IDF Continuing Education Course for Nurses: Primary Immunodeficiency Diseases and Immunoglobulin Therapy

The Immune Deficiency Foundation (IDF) is proud to offer this Online Continuing Education Course, developed as an initiative of the IDF Nurse Advisory Committee. This free, accredited course enhances the knowledge of the nurse clinician by providing an update on primary immunodeficiency diseases, immunoglobulin therapies and the nurse's role with these therapies.

Any nurse who is involved with administration and management of immunoglobulin therapy or the disease states where immunoglobulin is used would find this program very informative and applicable to practice.

Experience the convenience of online continuing education while earning five free CE credit hours!

Target Audience: Nurses

Program Goal

To enhance the knowledge of the nurse clinican by providing an update on primary immunodeficiency disease and immunoglobulin therapy by defining the differences between intravenous immunoglobulin therapy (IVIG) and subcutaneous immunoglobulin therapy (SCIG) and the nurse's role with these therapies.

Participants will learn to:

Describe the spectrum of disease presentation for primary immunodeficiency (PIDD)

Discuss the most common PIDD-humoral antibody deficiency

Identify the treatments used within the most common PIDD-humoral antibody deficiency

Understand the use of IVIG for treatment of PIDD

Understand the use of SCIG for treatment of PIDD

Describe the differences between IVIG and SCIG

Understand the clinician’s role with SCIG

Presentations and Presenters

Overview of Ig Therapy and Disease States in which it is Utilized

Jordan Orange, MD, PhD

Associate Professor of Pediatrics

Division of Allergy and Immunology

University of Pennsylvania School of Medicine

Children’s Hospital of Philadelphia

Philadelphia, PA

Primary Immunodeficiencies Combined T-cell and/or B-cell Immune Defects

Mark Ballow, MD

Division of Allergy, Immunology and Pediatric Rheumatology

Women and Children's Hospital of Buffalo

SUNY Buffalo

School of Medicine and Biomedical Sciences

Buffalo, NY

Intravenous Immunoglobulin Therapy (IVIG)

Kristin Epland, MSN, FNP-C

Midwest Immunology Clinic

Plymouth, MN

Subcutaneous Immunoglobulin Therapy (SCIG)

M. Elizabeth Younger, CRNP, PhD

Johns Hopkins University

Baltimore, MD

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The Nurse-Family Partnership for first-time moms and their babies

Image Courtesy of nursefamilypartnership.org

A program designed to help low-income, first-time moms and their babies is coming to northern Idaho.

The Nurse-Family Partnership is expected to start in Kootenai and Shoshone counties within the coming year, thanks to a collaboration between the Idaho Department of Health and Welfare and Spokane Regional Health District, which offers the same program in Washington.

Nurse-Family Partnership®, a maternal and early childhood health program, fosters long-term success for first-time moms, their babies, and society.

Nurse-Family Partnership's maternal health program introduces vulnerable first-time parents to caring maternal and child health nurses. This program allows nurses to deliver the support first-time moms need to have a healthy pregnancy, become knowledgeable and responsible parents, and provide their babies with the best possible start in life. The relationship between mother and nurse provides the foundation for strong families, and lives are forever changed – for the better.

The program allows public health nurses to visit interested first-time expectant moms every week or every other week until the baby is born. After the birth, the nurses continue regular visits until the child turns 2.

Officials said that since the program began in Spokane, Wash., in 2008, it has served 431 families, with 174 families currently enrolled.

In Idaho, the program is funded through a federal grant.

Laura DeBoer, health program manager for Idaho's maternal, infant and early childhood home visiting program, said contracting with the established program in Spokane will give Idaho's program a better chance of success. In Spokane, officials credit the program with improving prenatal health, reducing childhood injuries, increasing the time between the births of first and second children, increasing maternal employment rates and helping get kids ready for school.

"It's just amazing, some of the changes that can occur in these families," said Susan Schultz, who runs the Spokane health district's Nurse-Family Partnership.

Laura Nash, a 25-year-old single mother in Spokane, is the first graduate of the program there. Three years ago, she was a high school graduate working as a cashier and was about to become a mother for the first time. Nash was scared because she didn't know where her life was headed, and she feared she would ruin her child's life.

Today, she is working as a certified nursing assistant and studying toward becoming a nurse like her "mentor for life" — Rhonda Shrivastava, her nurse-family partner. Her 3-year-old daughter, Arianna, is "a very amazing, precocious, wonderful little girl who's going to go far. I wanted my daughter to have a better life, but I didn't know how."

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More seniors, but fewer living in nursing homes

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The past five years have been nothing but accommodating, she said. Even though she shares a bathroom with her 24-year-old granddaughter, she has her own room. If she wants to spend time with the family, she can. If she wants to close her door and crack open a book, she’s able to.HAMILTON — In November 2006, Jean Baker moved from rural Kentucky to a two-story West Chester Twp. home with her daughter, son-in-law and two grandchildren.

“I would never want to go and live in a nursing home or one of those assisted living places,” the 75-year-old said. “I could never afford it.”

Although Butler County is home to a growing number of senior citizens, fewer of them are living in nursing homes. The down trend can be attributed to what is often perceived as high cost for their services and increased accommodations in local programs that benefit senior citizens.

According to newly released 2010 Census data, 55 percent of Butler County’s 42,484 citizens ages 65 and older are living at home alone, with a spouse or with their children. Only 4 percent of the demographic lives in a nursing home.

Baker, who says she has never worked outside the home, is among them. Drawing social security from her deceased husband, she says there are not only financial obstacles in nursing home care, but the facilities themselves do not appeal to her.

“Here with my children I have everything,” Baker said. “We have televisions, computers, everything. My family has these things and they’ve agreed to share them with me.”

County wide, the number of people living in nursing homes has dropped 13.3 percent from 2,322 to 2,012 in the past 10 years.

The fact trends opposite the county’s rising senior population.

About 11.5 percent of Butler County is made up of those 65 and over. Ten years ago the demographic made up 10.7 percent.

Across the state, the percentage of seniors living in nursing homes dropped from 5.6 percent to 4.1 percent over the past 10 years, according to Census data.

Trend away from nursing homes cuts costs for seniors, state

According to AARP, the average cost for nursing home care is more than $50,000 a year and continues to increase. It can also vary widely depending on where a person lives.

About 65 percent of people in Ohio’s nursing homes have their care covered by Medicaid, according to the Council on Aging of Southwest Ohio.

Local programs such as Meals on Wheels and the offering of transportation services through senior centers can reduce costs for seniors, their families and the state of Ohio. The state is obligated to cover a senior’s nursing home costs if the patient qualifies for a level of care under the Medicaid system that requires nursing home usage.

Medicaid will also pay for seniors to be cared for in their homes, but those are much more manageable costs, according to Benjamin Johnson, spokesman for the Ohio Department of Job and Family Services.

“The cost of providing in-home care for a Medicaid patient is less expensive than providing nursing home care for that same patient in most cases,” he said.

Ann Munafo, executive director of the Middletown Area Senior Center, said nursing home costs can be a challenge even for seniors who consider themselves financially stable.

“Even if someone has a healthy retirement (savings), that can eat it up real quick,” she said.

Local programming

Local programming brought on by the creation of the Butler County Elderly Services Program in the late 1990s has gone a long way in contributing to the trend away from nursing homes, said Karen Dages, director of social services at the Hamilton-based Partners in Prime.

The tax levy funds in-home services from homemaking to personal care to Meals on Wheels. Partners in Prime and the Middletown Area Senior Center are two agencies that have contracts with the program to provide these accommodations.

Its levies have been successful when presented before voters, Dages said. Last November, voters approved the 1.3-mill levy with a 65.9 percent majority. In 2005, a five-year 2-mill levy passed with 54 percent of the vote and in 2001, a 1.3-mill levy passed as 57.5 percent of voters approved the initiative.

“I think everyone sees the value in keeping our seniors at home,” Dages said. “For seniors, they want to stay home where they’re comfortable. Children, they know mom and dad are happy. Plus, you’ve got property taxes and other things a city benefits from by living in a house.”

A similar program, PASSPORT, works through Medicaid and is overseen by the Council on Aging.

Betty Carter, of Middletown, said she relies on transportation services from the Middletown Area Senior Center to take her to doctor’s appointments. The 77-year-old had a hip replacement almost 10 years ago, and has since been determined to live on her own.

“If they didn’t have the services they offer here, you’d have to go to a nursing home,” she said of the position many seniors are in. “You couldn’t do it yourself.”

Senior centers also provide a sense of security, she said.

“If something were to happen and I couldn’t clean my house, I could call and have someone help me out,” she said. “That means a lot.”

Ultimately, the decision falls to seniors and their families, said Gary Horning, vice president of marketing and communications for Otterbein senior communities in Warren County.

“There will never be a need to eliminate 24-hour skilled nursing care,” Horning said. “In the grand scheme of things, there will always be a demand for a variety of wellness choices.”

Contact this reporter at (513) 705-2871 or asedlak@coxohio.com.

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Tragic Toll From Medical Errors'

BUFFALO, N.Y. When Mary Brennan-Taylor lost her mother to a series of preventable medical errors, she wasn't interested in suing the hospital where the mistakes had been made. 

"I wasn't interested in a lawsuit because that wouldn't help anyone," she says, "I was interested in culture change."

Now, Brennan-Taylor is bringing that culture change directly to students at the University at Buffalo. This summer, she was appointed adjunct research instructor of family medicine at the UB School of Medicine and Biomedical Sciences, a volunteer faculty appointment.

"Mary Brennan-Taylor came to being a patient safety advocate the hard way, after her mother died from a health care-acquired infection," says Lisa McGiffert, director of the Consumers Union Safe Patient Project. "She transformed her grief into action, collaborating with a unique University at Buffalo program that educates future doctors and nurses about the human impact of medical harm and the actions they can take to prevent such harm."

On Aug. 22, Brennan-Taylor, a Consumers Union patient advocate, will give a presentation on what happened to her mother to a class of third-year medical students at UB. In this video, she describes her story and discusses how UB is training medical students: http://www.youtube.com/watch?v=zY0DgygzCmg

By the end of the fall semester, she will have told her story to all UB students who will obtain their MD degrees in 2013.

"Every doctor that graduates from UB will hear Mary's story," says David Holmes, MD, associate vice chair of medical student education in the UB Department of Family Medicine and clerkship director. "Her story adds a very human dimension to our discussion about medical errors. It helps the students realize that it's not just statistics that we are talking about, it's somebody's Mom."

In July 2009, Alice Brennan, a vibrant, 88-year-old woman who lived independently, went into the hospital for a common medical problem that was not life-threatening. She died six weeks later from multiple hospital-acquired infections and from polypharmacy, the use of numerous medications, often more than are clinically indicated.

"It was a health care system failure," says Brennan-Taylor. "My mother was put on medications that I now know should never be given to elderly patients. It was a deadly cocktail. Then she contracted, not one, not two, but three hospital-acquired infections: MRSA (Methicillin-resistant Staphylococcus aureus), C. diff and VRE (vancomycin-resistant enterococci).

"There should have been some alerts from the pharmacy, there should have been some infection-control procedures. I never thought that a doctor or nurse intended to harm my mother, but there was an utter breakdown in the system," she says.

After her mother's death, Brennan-Taylor began searching for answers. She found that unfortunately, her experience was far from rare.

She learned that as many as one in three hospitalized patients will experience some form of medical error and that, according to a recently released report from the Office of the Inspector General, 180,000 Medicare patients die as a result of medical error every year. "That's just unacceptable," Brennan-Taylor states.

From that tragedy, Brennan-Taylor developed a passion for making sure that what she and her family experienced becomes an extremely rare event.

"I felt that I would be remiss if I didn't reach out," she says.

The UB medical school presentations start with a talk by Ranjit Singh, MD, assistant professor of clinical family medicine at UB and associate director of the department's Patient Safety Research Center; Brennan-Taylor then discusses her mother's case in detail.

Last semester, Brennan-Taylor also served as lecturer and coach to nursing students as part of an innovative patient-safety course (http://www.buffalo.edu/news/12641) in the UB School of Nursing.

Eventually, Brennan-Taylor hopes to develop a patient-safety guide or tool kit for consumers. She is working with the UB Patient Safety Research Center on a pilot project aimed at identifying and studying avoidable adverse events to understand what went wrong and how patients and caregivers could have intervened.

"UB is ahead of the curve on this," says Brennan-Taylor. "Instead of circling the wagons, they are asking, how can we be better doctors and nurses?"

In the meantime, she says, patients and their loved ones can help ensure better outcomes. She suggests:

--Before being admitted to a hospital, ask about the infection rate of the hospital and the surgeon who will perform the procedure. Ask if there has been an outbreak of C. diff, MRSA or VRE and how it was handled. Are infected patients isolated? Are visitors required to gown up before visiting infected patients?

"If the hospital can't tell you what its infection rate is and what its infection control procedures are, you might want to shop around," she says.

--Take sterile wipes when admitted to a hospital. "Wipe down the bed trays, the handrails, the telephone, any surfaces that you will be touching," she says.

--Talk to everyone who comes into your room, whether they are nurses, doctors, cleaners or visitors.

"Tell them to wash their hands before they touch you," she says. "If they open a privacy curtain with their hands and are about to perform a procedure on you, tell them to wash their hands first."

--If possible, have a family member or loved one with you at all times.

"This person is your advocate," she says, "they can be telling hospital personnel to wash their hands and they should also be asking lots of questions. Ask everyone who comes in to do a procedure on a patient, what is the procedure, why are they doing it? What is this medication and why is it being prescribed? What are the test results? What is the prognosis? What is the next step?"

--Have your advocate write everything that happens in a notebook. If possible, patients also should keep a notebook with them to record things where possible.

"Make sure you ask questions and that you get answers to your questions," Brennan-Taylor says. "And if you don't get answers, keep asking until you do."

The University at Buffalo is a premier research-intensive public university, a flagship institution in the State University of New York system and its largest and most comprehensive campus. UB's more than 28,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. Founded in 1846, the University at Buffalo is a member of the Association of American Universities.

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Clinical Research Aesthetic Nurse Counsellor Jobs in London

Clinical Research - Aesthetic Nurse Counsellor Job in London Are you a fully NMC registered General Nurse? Do you have fantastic patient skills alongside proficiency within a target driven environment? Are you looking for a challenging new career outside of the NHS? Flame Health are working alongside one of the UK’s leading Cosmetic Surgery groups who work within the field of aesthetic plastic surgery to offer the ideal candidate the exceptional opportunity to join their committed, friendly, professional and patient focused team based within their modern, state of the art facilities. The Role As a Aesthetic nurse/counsellor you will be working within a challenging sales/target driven environment, providing consultations and treatments to patients who are considering laser hair removal and associated aesthetic/cosmetic surgery treatments. You will be responsible for increasing awareness of the client’s products, treatments and procedures. The Person You must be a fully NMC Registered General Nurse ideally with post registration experience. Your ability to communicate with a wide variety of people is also of high importance as is the mind set to be flexible, friendly, approachable and a team player. We are looking for registered nurses who are looking to develop their career within an exciting, professional and commercial environment. An in depth understanding and passion to work within this target driven environment is essential. A successful track record in sales would be advantageous but is not essential. You must have the ability to demonstrate exceptional organizational, relationship building, communication and presentation skills. The Benefits 

•  Expert patient care consultancy sales, cosmetics surgery and aesthetic treatment training 
• Attractive hours including evenings and weekends 
• Pension 
• Private Healthcare 
• Life insurance 
• Maternity benefits 
• Home and car insurance 
• discounted 
• Childcare vouchers. 

Salary: £28,000 pa 

Category: Clinical Research 

Detailed Category: Flame Pharma / Clinical Research / Medical Affairs 

Location: London 

Detailed Location: Greater London Date Posted: 12/08/2011 Company: Flame Pharma 

To apply for this job or enquire about additional Aesthetic Nurse Counsellor Job Opportunities in London or the Greater London Region - Contact Flame Health on 0800 085 0858 - careers@flamehealth.com Flame Health LLP operates as an Employment Agency & Employment Business

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$189,000 Federal Funding for Marshall University’s School of Nursing

U.S. Rep. Nick Rahall (D-W.Va.) Thursday announced $189,000 in federal funding for Marshall University’s School of Nursing to provide loans and scholarships for graduate and post-graduate students enrolled in nursing programs.

“Nurses provide essential care for many of our citizens and they are in short supply,” said Rahall. “This funding not only assists Marshall in providing financial support for deserving students who have chosen to serve their communities as a health care professional, it also helps to supply the faculty needed to train those students.”

Marshall will receive two federal grant awards made available through the Health Resources and Services Administration (HRSA) at the U.S. Department of Health and Human Services: a $62,236 grant from the Nurse Faculty Loan program, which provide loans to students enrolled in advanced degree nursing programs who are preparing to serve as faculty in a school of nursing; and a $126,341 grant from the Scholarship for Disadvantaged Students program, which funds scholarships for full-time, financially needy students from disadvantaged backgrounds who are enrolled in nursing programs.

Following graduation, Nurse Faculty Loan recipients may cancel up to 85 percent of the loan over a consecutive four-year period while serving as full-time nurse faculty at a school of nursing. Recipients of Scholarships for Disadvantaged Students practice their health professions after graduation in underserved communities at rates two to three times the national average

source

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Urinary Tract Infections in Women

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Fifty to sixty percent of all women will experience at least one urinary tract infection during their lifetime. The urinary tract includes the kidneys, ureters, urinary bladder and urethra. The kidneys filter metabolic waste from the blood stream and excrete it as urine. They also help maintain the proper water and chemical balance in our bodies. The urine filters through the kidney and flows through the ureter to the bladder, which collects and holds the urine. The urine travels from the bladder through the urethra when a person urinates. The meatus is the external opening to the urethra and is located just above the vaginal opening

There are many interchangeable terms used to describe an infection of the urinary tract:

• Cystitis, bladder infection and UTI (or urinary tract infection) are all terms commonly used to describe an infection of the bladder and/or urethra.
• Kidney infection and pyelonephritis are both terms used to describe an infection of the kidney. Pyelonephritis is characterized by fever, chills, mid-back pain and often nausea and/or vomiting. Severe kidney infections may require hospitalization and can be life threatening. Pyelonephritis may develop if bladder infection symptoms are not recognized or treated quickly.

What causes a urinary tract infection?

The entire urinary tract is normally bacteria-free or sterile. Bacteria normally present in the vagina and anal area may easily enter the urethra through the meatus, during intercourse or when cleansing after urination and bowel movements. The female urethra is very short, making it easy for the bacteria to reach the bladder and multiply, causing a bladder infection. The bacteria may then migrate upward through the ureters into the kidneys and cause a kidney infection. Pregnant women are at greater risk of developing a kidney infection. Also, infrequent urination and decreased intake of water increases the risk of urinary tract infections.

What are the symptoms of a urinary tract infection?

The primary symptoms of a bladder infection include burning and pain with urination, frequency and urgency. Other symptoms may include incomplete emptying of the bladder, visible blood in the urine and brown or cloudy urine. Additionally, there may be painful spasms in the bladder, pain in the low abdomen, just above the pubic bone, and a low back ache.

Kidney infections may be accompanied by chills and fever, mid-back (flank) pain, nausea and sometimes vomiting, and a generalized feeling of illness. Burning with urination, frequency and urgency may also be present. To identify the "flank" area of the back, place your hands at the side of the waist - elbows pointing outward from the body with your fingers on the abdomen. The area where the thumbs are located is referred to the "flank" area.

How is a urinary tract infection treated?

Since UTI’s are caused by bacteria, antibiotics are needed to successfully treat the infection. For bladder infections, treatment usually lasts 3-7 days. Kidney infections require medication for 10-14 days. It is important to take the medication exactly as prescribed.

All the medication must be taken even if the symptoms go away before the medication is completed. Discontinuing the medication before it is gone may cause the symptoms to reoccur or allow the bacteria to develop antibiotic resistance, making it much more difficult to treat the next infection.

Cranberry juice (eight ounces daily) or cranberry pills may speed recovery by preventing the bacteria from adhering to the bladder wall.

To help reduce the burning and frequency of urination, phenazopyridine is available over-the-counter in drug stores. Some of the brand names for phenazopyridine are: Azo and Uristat. This medication turns the urine fluorescent orange and may stain underwear. It may also discolor other body fluids, especially the tears and may therefore cause staining of contact lenses. If a woman purchases this medication to relieve symptoms, it is important that she seek treatment for the infection within 24 hours. This medication should not be needed longer than 48 hours after beginning antibiotic therapy. Phenazopyridine should not be taken if a woman is pregnant. Women should also drink 6-8, eight ounce glasses of water daily. Avoid intercourse for 3-5 days. Decrease caffeine and alcohol intake to reduce irritation of the bladder and urethra.

Symptoms of the UTI should resolve within 2-3 days of starting antibiotics. If the symptoms are still present (even if improved) you should report this to your health care provider.

What can be done to prevent urinary tract infections?

• Drink 6-8 glasses of water daily and urinate frequently throughout the day.
• Use minimal caffeine and alcohol on a daily basis.
• Avoid daily use of mini-pads or panty liners that may cause irritation of the meatus.
• Avoid bubble baths and clothing that is tight or retains moisture. Wear underwear with a cotton crotch.
• Use additional lubrication during intercourse and urinate within 10-20 minutes after intercourse.
• After urination or bowel movements, wipe from front to back to avoid introducing bacteria into the meatus.
• Wash the vagina and meatus with warm water, but avoid direct soap applications. Soaps, body washes and feminine hygiene agents may cause external irritation and increase inflammation of the external urinary/genital tissue.
• If you have anal intercourse or anal/finger contact, wash the penis, vulva, hands and all sex toys prior to vaginal penetration. Condoms are encouraged during all anal contact, but don’t forget to change condoms before vaginal penetration.
• Use products containing cranberry regularly.
• Consider changing contraception methods. Spermicides can increase the risk of UTI’s, especially those used with diaphragm contraception.
• You should not delay urinating. Holding your urine longer can increase your risk of getting at UTI.
• Pelvic muscle exercises frequently throughout each day.

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Side Effects Of Swallowing Toothpaste

Sometimes someone accidentally swallow toothpaste (toothpaste) that is being used. But this should not become a habit, because swallowing toothpaste berflouride can cause side effects. Toothpaste usually contains various compounds such as detergents, chemicals and abrasive to clean teeth, dyes, calcium, and also taste. As well as some toothpastes now contain fluoride. This material is generally not safe if swallowed and the amount is too often exaggerated in the body. Some children sometimes enjoy the taste of toothpaste. But be aware that swallowing too much fluoride from toothpaste potentially cause permanent stains on teeth called fluorosis. Fluorosis This will cause a variety of different stains on the teeth like yellow stripes, or brown spots.

Children aged 1-4 years susceptible to this condition, because usually they swallow the toothpaste he uses. In more serious cases can cause black spots and gray even to the hole. A result of fluorosis stains are generally would continue to exist during the life of someone, as quoted from Healthcentre.org.uk, Thursday (05/26/2011). In addition, the amount of fluoride in the body that too much can cause poisoning and if ongoing can cause organ damage. In addition to other materials fluoride in toothpaste that can cause poisoning is triclosan.

Swallowing a large amount of regular toothpaste may cause stomach pain and possibly lead to intestinal obstruction. Meanwhile, other additional symptoms that can occur are:

1. Convulsions

2. Diarrhea

3. Difficulty breathing

4. Feels like salt or soap in the mouth

5. Heart rate slows

6. Shaking and in shock

7. Nausea and vomiting

8. Suddenly felt weakness

For that you should refrain from habits like swallowing toothpaste even though it feels good to avoid the accumulation of fluoride that can be dangerous, and use toothpaste that contains safe ingredients.

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MSG Seasonings Can Make Sense of Body Fat

Monosodium glutamate (MSG) commonly often associated with the emergence of a headache after eating. But recent studies have found that MSG can also increase waist circumference and obesity. The researchers found that people who eat lots of MSG will be more likely to be overweight or obese, so the size of waist circumference increased. MSG is one of the most widely used additives in the food world. Although likely more popular in Asian countries, but processed foods such as chips and canned food in the United States also contain MSG. In certain amount of MSG is considered safe, but sometimes, if the amount excessive or high sensitivity to people who could complain of headaches, nausea and other adverse reactions. Several studies have found a potential relationship between MSG use and weight.

The scientists said that people can eat large quantities if food is given MSG, because he makes a meal taste better. In addition, other evidence also suggests that MSG may interfere with signals in the body system which controls appetite and metabolism of the hormone leptin. “Consumption of MSG can cause the body to have leptin resistance, so the body can not process the energy received from food properly which makes gaining weight,” said Ka He, a nutrition scientist at the University of North Carolina, Chapel Hill, who led the study, as quoted by Reuters on Monday (5/30/2011).

Researchers found men and women who consume MSG average of 5 grams a day will tend to have excess weight around 30 percent compared with those who ate little MSG (less than 0.5 grams a day). While the people who are already overweight before, then the risk increased to 33 percent. The study involved more than 1,000 adults in China for 5.5 years and the results have been published in the American Journal of Clinical Nutrition. To that note lebl MSG content in every food consumed and avoid its use if cooking your own food.

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Diagnosis, Treatment, and Nursing Management of Ovarian Cance

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Care Planning Tool for People with Alzheimer’s Disease and Related Dementia

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Quality of Life Outcomes for People with Alzheimer’s Disease and Related Dementia Care Planning Tool for Providers Outcomes, Indicators, Measures & Related Good Practice

The Dementia Outcomes Planning Tool has been developed to provide a structured approach to examining and planning for quality of life issues with people who have dementia. The guiding principles and specific information allow care providers, in collaboration with care managers and consumers, to personalize and focus planning and monitoring of care for persons with Alzheimer’s disease and related dementia. Although these guidelines are general, it is expected that they be used to identify specific things that are important to the individual that can be followed, monitored and measured over time in order to insure that the person’s quality of life is fully supported. This Tool Recognizes Certain Values in Dementia Care:

Quality Of Life Outcomes For People With Dementia

• I have the best possible physical well-being
• I have meaningful relationships
• I experience hope because my future is valued and supported
• I am accepted and understood as an individual
• I am involved in life

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Nursing Management of a Patient with Ovarian Cancer

Nursing Management of a Patient with Ovarian Cancer
H.S., a 57 year old female with a medical history of hypertension and chronic kidney disease, was diagnosed with a Stage IIIB clear cell carcinoma of the ovary and had surgery in April of 2007. When the patient began to have physical discomfort, an exploratory lapartomy was performed. A pelvic mass had developed post peritoneal chemotherapy. The patient had surgery to remove the intraperitoneal port, pelvic mass fluid drainage and pelvic biopsy. Often patients with cancer develop cachexia and should be assessed for adequate nutritional intake. Martin (2006) states that one of the greatest challenges for a woman with ovarian cancer is malnutrition: she may have little appetite as a result of treatment of advancing disease, causing

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Skin Care Pressure Ulcer Prevention and Wound Management: Care of the Adult Inpatient

Nursing Practice Manual. Skin Care Pressure Ulcer Prevention and Wound Management Care of the Adult Inpatient

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Improving Wound Care in a Pediatric Surgical Ward

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Wound care management is becoming more complex for nurses due to new insights into wound healing (Hayward & Morrison, 1996, p.11) and because of the wide variety of wound dressings that are available (Wikblad & Anderson, 1995, p.312 and Miller, 1994, p.62). Erwin-Toth and Hocevar (1995, p.46) stated that there were approximately 400 brands of wound care dressings on the market to choose from and that wound care is made even more difficult because no one dressing method suits all wounds and the choice is dependent on the cause of the wound, infection, favorability and cost (Findlay, 1994, p.836). Because of these many different wound care techniques and dressings, nurses are becoming confused and nonplussed regarding wound care practice. Unfortunately, Millers (1994, p.62) research showed that in 85% of cases nurses were using inappropriate dressings, and O’Connor (1993, p.64) found in her study on wound care that nurses were having difficulty in applying their theory and knowledge to their practice.

Action Research was the strategy used for this study because it is very appropriate for nursing research. Traditional nursing research is failing nurses because so often they do not see its relevance to their practice (Greenwood, 1984, cited in Hart, 1995, p.9). Action Research is more suited to nursing, not only because of its problem solving and evaluating features, but also for its similarity to the stages of the nursing process of planning, acting, observing, reflecting and often replanting (Bellman 1996, p.130) . Action Research is also appropriate for nurses because, it does not require expert researchers; the participants define the problem themselves; both researchers and practitioners participate together in the process (Kemmis & McTaggart, 1988, pp.22-23, Hart & Bond, 1995, p.55 and Birkett, 1995, p.191); it is less structured and leaves room for possible changes; it is empowering for the participants; and reflective of their practice (Kemmis & McTaffart, pp.11-12, 50 and Titchen & Binnie, 1993, cited in Hart, 1995, p.8). Titchen and Binnie (1993, cited in Hart, 1995, p.8) also highlighted the empowering effect, and reflective practice, action research gave nurses so that they can hopefully free themselves from the medical hierarchy

The Setting and Problem

The setting of this project was a 16 bed surgical ward of a major pediatric teaching hospital. It was classified as a clean surgical ward and the case mix of patients were cardiac, ear, nose and throat (ENT), ophthalmic and the occasional others. Most of these patients were under the age of five years which made their participation in the project impossible. Because of the range of surgery performed there were many different wounds and many surgeons using different techniques in wound management even for the same procedure. This was confusing to the nursing staff and created an attitude that they did not have any say in their patients wound care.

Two issues of concern were raised by different members of the nursing staff. Firstly, the Unit Manager and Clinical Educator were concerned about the nursing staffs lack of observation and reflection on their patients wound care and the second was from the nurses regarding the many types of dressings and treatment used by different surgeons for as many different wounds--was one better than the others and for what wound? This was exacerbated even more by the introduction of yet another new dressing by one of the surgeons. From discussion on these two concerns it was decided to perform a ward audit using action research on how the nurses could improve their wound care practices and devise it so that quantitative outcomes could be compiled in the long term regarding the many types of wound management and dressings that were being used. The long term project would also be used to monitor infection rate which is required by the Health Department.

As the project was implemented as a ward audit, which did not involve patients or parents, neither financial assistance nor approval from the Hospital Ethics Committee was required.

The Planning

During the planning stage when discussions were held with senior nursing staff, the following strategies were proposed and developed:

1. A wound survey chart (See Appendix A) was devised that documented the process of observations to assess the effectiveness of wound care procedures and dressings for all the different wounds. This was formulated by two members of staff and shown to other staff for comments and suggestions for changes. For a long term project this survey chart was also shown to a member of the Hospital Research Department who made suggestions on how to improve it so data could be processed for quantitative research outcomes.
2. A research proposal was written in order to be able to inform, not only the nurses, but also the other disciplines that will be involved in the goals and objectives of the project.
3. The Head of the Surgical Department was also informed of the project and on his own reflection decided to collect data and take photos himself in his office when he saw the patients post-operatively. This information would also be made available for our project. The new dressing he was using, which he felt would promote better scarring outcomes in the future, was not removed until two weeks post-operatively so we needed his cooperation in obtaining the final outcome of the wound healing. The other surgeons and community liaison nurse were informed of the project by letter and discussion at a senior staff meeting. Out of the discussion at this meeting it was suggested that the data collected should be processed with the data they already had on the patients in their department. The same problem was raised when the Infection Control Department was informed of the project. This was our first major problem but was only relevant to the larger project in collecting data for quantitative outcomes. The facilitator would meet again with these departments to resolve this issue.
4. To provide us with a knowledge base for our decision making it was decided that the members of staff who were on relevant hospital committees, such as, infection control, product review, wound care, quality assurance, research and professional practice, would carry out literature reviews pertaining to their specific committee subject and our research project. This information they would present to the rest of the staff at following meetings or in-services. This would equip the nurses with evidence-based knowledge to obtain consensual agreement on decisions made for better practice strategies.
5. The Nurse Educator, who was reasonably familiar with the process of action research, became the facilitator and in this capacity held in-services to educate all the nurses regarding action research. This also helped to solicit more participation and inform the nurses of their role in the process.

Implementation

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Irritable Bowel Syndrome

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Irritable bowel syndrome (IBS) is a very common gastrointestinal condition that is diagnosed when a person has any of a variety of abdominal symptoms and/or a change in bowel habits in the absence of detectable organic pathology. It has been called a number of different names including “Spastic Colon.” Some individuals with IBS have abnormal sensations in their abdominal organs. It usually occurs in people who are between the ages of 20 and 50. It is seen in both sexes but is more common in women. It can be a chronic condition which tends to come and go over one's lifetime. Although it causes varying degrees of discomfort and inconvenient symptoms, it does not progress to any other diseases or cancer.

What Causes IBS?

IBS may be due to a variety of factors such as stress, diet, or hormones. Studies have shown that people with IBS may have changes in the way their intestinal muscles move food and liquid through the digestive tract.

What are Symptoms?

Individuals with IBS may have some of the following symptoms:

1. Change in the frequency of bowel movements from what is normal for the person ("normal" bowel movements are highly individual and range from 3 times a day to 3 times a week.)
2. Diarrhea, constipation, or alternating diarrhea and constipation.
3. Abdominal pain or discomfort which is often relieved by having a bowel movement.
4. Rectal pain or sensation of incomplete evacuation after having a bowel movement.
5. Increased abdominal bloating and/or gas.
6. Occasionally, painless diarrhea.

These symptoms may be associated with nausea, heartburn, headache, fatigue, anxiety, or depression. Factors such as stress may play an important role; some people can learn to recognize when their IBS is likely to "act up."

The following are not symptoms of IBS and should be reported immediately to your health care practitioner:

• Being awakened from your sleep by abdominal pain or diarrhea
• Fever, chills
• Blood in stool

How do I get tested for IBS?

The diagnosis of IBS is made after your health care practitioner reviews your medical history and does a physical examination. As indicated, additional blood and/or stool tests may be done.

Your medical history and description of symptoms is the most important part of the evaluation of IBS, since the physical exam and laboratory tests are usually entirely normal.

Your diet, especially regarding fiber, fat, lactose, gas-forming foods, caffeine, and alcohol intake, is important to consider. Also, drug use--including prescription and over-the-counter medications as well as recreational drugs--must be considered.

Symptoms similar to irritable bowel syndrome may be caused by lactose intolerance. This is the body's inability to digest lactose, a disaccharide found in milk products, which is frequently acquired as people get older. To test for this, you may be advised to eliminate milk products from your diet for 2 weeks to determine if your symptoms improve without lactose.

What is the Treatment for IBS?

Treatment may include counseling, dietary changes, and medications. There is no cure for IBS, but many things can be suggested to lessen the severity and frequency of symptoms.

Stress reduction

• Stress reduction techniques are often very useful for those individuals who note an association between their irritable bowel symptoms and stress.
• Exercise may reduce symptoms of IBS.

Diet

• Increase fiber content in your diet.
• Decrease fat intake.
• Avoid caffeine, alcohol, and sorbitol (a sweetener found in chewing gum).
• Avoiding gas-forming foods from the cruciferous vegetable family (cabbage, broccoli, brussel sprouts, cauliflower, radishes, turnips), beans, and legumes may help.
• Avoid large meals - smaller, more frequent meals may reduce symptoms.

Medications

• If diarrhea is a prominent symptoms of IBS, an antidiarrheal medication may be recommended by your health care practitioner.
• If pain, gas, or bloating are prominent symptoms, an antispasmodic medication may be prescribed.
• Antidepressants are sometimes used for chronic pain problems.

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Cerebral Palsy

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Cerebral palsy, a disorder that affects motor skills, muscle tone, and muscle movement, is a disorder which is most commonly due to damage during prenatal, perinatal, and postnatal periods during the pregnancy process.

Classifications

• Spastic Cerebral Palsy, Cerebral Palsy includes four classifications. Spastic cerebral palsy, the first subcategory of cerebral palsy, affects about seventy to eighty percent of individuals with the disorder. Spastic cerebral palsy is the most common classification of this particular disorder. This condition involves the stiffness of muscles in the body. Spastic cerebral palsy includes differentiating factors which set apart the levels of severity. The differentiating factors include the number of body extensions affected. The scissors affect refers to both legs muscles becoming tight and hard to control. Scissoring refers to the legs turning in and crossing at the knees.
• Athetoid Cerebral Palsy, Athetoid cerebral palsy affects about ten percent of children. "Athetoid cerebral palsy is caused by damage to the cerebellum or basal ganglia. These areas of the brain are responsible for processing the signals that enable smooth, coordinated movements as well as maintaining body posture (About Cerebral Palsy)." Children with athetoid cerebral palsy also have a difficult time maintaining posture.
• Mixed Cerebral Palsy, Mixed cerebral palsy affects about ten percent of children. This classification of cerebral palsy combines the affects of spastic cerebral palsy and athetoid cerebral palsy. This condition is due to the injuries to both the pyramidal and extra pyramidal areas of the brain (About Cerebral Palsy)."
• Ataxic Cerebral Palsy, "Ataxic cerebral palsy is classified by low muscle tone and poor coordination of movements (About Cerebral Palsy)." Ataxic cerebral palsy is the rarest form of this disorder, affecting about five to ten percent of children with cerebral palsy. It alters the child’s depth perception and balance.

Etiology

In about forty percent of all cases, the cause for cerebral palsy is unknown. The most prevalent cause of cerebral palsy is prenatal factors. Included in this category are radiation exposure, fetal anoxia, and brain growth deficiency. Perinatal factor include birth complications, cerebral hemorrhage, and trauma to brain during birth. Postnatal factors include prematurity, asphyxia, and head trauma.

Symptoms

Individuals with cerebral palsy will have neuromotor symptoms, such as persistence of primitive reflexes in infancy. A symptom that is connected with each disorder is spasticity and rigidity of muscles. Ataxia, which affects balance and coordination, also affects many individuals with cerebral palsy.

Those with cerebral palsy also have problems with motor development. A delay in motor development is expected in most cases. Also, in severe cases, some may develop permanent deficiency in motor control.

Individuals with cerebral palsy may also develop poor perceptual and attention problems, emotional disturbances, educational problems, and communication and speech disorders. Those with cerebral palsy can expect to have normal mental development in about fifty percent of all cases.

Treatment

Therapy is considered crucial in order for those with cerebral palsy to receive a good prognosis for their future. A large part of treatment involves physical therapy, which usually begins a few weeks after birth. In physical therapy programs, two sets of exercises work towards specific goals for the cerebral palsy patients. The first goal prevents the weakening or deterioration of muscles. The second prevents muscles from becoming fixed in an uncomfortable position.

Drug therapy is also used to control spasticity. The drugs help the child’s muscles to become less tense and more easily controlled. "The three medications that are used most often are diazepam, which acts as a general relaxant of the brain and body; baclofen, which blocks signals sent from the spinal cord to contract the muscles; and dantrolene, which interferes with the process of muscle contraction (Treatment of Cerebral Palsy)."

Surgery is another option for those suffering from cerebral palsy. This option is recommended when the tensing of muscles is severe enough to cause problems with movement. The main reason for surgery is to elongate muscles. Even so, surgery is usually accompanied by a long period of rest and recovery, which usually lasts about six months.

Prognosis

The prognosis of cerebral palsy depends upon each individual with the disorder. Depending on the severity of each case, prognosis for higher levels of functioning with rehabilitation is considered good for most children.

Overcoming Cerebral Palsy

Many young individuals with cerebral palsy try to overcome their disability. One young boy who was diagnosed at birth with spastic cerebral palsy was limited in the amount he could do, but not in the amount he wanted to achieve. He is now in his twenties, but throughout his life he has been able to accomplish many of his goals. Aside from attending school until his graduation in 2000, he has been able to work a part-time job. He was also able to attend all of his high school dances. He has maintained a stand that he wants to be independent, and for most of his daily activities he is able to be. Like many with cerebral palsy, he has a normal functioning brain, but is handicapped by his limited motor ability.

The motivation of those with cerebral palsy is also shown by a young girl, who made a huge impact on my life. Although this child is young, she has made a huge impact on my life. She is one of the happiest kids I have had the chance to meet. She always manages to have a smile on her face. She, like the young man above, has spastic cerebral palsy, but to a more severe condition. She is wheelchair bound, but there is hope that her physical therapy will help her to overcome the use of the wheelchair. She also has very strong feelings about being independent. It would be very easy for her to let others do things for her, because many try to. This little girl will not let that happen. For example, she wants to crawl from room to room, without being carried, and she wants to feed herself, and take her drinks without the help of others.

Looking at these two amazing people, makes me realize how much drive they must have to want to be independent. They strive to do anything that can be done without the help of others by themselves. Children with cerebral palsy have a hard time doing things normal kids can , but the rewards to see them accomplish what may seem impossible is unlimited.

Mechanical aids are also very useful for individuals with cerebral palsy. These devices range from computers to walkers or wheelchairs. These devices help individuals with cerebral palsy overcome the limitations their disorder has given them.

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NANDA NIC NOC Linkages

NANDA-I (North American Nursing Diagnoses Association International)

The NANDA International Classification is used for the identification of nursing diagnoses. The classification is recognized as a well established diagnosis terminology which is included in UMLS and recognized by ANA. The NANDA Nursing Diagnoses: Definition & Classification 2009-2011 includes 21 new diagnoses, 9 revised diagnoses, 6 retired diagnoses, and has a total of 202 nursing diagnoses for use in practice. Each diagnosis has a definition and the actual diagnoses include defining characteristics and related factors. Risk diagnoses include risk factors (NANDA-I, 2009). In this study, NANDA-I diagnoses are based on 155 nursing diagnoses including related factors and signs/symptoms (NANDA-I, 1999) used in the study hospital.

NOC (Nursing Outcomes Classification)

The current 4th edition Nursing Outcomes Classification has 385 outcomes with definitions, indicators, and measurement scales (1 to 5) for use at the individual, family, and community levels. It includes 58 new outcome labels and 67 revised outcomes (Moorhead et al., 2008). NOC allows nurses to follow changes in or maintenance of outcome states over time and across settings. Before providing an intervention, nurses use NOC to understand the patient’s current problems and nursing diagnoses and rate the chosen outcome to obtain a baseline rating. After providing an intervention, NOC is used to measure the outcome and determine a change score. In this study, NOC outcomes are defined as the second edition of NOC with 260 outcomes labels (Johnson, Maas, & Moorhead, 2000) as the available terminology in the study hospital

NIC (Nursing Interventions Classification)

The NIC taxonomy has 7 domains and 30 classes and 542 interventions in the fifth edition. It currently contains 34 new interventions and 77 revised interventions (Bulechek et al., 2008). Each intervention has a list of more specific activities for implementing the intervention that are selected based on the patients needs. In the study, NIC interventions from the third edition with 468 interventions were used in the study hospital as part of the nursing care planning (Dochterman & Bulechek, 2000)

NANDA NIC NOC NNN Linkages

NNN linkages provide associations between three standardized languages recognized by the American Nurses Organization: NANDA-I, NIC, and NOC. The first step in the process to link NNN is for nurses to determine a nursing diagnosis using NANDA-I diagnoses. The diagnoses that occur most frequently reflect their importance in representing an entire group of patients. After determining the nursing diagnosis, nurses consider which NOC outcomes are appropriate for the patient situation, and then choose NIC interventions that are most likely to achieve the desired outcome (Johnson, 2006).

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Understanding, Accepting, and Managing Anger in Disasters

Understanding, Accepting, and Managing Anger in Disasters. Disasters may evoke a broad spectrum of reactions in survivors, as well as responders. The cause and phase of the disaster, whether natural or human caused, may influence the intensity of emotions. Across the spectrum of reactions, anger is often one of the most understandable but most difficult to manage. Anger can be productive if channeled in the right way, but it can also become a significant obstacle to recovery, eroding physical and mental health, as well as family and community cohesion. In some instances, it can even represent a danger to mental health responders who want to assist survivors. It is important that responders and caregivers understand anger in the post-disaster environment and use effective anger management strategies.

Understanding Anger

Disasters of human intent that cause loss of innocent lives, such as terrorist attacks, may generate the most anger, while natural disasters are often considered beyond human control. However, some survivors may become intensely angry once they recognize human factors involved in a natural disaster (e.g., they may feel that the government neglected to mitigate the disaster through upgrades to the physical infrastructure or provided insufficient post-disaster resources). As a result, some survivors may project anger toward counselors, if they perceive the counselors to be representatives of government agencies. Of course, the intensity of anger can be highly variable, the targets of anger can shift or remain fixed, and targets are not mutually exclusive.

Anger can be projected toward several targets at once, and assisting survivors with anger can be tricky because it is a dynamic and ever-changing reaction. As such, we cannot suggest a universal approach to coping with anger. Some survivors feel entitled to their anger and are not quick to let it go, and some degree of anger must be allowed. Counselors should introduce anger management techniques slowly while emphasizing that anger management is actually a way of shifting control back to survivors, not just a ploy to quiet them.

Accepting Anger

Anger can be motivating in some instances and actually a powerful force in overcoming certain obstacles. But anger can be unpleasant and there is a natural tendency to see anger as a negative emotion that should be squelched. Before suggesting that anger is counterproductive in disaster recovery, responders should consider the following:

• Is the anger justified?
• Is the anger purposeful?
• Can the anger be channeled in a constructive manner?
• Does something about the target or intensity of the anger represent a danger?

Allowing ventilation, affirming the anger, and demonstrating that it can be tolerated and understood are effective first steps to de-escalating anger. But these steps must be taken safely and constructively if possible. Survivor anger, which increases or escalates over time, is common in long-term recovery projects during the “disillusionment” phase, when frustration runs high. In such instances, verbal de-escalation and relaxation techniques are useful. Anticipate escalating anger in recovery projects that survivors may perceive as delayed, “too little, too late,” or complicated by setbacks.

Managing Anger

Anger can be contagious, and even counselors can become angry, especially if they have been impacted by the disaster. This is not uncommon and should be both acknowledged in training and reinforced in team supervision. Survivors benefit most from counselors who can remain neutral and avoid being pulled into the “blame game,” yet sustain their compassion and commitment in the face of anger. Counselors who become consumed with anger are not helpful to survivors.

During the impact phase or later with populations that are hard to reach, counselors are often meeting survivors for the first time—and during one of the worst times of the survivors’ lives. Without much of a baseline knowledge of an individual, it can be difficult to assess when a survivor may cross that fine line between losing emotional control and losing physical control to the point of becoming a danger. Anger may also be an issue as people assess their losses during the disillusionment phase of disaster, especially if resources are not fully realized as expected. The following are three simple safety tips:

• Never sacrifice safety for rapport: As a disaster responder whose primary skill set is talking and listening, you know that building trust and creating an empathic connection is critical, but these should not be to one’s own detriment. You can rebuild rapport quicker than you will heal from a physical or psychological injury if a survivor becomes violent.
• Getting out or away too soon is always better than too late: Trust your instinct and intuition. If the situation or behavior feels threatening or dangerous, it probably is
• Don’t run from danger; run toward safety: Always have a plan B or exit strategy for any situation. In a home, know at least two ways out of the structure; in the community, identify safe places to go (e.g., lighted area, safe people) if the going gets rough.

In conclusion, counselors should be mindful to stay within the scope of their assigned program roles. After many years of work in the field of disaster response, one constant is true: the issues people have prior to the disaster are likely the same ones they have in the aftermath, especially those related to character and personality. Assisting a survivor in managing his or her anger is one way to help survivors cope with their response to the disaster, but if the survivor had long-standing issues with anger management prior to the disaster, these will likely continue and may even be exacerbated by the event. In some cases, these issues limit the effect of our assistance, so you may need to reconsider your definition of success. Full resolution is not always the goal

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Nursing Care Plan For Inguinal Hernia

Nursing Care Plan for Inguinal Hernia. Hernia is a protrusion or projection of an organ or organ part through an abnormal opening in the containing wall of its cavity, a hernia results. An inguinal hernia occurs when the omentum, the large or small intestine, or the bladder protrudes into the inguinal canal. In an indirect inguinal hernia, the sac protrudes through the internal inguinal ring into the inguinal canal and, in males, may descend into the scrotum. In a direct inguinal hernia, the hernial sac projects through a weakness in the abdominal wall in the area of the rectus abdominal muscle and inguinal ligament.

Hernia is classified into three types:

• Reducible, Hernias can be reducible if the hernia can be easily manipulated back into place
• Irreducible or incarcerated, this cannot usually be reduced manually because adhesions form in the hernia sac.
• Strangulated, if part of the herniated intestine becomes twisted or edematous and causing serious complications, possibly resulting in intestinal obstruction and necrosis.

Inguinal hernias can be direct which is herniation through an area of muscle weakness, in the inguinal canal, and inguinal hernias indirect herniation through the inguinal ring. Indirect hernias, the more common form, can develop at any age but are especially prevalent in infants younger than age 1. This form is three times more common in males.

Causes for Inguinal Hernia

An inguinal hernia is the result of either a congenital weakening of the abdominal wall, traumatic injury, aging, weakened abdominal muscles because of pregnancy, or from increased intra-abdominal pressure (due to heavy lifting, exertion, obesity, excessive coughing, or straining with defecation).

Inguinal hernia is a common congenital malformation that may occur in males during the seventh month of gestation. Normally, at this time, the testicle descends into the scrotum, preceded by the peritoneal sac. If the sac closes improperly, it leaves an opening through which the intestine can slip, causing a hernia.

Complications for Inguinal Hernia

Inguinal hernia may lead to incarceration or strangulation. That can interfere with normal blood flow and peristalsis, and leading to intestinal obstruction and necrosis.

Nursing Assessment Nursing care plan for Inguinal Hernia

Patient History, an infant or a child may be relatively free from symptom until she or he cries, coughs, or strains to defecate, at which time the parents note painless swelling in the inguinal area. On adult patient may occurs of pain or note bruising in the area after a period of exercise. More commonly, the patient complains of a slight bulge along the inguinal area, which is especially apparent when the patient coughs or strains. The swelling may subside on its own when the patient assumes a recumbent position or if slight manual pressure is applied externally to the area. Some patients describe a steady, aching pain, which worsens with tension and improves with hernia reduction

Physical Examination, If the patient has a large hernia, inspection may reveal an obvious swelling in the inguinal area. If he has a small hernia, the affected area may simply appear full. As part of your inspection, have the patient lie down. If the hernia disappears, it's reducible. Also ask him to perform Valsalva's maneuver; while he does so, inspect the inguinal area for characteristic bulging.

Auscultation should reveal bowel sounds. The absence of bowel sounds may indicate incarceration or strangulation. Palpation helps to determine the size of an obvious hernia. It also can disclose the presence of a hernia in a male patient.

Diagnostic tests

Commonly No specific laboratory tests are useful for the diagnosis of an inguinal hernia. Diagnosis is made on the basis of a physical examination. Although assessment findings are the cornerstone of diagnosis, suspected bowel obstruction requires X-rays and a white blood cell count, which may be elevated.

Treatment for Inguinal Hernia

The choice of therapy depends on the type of hernia. For a reducible hernia, temporary relief may result from moving the protruding organ back into place. Afterward, a truss may be applied to keep the abdominal contents from protruding through the hernial sac. Although a truss doesn't cure a hernia, the device is especially helpful for an elderly or a debilitated patient, for whom any surgery is potentially hazardous.

Herniorrhaphy is the preferred surgical treatment for infants, adults, and otherwise-healthy elderly patients. This procedure replaces hernial sac contents into the abdominal cavity and seals the opening. Another effective procedure is hernioplasty, which involves reinforcing the weakened area with steel mesh, fascia, or wire.

Strangulated or necrotic hernia requires bowel resection. Rarely, an extensive resection may require a temporary colostomy

Primary Nursing Diagnosis: Pain related to swelling and pressure

Primary nursing Outcomes: Pain, disruptive effects; pain level

Primary nursing Interventions: Analgesic administration; pain management

Nursing Outcome, Nursing Interventions, and Patient Teaching For Inguinal Hernia

Common Nursing diagnoses found on Nursing care plan for Inguinal Hernia

• Activity intolerance
• Acute pain
• Ineffective tissue perfusion: Gastro Intestinal
• Risk for infection
• Risk for injury

Nursing outcomes nursing care plans for Inguinal Hernia

• The patient will perform activities of daily living within the confines of the disease process.
• The patient will express feelings of comfort.
• The patient's bowel function will return to normal.
• The patient will remain free from signs or symptoms of infection.
• The patient will avoid complications.

Nursing interventions Nursing Care Plan For Inguinal Hernia

• Apply a truss only after a hernia has been reduced. For best results, apply it in the morning before the patient gets out of bed.
• Assess the skin daily and apply powder for protection because the truss may be irritating.
• Watch for and immediately report signs of incarceration and strangulation.
• Closely monitor vital signs and provide routine preoperative preparation. If necessary, When surgery is scheduled
• Administer I.V. fluids and analgesics for pain as ordered.
• Control fever with acetaminophen or tepid sponge baths as ordered.
• Place the patient in Trendelenburg's position to reduce pressure on the hernia site.

After surgery,

• Provide routine postoperative care.
• Don't allow the patient to cough, but do encourage deep breathing and frequent turning.
• Apply ice bags to the scrotum to reduce swelling and relieve pain; elevating the scrotum on rolled towels also reduces swelling.
• Administer analgesics as necessary.
• In males, a jock strap or suspensory bandage may be used to provide support.

Patient teaching home health guide Nursing Care Plan For Inguinal Hernia

• Explain what an inguinal hernia is and how it's usually treated.
• Explain that elective surgery is the treatment of choice and is safer than waiting until hernia complications develop, necessitating emergency surgery.
• Warn the patient that a strangulated hernia can require extensive bowel resection, involving a protracted hospital stay and, possibly, a colostomy.
• Tell the patient that immediate surgery is needed if complications occur.
• If the patient uses a truss, instruct him to bathe daily and apply liberal amounts of cornstarch or baby powder to prevent skin irritation.
• Warn against applying the truss over clothing, which reduces its effectiveness and may cause slippage. Point out that wearing a truss doesn't cure a hernia and may be uncomfortable.
• Tell the postoperative patient that he'll probably be able to return to work or school and resume all normal activities within 2 to 4 weeks.
• Explain that he or she can resume normal activities 2 to 4 weeks after surgery.
• Remind him to obtain his physician's permission before returning to work or completely resuming his normal activities.
• Before discharge, Instruct him to watch for signs of infection (oozing, tenderness, warmth, redness) at the incision site. Tell him to keep the incision clean and covered until the sutures are removed.
• Inform the postoperative patient that the risk of recurrence depends on the success of the surgery, his general health, and his lifestyle.
• Teach the patient signs and symptoms of infection: poor wound healing, wound drainage, continued incision pain, incision swelling and redness, cough, fever, and mucus production.
• Explain the importance of completion of all antibiotics. Explain the mechanism of action, side effects, and dosage recommendations of all analgesics.
• Caution the patient against lifting and straining.

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NCP Nursing Care Plan For Benign Prostatic Hyperplasia (BPH)

Although almost men older than 50 have some prostatic enlargement, with benign prostatic hyperplasia (BPH), the prostate gland enlarges sufficiently to compress the urethra and cause some overt urinary obstruction. It is the most common cause of obstruction of urine flow in men. The degree of enlargement determines whether or not bladder outflow obstruction occurs. As the urethra becomes obstructed, the muscle inside the bladder hypertrophies in an attempt to assist the bladder to force out the urine. BPH may also cause the formation of a bladder diverticulum that remains full of urine when the patient empties the bladder. Depending on the size of the enlarged prostate, the age and health of the patient, and the extent of obstruction, BPH is treated symptomatically or surgically.

Causes for Benign prostatic hyperplasia (BPH)

A link between Benign prostatic hyperplasia (BPH) and hormonal activity suggests.  As males age, production of androgenic hormones decreases, causing an imbalance in androgen and estrogen levels and high levels of dihydrotestosterone, the main prostatic intracellular androgen.

Other causes of Benign prostatic hyperplasia (BPH) include:

·         Neoplasm

·         Arteriosclerosis

·         Inflammation

·         Metabolic Imbalance

·         Nutritional disturbances.

Complications for Benign prostatic hyperplasia (BPH)

• Urinary stasis, urinary tract infection (UTI), or
• Renal calculi
• Bladder wall trabeculation
• Detrusor muscle hypertrophy
• Bladder diverticula and saccules
• Urethral stenosis
• Hydronephrosis
• Paradoxical (overflow) incontinence
• Acute or chronic renal failure
• Acute postobstructive diuresis.

Nursing Diagnosis Benign Prostatic Hyperplasia (BPH)

Nursing Diagnosis for Benign Prostatic Hyperplasia (BPH) determine by data that we collect in nursing assessment.

Nursing Assessment nursing care plans for Benign Prostatic Hyperplasia (BPH)

BPH Clinical features depend on the extent of prostatic enlargement and on the lobes affected. Patient history, generally, men with suspected BPH have a history of frequent urination, nocturia, straining to urinate, weak stream, and an incomplete emptying of the bladder

Patient usually complains of a group of symptoms known as prostatism: decreased urine stream caliber and force, an interrupted stream, urinary hesitancy, and difficulty starting urination, which results in straining and a feeling of incomplete voiding.

As the obstruction increases, the patient may report frequent urination with nocturia, dribbling, urine retention, incontinence and, possibly, hematuria.

Physical examination. Inspect and palpate the bladder for distension.

Physical examination reveals a visible midline mass above the symphysis pubis, which represents an incompletely emptied bladder. Palpation discloses a distended bladder, A digital rectal exam (DRE) reveals a rubbery enlargement of the prostate, but the degree of enlargement does not consistently correlate with the degree of urinary obstruction. Some men have enlarged prostates that extend out into soft tissue without compressing the urethra. Determine the amount of pain and discomfort that is associated with the DRE.

Diagnostic tests Benign Prostatic Hyperplasia (BPH)

Several tests help to confirm Benign Prostatic Hyperplasia (BPH) diagnosis:

·         Excretory urography may indicate urinary tract obstruction, hydronephrosis, calculi or tumors, and filling and emptying defects in the bladder.

·         Elevated blood urea nitrogen

·         Serum creatinine levels suggest impaired renal function.

·         Urinalysis and urine culture

·         Cystourethroscopy

·         Intravenous pyelography (IVP)

·         Transrectal prostatic ultrasound (TRUS)

·         A prostate-specific antigen test may be performed to rule out prostatic cancer.

Nursing diagnosis nursing care plans for  Benign Prostatic Hyperplasia (BPH)

Primary nursing diagnosis:

Urinary retention (acute or chronic) related to bladder obstruction

Common nursing diagnosis found in patient with Benign Prostatic Hyperplasia (BPH)

·         Acute pain

·         Fear/Anxiety [specify level]

·         Impaired urinary elimination

·         deficient Knowledge regarding condition,prognosis, treatment, self-care, and discharge needs

·         Risk for infection

·         Risk for injury

·         Sexual dysfunction

·         Urinary retention

Nursing care plans for Benign Prostatic Hyperplasia (BPH)

Common nursing diagnosis found in patient with Benign Prostatic Hyperplasia (BPH);  Acute pain,  Fear, Anxiety, Impaired urinary elimination,  deficient Knowledge, Risk for infection, Risk for injury, Sexual dysfunction, Urinary retention

Nursing Priorities Nursing care plans for Benign Prostatic Hyperplasia (BPH)

·         Relieve acute urinary retention.                                                

·         Promote comfort.

·         Provide information about disease process, prognosis, and treatment needs.

·         Prevent complications.

·         Help client deal with psychosocial concerns.

Sample Nursing care plans for Benign Prostatic Hyperplasia (BPH) with nursing diagnosis Urinary retention (acute or chronic)

Nursing diagnosis	Nursing interventions	Rationale	Evaluations
Urinary retention (acute or chronic) related to bladder obstruction, Decompensation of detrusor musculature	·       Review medical history for diagnoses such as prostatic hypertrophy, scarring, recurrent stone formation ·       Ask client about stress incontinence when moving, sneezing, coughing, laughing, or lifting objects. ·       Monitor vital signs ·       Observe urinary stream, size and force. ·       Prepare for and assist with urinary drainage, such as emergency cystostomy. ·       Prepare for procedures, such as the following: laser, transurethral microwave thermotherapy (TUMT), Cortherm, Prostatron, and transurethral needle ablation (TUNA), Urethral stent, Open prostate resection procedures, such as TURP	·      suggest detrusor muscle atrophy and/or chronic overdistention because of outlet obstruction ·      High urethral pressure inhibits bladder emptying or can inhibit voiding until abdominal pressure increases enough for urine to be involuntarily lost. ·      Evaluating degree of obstruction and choice of intervention. ·      May be indicated to drain bladder during acute episode ·      done to quickly create a wide open prostatic fossa, often resulting in immediate restoration of normal urine flow	·   Void in sufficient amounts with no palpable bladder distention. ·    Verbalize understanding of causative factors and appropriate interventions , Demonstrate techniques/behaviors to alleviate/prevent retention. ·   Voiding pattern normalized. .

Benign Prostatic Hyperplasia (BPH), Patient Teaching Discharge And Home Healthcare Guidelines

Patient teaching discharge and home healthcare guidelines for patient with Benign Prostatic Hyperplasia (BPH). Patient usualy  need assistance with management of therapy and catheter. Provide instructions about all medications used. Provide instructions on the correct dosage, route, action, side effects, and potential drug interactions and when to notify these to the physician, Provide information about specific procedures and tests and what to expect afterward, such as catheter, bloody urine, and bladder irritation

·         Instruct patients about the need to maintain a high fluid intake, to ensure adequate urine output.

·         Teach the patient to monitor urinary output for 4 to 6 weeks after surgery to ensure adequacy in volume of elimination combined with a decrease in volume of retention. Teach the patient to recognize the signs of UTI. Urge him to immediately report these signs to the physician because infection can worsen the obstruction.

• After the catheter is removed, the patient may experience urinary frequency, dribbling and, occasionally, hematuria. Reassure him and family members that he'll gradually regain urinary control
• Instruct the patient to follow the prescribed oral antibiotic regimen, and tell him the indications for using gentle laxatives. 

Postoperative Patient teaching

·         Provide information about sexual anatomy and function as it relates to prostatic enlargement helps client understand the implications of proposed treatments because they might affect sexual performance.

·         Encourage the patient to discuss any sexual concerns he or his partner may have after surgery with the appropriate counselors.

·         Reassure the patient that a session can be set up by the nurse or physician whenever one is indicated. Usually, the physician recommends that the patient have no sexual intercourse or masturbation for several weeks after invasive procedures.

·         Reinforce prescribed limits on activity. Warn the patient against lifting, performing strenuous exercises, and taking long automobile rides for at least 1 month after surgery because these activities increase bleeding tendency. Also caution him not to have sexual intercourse for at least several weeks after discharge

Prevention

Instruct the patient to report any difficulties with urination to the physician immediately. Explain that BPH can recur and that he should notify the physician if symptoms of urgency, frequency, difficulty initiating stream, retention, nocturia, or bladder distension recur.

• Urge the patient to seek medical care immediately if he can't void at all, if he passes bloody urine, or if develops a fever.
• Reinforce importance of medical follow-up for at least 6 months to 1 year, including rectal examination and urinalysis.

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