Cardiac Catherterization

Cardiac Catheterization
This is a procedure done on the heart. A doctor inserts a thin plastic tube (catheter) into an artery or vein in the arm or leg. It is advanced into the chambers of the heart or into the coronary arteries
Purpose This test is used to measure blood pressure within the heart and the amount of oxygen in the blood. It's also used to get information about the pumping ability of the heart muscle. It may be also used to determine the need for surgery
Catheters are also used to inject dye into the coronary arteries. This is called coronary angiography or coronary arteriograph. Catheterization is also done on infants and children to examine or treat congenital heart defects.
Nursing care after cardiac catheterization
Ø Monitor pulse and blood pressure every 15minutes for 1 hour and then every 30 minutes for 3 hours.
Ø Check the pulse that is distal to the catheter insertion site to determine patency of the artery the pulse may be slightly diminished for 24 hours because of arterial spasms or edema at the site
Ø Monitor insertion site for signs of bleeding, swelling (hematoma), inflammation and tenderness.
Ø If femoral approach was used, patient should be kept on bed rest for 3-4 hours.
Ø Bed should be flat or the head of the bed should not be elevated more than 30degrees.
Ø Keep the affected leg straight.
Ø If the brachial site is used for cardiac catheterization, keep the arm straight for several hours usually with an arm board.
Ø Patient can be up in room as soon as vital sighs are stable.

Diabetic foot ulcer

Diabetic Foot Ulcers
Diabetic foot ulcer is the leading cause of amputations in the United States. Family physicians have a pivotal role in the prevention and early diagnosis of diabetic complication. Management of the disease requires a thorough knowledge of the major risk factors for amputation. The most common risk factor is diabetic neuropathy.
Etiology
Diabetic foot ulcer occurs due to foot injuries and poorly controlled diabetes that prevents healing.
Loss of sensation in the foot secondary to peripheral neuropathy.
Peripheral vascular disease
Risk Factors
• History of previous ulceration and amputation.
• Absence of sensation due to neuropathy
• Arterial insufficiency
• Foot deformity and callus
• Limited joint mobility
• Poor glucose control
• Obesity
• Impaired vision
• Poor foot wear that causes skin breakdown
Prevention
• Teach patients to have doctor check foot regularly
• Wear comfortable shoes and cotton socks.
• Check foot everyday
• Treat cuts, scrapes and blisters, see doctor if wound does not heal within a reasonable time.
• Keep feet clean by washing with soap and water at least twice every day
• Cut toenails correctly
• Treat athletes foot
• Get proper treatment for thickened skin callus and corn.
• Avoid heating pads and hot water soaks
• Take action to improve circulation

Obesity and Type 2 diabetes in Children

Background information on type 2 diabetes and obesity in children

Childhood obesity and Type 2 diabetes in children have reached epidemic proportions in the United States and continues to grow. Obesity is defined as an excessively high amount of body fat (Cline, Spradlin & Plucker, 2005). Type 2 diabetes occurs when the body fails to properly use insulin, a hormone, used to convert sugar to energy (All about Diabetes p1). These increases affect all ages, ethnic groups, and gender. According to the New York State Department of Health (2004), the Diabetes Center of Excellence reported that between 10%-20% of newly diagnosed school age children have type 2 diabetes. Obesity is one of the principal risk factors of type2 diabetes. Overweight children have doubled from 15% in the 1970s to nearly 30 % in 2006 while obesity has tripled from 5 to 15 % in the United States. Twenty percent of elementary school students New York City are considered obese (Thorpe, 2004).
Type 2 diabetes was once previously known as adult onset diabetes a condition confined to adults age 40 and older. However, as a result of the number of children being diagnosed with this form of diabetes, the name was changed to type 2 diabetes. Nestle, 2005 stated that if the current rate of obesity continues, diabetes would eventually develop in one in three children who were born in 2000 (Nestle, 2005). Diabetes is the sixth leading cause of death nationally but the fourth leading cause of death in New York City largely because of its high rate of obesity among Hispanics and African American residents who are poor and working does not have the time to provide nutritional meals for their children or do not live in communities where they have access to safe play grounds for physical activity (Nestle, 2005).
The Causes and Risk Factors
Obesity and type 2 diabetes substantially decrease life expectancy, as type 2 diabetes progresses other complications such as end stage renal diseases, high blood pressure and peripheral neuropathy develops which eventually leads to death. There is also an increase health care cost to government for those children who are uninsured. Children who are obese often develop asthma, obstructive sleep apnea and psychological problems such as low self- esteem. Sedentary routine in schools exist as a result of reduced tax revenues for schools. The reduction of money has forced many schools to reduce or eliminate time for physical education classes. In addition, more families consist of working parents, which prevent the parent from supervising their children’s meals and active play. Further there has been a decrease in physical activity at home, as more children watch television or play games on the computer rather than playing soccer, basketball or jump rope. Parents have little or no time to prepare nutritious foods therefore; there has been a greater consumption of non-nutritional foods prepared outside of the home (Nestle, 2005).
Interactive questions
Ø What can parents do prevent obesity and type 2 diabetes in children?
Ø What can the government do in our school system to prevent obesity and type 2 diabetes in children?

conjestive heart failure interactive questions

1.What is the primary diagnostic tool for diagnosis?
2.List 4 signs of left side failure?
3. What causes fluid overload in CHF patients?

CONGESTIVE HEART FAILURE

Congestive Heart Failure
According to the American Heart Association, Congestive Heart Failure (CHF) is the leading cause of hospitalization for the geriatric population. There are approximately 500,000 people being diagnosed each year and approximately 5million people living with this disease in the United States. CHF is caused by heart disease, the heart is no longer able to pump blood to the systems of the body or remove all the blood that enters the ventricles.
CHF is diagnosed by careful assessment by the doctor. Some of the signs and symptoms that the doctor’s check for are, irregular heart sounds, and abnormal breath sounds, enlarge and distended neck veins. One of the best tools for diagnosis is an echocardiogram (ECHO). ECHO uses ultra sound waves to take pictures of the heart while it is beating. The test can state if both sides of the heart is failing and determine if valves are working properly.
Although as nurses we do not diagnose patients, often we have patients who are at risk for CHF and we are able to assess the patient and gets medical intervention before the patient become too overload with fluid. These are the signs and symptoms that we should look for.
Signs and Symptoms of left side failure
Ø Fatigue.
Ø Shortness of breath.
Ø Drowning feeling
Ø Dry hacking cough/wheezing
Ø Sleep apnea.
Ø Skin in clammy and pale.
Signs and symptoms of right side failure
Ø Fatigue
Ø Swelling of feet, ankles, legs, stomach (edema).
Ø Depressed appetite/nausea.
Ø Loss of muscle mass.
http://www.medicinenet.com/congestive_heart_failure/article.htm

http://www.nlm.nih.gov/medlineplus/ency/article/000158.htm

Hand hygiene interaction questions

1. Identify ways to remind co-workers to wash their hands.
2. why is it necessary to wash your hands.

Hand hygiene

Hand Hygiene

One of the first things we learned in nursing school was the importance of hand washing. According to the Center for Disease Control, 2 million people each year become ill as a result of a hospital acquired infection. Proper hand hygiene is critical to prevent these infections, which contribute to death of nearly 90,000 hospital patients per year and $4.5 billion in medical expenses. Hand washing is one of the most essential skills of infection control especially in the hospital; yet many nurses and other health care personnels ignore this basic rule and contribute to many nosocomial infections. Therefore, I want to remind everyone to wash their hands especially when you enter a patient’s room and when you are leaving the patients room. There are many other occasions when the hands should be washed. These links will give you additional information please visit:

http://www.mayoclinic.com/health/hand-washing/HQ00407
www.handhygiene.org/
http://www.mass.gov/dph/cdc/handwashing/handwashing/_brochure.pdf

Good hand washing involves using soap and water or using an alcohol –based hand sanitizer. Follow these instructions for washing with soap and water.

Ø Wet your hands and arms with warm, running water and apply liquid soap, bar soap is not recommended because it may harbor microorganisms. Lather well.
Ø Rub your hands vigorously together for at least 15 seconds.
Ø Scrub all surfaces, including the backs of your hands, wrist, between your fingers and under your fingernails.
Ø Leave water running during the entire procedure.
Ø Holding your hands and forearms lower than your elbows, rinse thoroughly, starting at one moving down the arm
Ø Dry your hands with a clean or disposable towel.
Ø Use a dry towel to turn off the faucet.