Crohn's Disease

By: Karlie Peters RN

Crohn’s “is a chronic inflammatory process in the gastrointestinal tract but with intermittent activation” (Crohn’s disease and IBS, 2007). Crohn’s is caused by an inflammation, which can cause “abdominal pain, severe diarrhea, and even malnutrition” (Mayo Clinic, 2009). The inflammation process can affect any aspect of the digestive system, but it is generally localized to the area of the distal parts, the ileum and colon. Crohn’s affects the deep layers of bowel tissue. “Crohn’s disease can be both painful and debilitating and sometimes may lead to life-threatening complications” (Mayo Clinic, 2009).

Signs and symptoms of Crohn’s include “diarrhea, abdominal pain and cramping, bloody stool, ulcers, reduced appetite and weight loss, fever, fatique, arthritis, eye inflammation, skin disorders, inflammation of the live or bile ducts, and even delayed growth or sexual development, in children” (Mayo Clinic, 2009).

Crohn’s disease has been linked to four components, they include “genetic predisposition to an increased intestinal permeability, an oropharyngeal bacterium that increases the mucosa; permeability of the small intestine with only a minimal inflammatory reaction, an adherent-invasive strain of Escherichia coli that penetrates the mucosa and causes an acute inflammatory reaction in the intestinal wall, and finally a secondary invasion of bacteria causing the chronic inflammatory characteristics” (Crohn’s disease and IBS, 2007).

Nurses can inform patients that the cause of Crohn’s disease is still unkown, but was previously thought of as being agitated from diet or stress. Researchers are now looking more towards a number of factors, “such as heredity and a malfunctioning immune system” (Mayo Clinic, 2009). Nurses can educate patients with the risk factors of Crohn’s disease. There are several risk factors and they include: “age, ethnicity, family history, cigarette smoking, where you live, isotretinoin (Accutane) use, and nonsteroidal anti-inflammatory drugs (NSAIDs)” (Mayo Clinic, 2009).

Teaching individuals that Crohn’s is diagnosed between in the ages of 20-30, with Caucasians having the highest risk, even those of Ashkenazi Jewish decent are even greater. Individuals whom have a close relative, like a parent or sibling, have a 1 in 5 risk. Cigarette smoking is “a determining factor for composition of the subgingival microflora” (Crohn’s disease and IBS, 2007). Lars Oble (2007) quoted that “a culture from the oral cavity of smokers showed an increased Gram-negative bacterial colonization.”

Once individuals get a general idea of the Crohn’s disease process, the individual should be identifying their own risk factors, for example, if an individual smokes, then cessation of smoking should be encouraged. Individuals should be seeking their primary physician if they are having signs and symptoms. Keeping a journal to write down all medications, a daily journal of food intake, along with personal information, such as major stresses or recent life changes, and making notes of bowel habits will help aid the physician in proper medical assistance. There are alternative medicines that include “herbal and nutritional supplements, probiotics, fish oil, and acupuncture” (Mayo Clinic, 2009). To feel in control of a disease, such as Crohn’s disease, then organizations, like Crohn’s and Colitis Foundation of America (CCFA) (888-MT-GUTPAIN) can help with providing information and accessing of support groups in the local areas.

Reference Page
Mayo Clinic. (1998-2009). Mayo Clinic. Retrieved from http://www.mayoclinic.com/ on
October, 6th 2009.
Olbe, L. (2008). Concept of Crohn's disease being conditioned by four main components,
and irritable bowel syndrome being an incomplete Crohn's disease. Scandinavian Journal of Gastroenterology, 43.

NOTE: This blog post reflects the work of Karlie Peters, RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

DASH Diet and Hypertension

By: Debra Minnifield, RN

The “Dash Diet”, which stands for Dietary Approaches to Stop Hypertension, is credited with effectiveness in reducing blood pressure in African Americans and older adults. The focus of the DASH diet is to lower and control blood pressure. The use of this diet could reduce blood pressure by a few points in only two weeks and reduce it eight to fourteen points over time. Its other health benefits include protection against heart disease, stroke, osteoporosis and even diabetes. Use of the DASH diet may even potentiate the action of antihypertensive medications and decrease insulin resistance.

The Dash Diet formed the basis for the new SDA My Pyramid and is recommended by:

• The National Heart, Lung, and Blood Institute

• The American Heart Association

• The 2005 Dietary Guidelines for Americans

• US guidelines for treatment of high blood pressure

The DASH diet controlling portion sizes and consists of whole grains, low fat dairy products, fish poultry, legumes fruits, and vegetables. The diet is low in saturated fat, sodium, cholesterol and total fat. However, the diet is high in protein, magnesium, calcium and potassium. Red meat and sweets may be consumed in moderation.

As advocates, nurses can educate and empower clients to take control of their health by encouraging the use of the DASH diet. Nurses should perform thorough assessments and urge patients to make lifestyle modifications, such as engaging regularly in appropriate exercise, limiting their alcohol intake and avoiding tobacco.

References:

Hypertension in African Americans. Minority Nurse (2003).

www.mayoclinic.com,retrieved October 10,2009

Note: This blog post reflects the work of Debra Minnifield, RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Obesity in America

BY: Lora Hartman-Devine, RN

Obesity is a disease that affects millions of Americans and often is chronic in nature. Obesity can be caused by genetics, emotions, age, and medications. Obesity is commonly defined within the medical community as men with more that 25% fat and women with more than 30% are considered obese. According to the Center for Disease Control and Prevention, having a Body Mass Index (BMI) of greater than 25. Incorporation of using the BMI into nursing health assessments can help better treat our patients.
Many health risks are associated with the person that is overweight. Diabetes, coronary artery disease, hypertension and depression are a few of the prevalent diseases that occur due to obesity. The stress of trying to “fit in” within a society that equates beauty with thinness can be daunting to a person that is overweight leading to emotional and psychological problems in addition to the physical ailments.
Health care interventions should occur for those that are obese. Nurses, in conjunction with other healthcare professionals can work with patients in developing goals to reach a healthy weight. Nursing interventions can be customized to meet the needs of the patient through diet, exercise and counseling. Exploration of alternative means can be utilized to work towards the established goals as well. The nurse that is able to work with the patient towards developing a healthier eating lifestyle will help the patient avoid further medical problems. Nutritional counseling as well as simple exercises can be incorporated into care plans. Education and prevention are both key factors in dealing with obesity.
Education within communities is vital to help decrease the rate at which obesity is occurring. Communities that alliance with churches, schools and health organizations often offer education and prevention methods to overcome obesity and overeating. Referrals to these groups or agencies to clients that are overweight can greatly impact their attitude toward weight loss and influence the process. Nurses that are able to work together with community resources, and patient preference will help to reduce the number of Americans affected by this chronic disease.

References
1 .http://www.webmd.com/diet/understanding-obesity-2 2. 2.
2.http://www.emedicinehealth.com/obesity/page4_em.htm
3. Brown, I., Stride, C., Psarou, A., Brewins, L., & Thompson, J. (2007). Management of obesity in primary care: nurses' practices, beliefs and attitudes. Journal of Advanced Nursing, 59(4), 329-341.

NOTE: This blog post reflects the work of Lora Hartman-Devine, RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Raiding the Medicine Cabinet

By: Zondra Davis, RN

Drug addiction is characterized by compulsive use of a controlled substance for non-medical purposes despite deleterious effects from continued use. Physical dependence is manifested by painfully uncomfortable withdrawal symptoms after cessation of a drug. It is difficult for some to associate these outcomes with a curious teen raiding the medicine cabinet, but the epidemic of prescription drug abuse warrants our attention.

Vulnerable teens, ill-informed about the adverse consequences of prescription drug abuse have found themselves on the fast track to chronic illness as a result of prescription drug addiction. While illicit drug use has steadily declined among youth, prescription drug abuse has seen an astronomical increase! What can we do as healthcare providers to protect teens from reckless pleasure-seeking escapes in a pill bottle?
Assessing for and talking about substance abuse can be uncomfortable; nevertheless, it is an essential component that should occur at each healthcare contact for the developing adolescent. Substance abusers are more likely to engage in risky behaviors that result in sexually transmitted diseases-including HIV and to suffer from traumatic injuries that can disable for life. Depression and other mood and psychiatric disorders often accompany drug abuse.
Teens need to be educated about the lethality and morbidity that pervades substance abuse communities. Parents need to be aware of the signs of prescription drug abuse. Empirical data suggest that universal interventions have potential for public health impact by reducing many types of prescription drug abuse among adolescents and young adults (Spoth, Trudeau, Shin, & Redmond, 2008).

The fragility or resilience of familial relationships can be tested during the tumultuous teen years. The best nursing approach will be aimed at identifying teens at risk for substance abuse disorders so that preventative strategies can be employed. Positive communication and effective nursing education for parents and teens can avert the negative health outcomes linked to long term substance abuse disorders.

1. Spoth, R., Trudeau, L., Shin, C., & Redmond, C. (2008). Long-term effects of universal
preventative interventions on prescription drug misuse. Addiction. Jul; 103(7): 1160-8

NOTE: This blog post reflects the work of Zondra Davis, RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Hypertension Nursing Managment

By Jamie Brinton, RN

Hypertension is often referred to as the silent killer because there are frequently no symptoms associated with it, but it can lead to stroke, heart failure and heart attack. As nurses we help our patients decrease their risk of hypertension and manage hypertension through screening and education.

The first responsibilities of nurses for managing patients hypertension is to understand the disease itself. Primary hypertension is hypertension that has no identifiable cause, such as kidney failure or pregnancy. Most people who suffer from hypertension are suffering from primary hypertension. Even though there is not identifiable cause, there are several factors that may contribute to primary hypertension.

Hypertension occurs when the systemic vascular resistance is too high. Systemic vascular resistance, or SVR, is the amount the heart must work against to push the blood from the heart to the arteries.

Now that we understand the physiology of high blood pressure, we can look at what factors cause a high SVR. Obesity, stress, smoking, and caffiene use can lead to the release of epinephrine. Epinephrine increases the resistance, which in turn leads to an increased blood pressure. Obesity can also activate the renin-angiotension-aldosterone system. Angiotension II, is a potent vasoconstrictor, which also increases the resistance and therefore blood pressure. Genetics are a major risk factor for hypertension. It is believed that genetics effects angiotension and this increased hormone leads to the increased resistance in the body. Salt can cause an increased volume in the vascular system. This increase puts pressure on the ventricles making it harder to move the blood from the heart to the body. (Chummun, 2009)

As nurses we would not expect all of our patients to fully understand the causes of hypertension. However, it is important for nurses to understand the causes of the disease in order to fully answer patients questions.

The next step in managing hypertension for our patient's is education. Once a lifestyle assessment has been made, we can begin teaching. I would begin with telling patients at risk for hypertension the reasons it needs to be addressed. Hypertension can lead to other serious conditions such as heart failure, heart attacks and stroke. Furthermore, hypertension is associated with symptoms that effect quality of life such as fatigue, head aches, dizziness, sob, tinnitus, blurred vision, confusion and irregular heart beat. (Chummun,2009)

Next I would address their individual risk factors. Those who have a BMI greater than 25 can begin with weight loss. Programs such as weight watchers and seatle sutton promote portion control and making choices with lean protein, high in fiber and whole grains. I would give them a copy of a the updated food pyramid. Furthermore, teach them to look for food products that are approved by the American Heart Association. I know that at Jewel, they have heart tags next to price tags on items approved by the AHA. Increased physical activity will help patients loose weight, reduce stress, and lower cholesterol. All of these will help decrease their risk of hypertension. I would recommend inactive patients to set small achievable goals at first and gradually increase their activity as it become a permanat part of their lifestyle. As mentioned before excessive alcohol and caffiene intake can increase epinephrine levels and therefore increase blood pressure. Teach patients to limit these items and make sure they understand the effects of these on blood pressure. Stress is a part of life, but stress reduction is essential to prevent hypertension. Teach your patients stress reducing activities such as exercise, meditation, increased social support, aromatherapy, massage, baths and decreased worrying. Tell patients to put themselves on their to do list. Daily activities for stress reduction should be as important as work, school, and family.

Finally, it is important to make sure that patients know that by modifying the risk factors and taking an active role in the management of hypertension, shows a marked decrease in morbidity and mortality.

References:

Chummun, H. (2009). Hypertension - a contemporary approach to nursing care. British Journal of Nursing (BJN), 18(13), 784-789

NOTE: This blog post reflects the work of Jamie Brinton, RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Glaucoma

BY: Bisola A. Adeniran, RN



Glaucoma is a progressive disease of the optic nerve that can lead to loss of vision. It is usually due to increased intraocular pressure (IOP), but it can be due to to other causes. Open-angle glaucoma (or primary open-angle glaucoma (POAG) is one of the two main types of glaucoma, and it is common. The other type, angle-closure glaucoma is less common. Open-angle glaucoma affects all ages, but it occurs more often in people over 40. It is the second leading cause of blindness in the United States

Whose at Risk?
Family History of Glaucoma
Clients with Diabetes
Clients with Myopia (nearsightedness)
Previous eye injury
Regular, or long-term streoid use
African Americans (have a greater tendency)
Clients with low blood pressure
Restricted blood flow to the optic nerve

Normal eye blood pressure is maintained by a balance of fluid that flows into the front of the eye and then drains out. Thje angle of the eye where the iris and the cornea meet is where the fluid drains into the trabecular meshwork. If this drainage is obstructed it increases presuure on the optic nerve which can lead to vision loss.
Usually, there are no warning symptoms. Later stages of the disease include loss of peripheral vision in small areas, blurred vision, halos around lights, blind spots, and poor night vision. Frequent eye examinations help with screening and diagnosis of glaucoma. There is no cure for glaucoma but laser eye surgery may help improve the draining of the excess fluid. Eye drops that help to lower the pressure inside the eye are often prescribed.

Teaching
Since this is a silent eye killer of eyesight, patients often pay no attention to the symptoms. Nurses must emphasize and encourage early screening with eye examinations. The nurse can encourage clients to to inform their primary health care provider that if they symptoms of chronic glaucoma including: Any signs of eye infection, pain in the eye, redness of the eye and sudden vision changes.

References:
www. glaucomafoundation.org



NOTE: This blog post reflects the work of Bisola Adeniran, RN with editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Epilepsy

BY: Rosalind Anderson, RN

Several months ago my best friend bought a 42in LCD television for her mom. The television was quite the focal point in her mom’s small one bedroom apartment living room. Her mom’s nightly ritual included curling up on her recliner and watching her favorite late-night programs until she fell asleep. She usually would awaken in the middle of the night, turn off her television and go to bed. However a few months later her mother started to notice that she would wake up in front of the television with very bad headaches, dizziness and feeling disoriented. It wasn’t until she noticed a hole in her wall the morning following such an incident that she realized what had happened. My best friend’s mother suffers from epilepsy and had been suffering seizures. It wasn’t until she visited with her neurologist that the reason for her increase in seizures was known. Her neurologist identified the new television as the trigger for her increased seizure activity.
Epileptic seizures are the result of transient cerebral dysfunction caused by abnormal electrical activity in the brain presenting as sudden recurrent attacks of memory, sensory or psychic manifestations with or without loss of consciousness or generalized convulsions (Levenson, 2008). Some causes of seizures are genetic, brain disease, trauma, infection, febrile illness, electrolyte imbalances and eclampsia (Lawal, 2005). However approximately one third of adult epilepsy cases are idiopathic.
The standard medical treatment of epilepsy is with antiepileptic drugs (AEDs) (Lawal, 2005). However nonpharmacologic management such as surgery involving brain dissection or implantation of electrical devices may be used for those who do not respond to pharmacologic treatment (Kanceski et.al, 2005).
Despite use of AEDs or nonpharmacologic therapies, there are factors which may trigger seizures. These include emotional stress, insomnia, hormonal changes, alcohol/drug abuse, and photosensitivity. In photosensitivity, seizures are provoked by flickering light such as reflections from sunlight, flashing neon lights or watching television, as in this case. Sitting a few meters from the television would help to prevent these light-induced seizures (Lawal, 2005). However given the small dimensions of my friend’s mom’s living room, to the proportion of the visual area occupied by the television, this was not possible.
In additional to being knowledgeable of surgical and pharmacologic therapies and their side effects, and encouraging adherence to the treatment regimen, the nurse caring for the patient with epilepsy can assess for these triggers and teach the patient to do so also.
Unfortunately my friend had to trade in her mom’s television for a smaller one. After the switch, her mom did not experience any more seizures while watching television; and I got a good deal on a TV.

NOTE: This blog post reflects the work of Rosalind Anderson, RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Congestive Heart Failure

By Lynn Christain RN

According to the CDC, over five million people have heart failure in the United States, with 550 thousand new cases diagnosed each year. Over 287 thousand people will die this year as a result of congestive heart failure. The most common causes include coronary artery disease, hypertension, and diabetes.
Education of this group of individuals is vital in minimizing mortality and hospitalizations, as congestive heart failure is the most common admission diagnosis for the population using Medicare (CDC, 2009).

While and Kiek (2009), state that evidence supports that self-management programs have a positive affect on the quality of life and self care behaviors elicited by this group of individuals. In conjunction with this self-efficacy, nurse-directed patient education also plays a large role in management of this disease (2009).
As nurses, we must advocate for our patients psychological support network as many patients with CHF also have anxiety and depression. In addition, regular exercise, teaching about the patients medications and ensuring they have a clear understanding of why each medication is important is essential. Daily blood pressure and weight checks are important, as is keeping an accurate log. Identifying 1-2 pound weight gain in a 24 hour period or 3 pound weight gain in a week as warning sign and the primary health care provider should be notified. Other early warning signs that patients should be aware of are shortness of breath and difficulty lying in a flat position. All of these signs are vital to detecting fluid overload and may indicate the need for adjustment in the patient’s diuretics.
When educating a patient on their diet, emphasizing fresh fruits, meat and vegetables, and choosing foods low in salt, such as, poultry, legumes, milk, yogurt, pasta, rice and legumes, is important. Encourage patients to season with herbs, spices and fruit juices instead of salt. It is also important to teach patients to read labels and be able to identify the amount of sodium in less that 350 milligrams per serving. Another way to identify foods high in sodium is by locating the ingredients, if salt or sodium is listed in the first five ingredients, it is probably too high (UCSF, 2009).
Congestive heart failure is best managed by self-efficacy; patients must become their own advocates. In order for patients to transition into their own advocate, they must perceive their susceptibility to the disease as a serious illness and make educated choices regarding the modifiable factors that potentate the disease process such as diet, exercise, medication compliance, and follow up health visits. Often these modifiable factors are seen as barriers by CHF Patients. Education regarding how to change these modifiable factors will reduce the likelihood of exacerbations of CHF, thereby becoming more self sufficient in managing their own disease process.
It is important to acknowledge however, that each patient will differ in educational backgroupnd and cultural considerations must be made accordingly.

References
Centers for Disease Control and Prevention. Division for Heart Disease and Stroke Prevention. Retrieved from http://www.cdc.gov/dhdsp/library/fs_heart_failure.htm.

University of California. Diet and Congestive heart failure. Retrieved from http://www.ucsfhealth.org/adult/edu/dietAndHeartFailure/index.html.

While, A., & Kiek, F. (2009). Chronic heart failure: promoting quality of life. British Journal of Community Nursing, 14(2), 54-59.

Note: This blog post reflects the work of Lynn Christian RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.