in process for the following languages: Chinese, Dutch, French, German, Icelandic, Japanese, Korean, Portuguese, and Spanish.

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Nursing Interventions Classification (NIC)

Nursing Interventions Classification (NIC). The Nursing Interventions Classification (NIC) is a comprehensive, research-based, standardized classification of interventions that nurses perform. It is useful for clinical documentation, communication of care across settings, integration of data across systems and settings, effectiveness research, productivity measurement, competency evaluation, reimbursement, and curricular design. The Classification includes the interventions that nurses do on behalf of patients, both independent and collaborative interventions, both direct and indirect care. An intervention is defined as "any treatment, based upon clinical judgment and knowledge that a nurse performs to enhance patient/client outcomes." While an individual nurse will have expertise in only a limited number of interventions reflecting on her or his specialty, the entire classification captures the expertise of all nurses. NIC can be used in all settings (from acute care intensive care units, to home care, to hospice, to primary care) and all specialties (from critical care to ambulatory care and long term care). While the entire classification describes the domain of nursing, some of the interventions in the classification are also done by other providers. NIC can be used by other non-physician providers to describe their treatments.

NIC interventions include both the physiological (e.g. Acid-Base Management) and the psychosocial (e.g. Anxiety Reduction). Interventions are included for illness treatment (e.g. Hyperglycemia Management), illness prevention (e.g. Fall Prevention), and health promotion (e.g. Exercise Promotion). Most of the interventions are for use with individuals but many are for use with families (e.g. Family Integrity Promotion), and some are for use with entire communities (e.g. Environmental Management: Community). Indirect care interventions (e.g. Supply Management) are also included. Each intervention as it appears in the classification is listed with a label name, a definition, a set of activities to carry out the intervention, and background readings.

The 542 interventions in NIC (5th ed.) are grouped into thirty classes and seven domains for ease of use. The 7 domains are: Physiological: Basic, Physiological: Complex, Behavioral, Safety, Family, Health System, and Community. Each intervention has a unique number (code). NIC interventions have been linked with NANDA nursing diagnoses, Omaha System problems, and NOC outcomes. The classification is continually updated with an ongoing process for feedback and review. In the back of the book, there are instructions for how users can submit suggestions for modifications to existing interventions or propose a new intervention. All contributors whose changes are included in the next edition are acknowledged in the book. New editions of the classification are planned for approximately every 4 years. The classification was first published in 1992, the second edition in 1996, the third edition in 2000, the fourth edition in 2004, and the fifth edition in 2008. Work that is done between editions and other relevant publications that enhance the use of the classification are available from the Center for Nursing Classification & Clinical Effectiveness at the College of Nursing, The University of Iowa.

NIC is recognized by the American Nurses' Association (ANA) and is included as one data set that will meet the uniform guidelines for information system vendors in the ANA's Nursing Information and Data Set Evaluation Center (NIDSEC). NIC is included in the National Library of Medicine's Metathesaurus for a Unified Medial Language and the cumulative index of nursing Literature (CINAHL). NIC is also included in The Joint Commission as one nursing classification system that can be used to meet the standard on uniform data. The National League for Nursing has made a 40-minute video about NIC to facilitate teaching of NIC to nursing students and practicing nurses. Alternative Link has included NIC in its ABC codes used for reimbursement for alternative providers. NIC is registered in HL7 and is mapped into SNOMED (Systemized Nomenclature of Medicine).

Hundreds of health care agencies have adopted NIC for use in standards, care plans, competency evaluation, and nursing information systems; nursing education programs are using NIC to structure curriculum and identify competencies of graduating nurses; authors of major texts are using NIC to discuss nursing treatments; and researchers are using NIC to study the effectiveness of nursing care. Interest in NIC has been demonstrated in several other countries, notably Brazil, Canada, Denmark, England, France, Germany, Iceland, Japan, Korea, Spain, Switzerland, and The Netherlands. NIC has been translated into Chinese, Dutch, French, German, Icelandic, Japanese, Korean, Portugese, and Spanish; other translations are in progress.

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North American Nursing Diagnosis Association International

In 1973, the first conference on nursing diagnosis was held to identify nursing knowledge and to establish a classification system suitable for computerization. From this conference developed the National Group for the Classification of Nursing Diagnosis, composed of nurses from different regions of the United States and Canada, representing all elements of the profession: practice, education, and research. From 1973 to the present, the National Group has met 15 times. Its most recent list of nursing diagnoses is presented at the end of Section One.

In 2003, the organization was renamed the North American Nursing Diagnosis Association International (NANDA). In addition to reviewing and accepting nursing diagnoses for addition to the list, NANDA also reviews previously accepted nursing diagnoses. For example, in 1994, NANDA revised ten previously accepted diagnoses.

In March 1990, the first issue of Nursing Diagnosis, NANDA’s official journal, was published. This journal aims to promote the development, refinement, and application of nursing diagnoses and to serve as a forum for issues pertaining to the development and classification of nursing knowledge. The journal is now named Nursing Diagnosis: The International Journal of Nursing Language and Classification.

At the International Council of Nursing (ICN) in Seoul in 1989, the Canadian and American Nurses Associations proposed a resolution to the Council of National Representatives. The resolution asked that “ICN encourage member nurses’ associations to become involved in developing classification systems for nursing care, nursing information management systems, and nursing data sets to provide tools that nurses in all countries could use to describe nursing and its contributions to health” (Clark & Lang,

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NANDA Nursing Diagnosis

NANDA Nursing Diagnosis. A nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable The general need or problem in Nursing diagnosis is stated without the distinct cause and signs and symptoms, which would be added to create a client diagnostic statement when specific client information is available. For example, when a client displays increased tension, apprehension, quivering voice, and focus on self, the nursing diagnosis of Anxiety might be stated: severe Anxiety related to unconscious conflict, threat to self-concept as evidenced by statements of increased tension, apprehension; observations of quivering voice focus on self. In addition, diagnoses identified within these guides for planning care as actual or risk can be changed or deleted and new diagnoses added, depending entirely on the specific client information. NANDA Nursing Diagnosis

Nursing diagnosis accepted for use and research for 2009–2011
NANDA Nursing Diagnosis:
Activity Intolerance [specify level]
Activity Intolerance, risk for
Activity Planning, ineffective
Airway Clearance, ineffective
Allergy Response, latex
Allergy Response, risk for latex
Anxiety [specify level]
Anxiety, death
Aspiration, risk for
Attachment, risk for impaired
Autonomic Dysreflexia
Autonomic Dysreflexia, risk for
Behavior, risk-prone health
Bleeding, risk for
Body Image, disturbed
Body Temperature, risk for imbalanced
Bowel Incontinence
Breastfeeding, effective
Breastfeeding, ineffective
Breastfeeding, interrupted
Breathing Pattern, ineffective
Cardiac Output, decreased
Caregiver Role Strain
Caregiver Role Strain, risk for
Childbearing Process, readiness for enhanced
Comfort, impaired
Comfort, readiness for enhanced
Communication, impaired verbal
Communication, readiness for enhanced
Conflict, decisional
Conflict, parental role
Confusion, acute
Confusion, risk for acute
Confusion, chronic
Constipation
Constipation, perceived
Constipation, risk for
Contamination
Contamination, risk for
Coping, defensive
Coping, ineffective
Coping, readiness for enhanced
Coping, ineffective community
Coping, readiness for enhanced community
Coping, compromised family
Coping, disabled family
Coping, readiness for enhanced family
Death Syndrome, risk for sudden infant
Decision-Making, readiness for enhanced
Denial, ineffective
Dentition, impaired
Development, risk for delayed
Diarrhea
Dignity, risk for compromised human
Distress, moral
Disuse Syndrome, risk for
Diversional Activity, deficient
Electrolyte Imbalance, risk for
Energy Field disturbed
Environmental Interpretation Syndrome, impaired
Failure to Thrive, adult
Falls, risk for
Family Processes, dysfunctional
Family Processes, interrupted
Family Processes, readiness for enhanced
Fatigue
Fear
Feeding Pattern, ineffective infant
Fluid Balance, readiness for enhanced
[Fluid Volume, deficient hyper/hypotonic]
Fluid Volume, deficient [isotonic]
Fluid Volume, excess
Fluid Volume, risk for deficient
Fluid Volume, risk for imbalanced
Gas Exchange, impaired
Glucose Level, risk for unstable blood
Grieving
Grieving, complicated
Grieving, risk for complicated
Growth, risk for disproportionate
Growth and Development, delayed
Health Maintenance, ineffective
Health Management, ineffective self [formerly Therapeutic Regimen Management, ineffective]
Health Management, readiness for enhanced self [formerly Therapeutic Regimen Management, readiness for enhanced]
Home Maintenance, impaired
Hope, readiness for enhanced
Hopelessness
Hyperthermia
Hypothermia
Identity, disturbed personal
Immunization Status, readiness for enhanced
Infant Behavior, disorganized
Infant Behavior, readiness for enhanced organized
Infant Behavior, risk for disorganized
Infection, risk for
Injury, risk for
Injury, risk for perioperative positioning
Insomnia
Intracranial Adaptive Capacity, decreased
Jaundice, neonatal
Knowledge, deficient [Learning Need] [specify]
Knowledge [specify], readiness for enhanced
Lifestyle, sedentary
Liver Function, risk for impaired
Loneliness, risk for
Maternal/Fetal Dyad, risk for disturbed
Memory, impaired
Mobility, impaired bed
Mobility, impaired physical
Mobility, impaired wheelchair
Motility, dysfunctional gastointestinal
Motility, risk for dysfunctional gastointestinal
Nausea
Neglect, self
Neglect, unilateral
Noncompliance [Adherence, ineffective] [specify]
Nutrition: less than body requirements, imbalanced
Nutrition: more than body requirements, imbalanced
Nutrition: more than body requirements, risk for imbalanced
Oral Mucous Membrane, impaired
Pain, acute
Pain, chronic
Parenting, impaired
Parenting, readiness for enhanced
Parenting, risk for impaired
Perfusion, ineffective peripheral tissue
Perfusion, risk for decreased cardiac tissue
Perfusion, risk for ineffective cerebral tissue
Perfusion, risk for ineffective gastrointestinal
Perfusion, risk for ineffective renal
Peripheral Neurovascular Dysfunction, risk for
Poisoning, risk for
Post-Trauma Syndrome [specify stage]
Post-Trauma Syndrome, risk for
Power, readiness for enhanced
Powerlessness [specify level]
Powerlessness, risk for
Protection, ineffective
Rape-Trauma Syndrome
(Rape-Trauma Syndrome: compound reaction retired 2009)
(Rape-Trauma Syndrome: silent reaction retired 2009)
Relationship, readiness for enhanced
Religiosity, impaired
Religiosity, risk for impaired
Religiosity, readiness for enhanced
Relocation Stress Syndrome
Relocation Stress Syndrome, risk for
Resilience, impaired individual
Resilience, readiness for enhanced
Resilience, risk for compromised
Role Performance, ineffective
Self-Care, readiness for enhanced
Self-Care Deficit: bathing
Self-Care Deficit: dressing
Self-Care Deficit: feeding
Self-Care Deficit: toileting
Self-Concept, readiness for enhanced
Self-Esteem, chronic low
Self-Esteem, situational low
Self-Esteem, risk for situational low
Self-Mutilation
Self-Mutilation, risk for
Sensory Perception, disturbed (specify: visual, auditory, kinesthetic, gustatory, tactile, olfactory)
Sexual Dysfunction
Sexuality Pattern, ineffective
Shock, risk for
Skin Integrity, impaired
Skin Integrity, risk for impaired
Sleep, readiness for enhanced
Sleep Deprivation
Sleep Pattern, disturbed
Social Interaction, impaired
Social Isolation
Sorrow, chronic
Spiritual Distress
Spiritual Distress, risk for
Spiritual Well-Being, readiness for enhanced
Stress Overload
Suffocation, risk for
Suicide, risk for
Surgical Recovery, delayed
Swallowing, impaired
(Therapeutic Regimen Management, effective retired 2009)
(Therapeutic Regimen Management, ineffective community retired 2009)
Therapeutic Regimen Management, ineffective family
Thermoregulation, ineffective
(Thought Processes, disturbed retired 2009)
Tissue Integrity, impaired
Transfer Ability, impaired
Trauma, risk for
Trauma, risk for vascular
Urinary Elimination, impaired
Urinary Elimination, readiness for enhanced
Urinary Incontinence, functional
Urinary Incontinence, overflow
Urinary Incontinence, reflex
Urinary Incontinence, stress
(Urinary Incontinence, total retired 2009)
Urinary Incontinence, urge
Urinary Incontinence, risk for urge
Urinary Retention [acute/chronic]
Ventilation, impaired spontaneous
Ventilatory Weaning Response, dysfunctional
Violence, [actual/]risk for other-directed
Violence, [actual/]risk for self-directed
Walking, impaired
Wandering [specify sporadic or continual]

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Top high paying nursing specialties

Top 10 high paying nursing specialties

1. Certified Registered Nurse Anesthetist
2. Nurse Researcher
3. Psychiatric Nurse Practitioner
4. Certified Nurse Midwife
5. Pediatric Endocrinology Nurse
6. Orthopedic Nurse
7. Nurse Practitioner
8. Clinical Nurse Specialist
9. Gerontological Nurse Practitioner
10. Neonatal Nurse

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Treatment for Acute Renal Failure ARF

Preventive Measures

• Identify patients with preexisting renal disease.
• Initiate adequate hydration before, during, and after any procedure requiring NPO status.
• Avoid exposure to nephrotoxins. Be aware that the majority of drugs or their metabolites are excreted by the kidneys.
• Monitor chronic analgesic use some drugs may cause interstitial nephritis and papillary necrosis.
• Prevent and treat shock with blood and fluid replacement. Prevent prolonged periods of hypotension.
• Monitor urinary output and CVP hourly in critically ill patients to detect onset of renal failure at the earliest moment.
• Schedule diagnostic studies requiring dehydration so there are rest days, especially in aged who may not have adequate renal reserve.
• Pay special attention to draining wounds, burns, and so forth, which can lead to dehydration and sepsis and progressive renal damage.
• Avoid infection; give meticulous care to patients with indwelling catheters and I.V. lines.
• Take every precaution to make sure that the right person receives the right blood to avoid severe transfusion reactions, which can precipitate renal complications.

Corrective and Supportive Measures

• Correct reversible causes of acute renal failure (eg, improve renal perfusion; maximize cardiac output, surgical relief of obstruction).
• Be alert for and correct underlying fluid excesses or deficits.
• Correct and control biochemical imbalances treatment of hyperkalemia.
• Restore and maintain blood pressure.
• Maintain nutrition.
• Initiate hemodialysis, peritoneal dialysis, or continuous renal replacement therapy for patients with progressive renal failure and other life-threatening complications.

Patient teaching & home health guidance for patient with renal failure acute

• Explain that the patient may experience residual defects in kidney function for long period after acute illness.
• Encourage reporting for routine urinalysis and follow-up examinations.
• Advise avoidance of any medications unless specifically prescribed.
• Recommend resuming activity gradually because muscle weakness will be present from excessive catabolism.

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