Atrial Fibrillation

By Lisa Lemenger RN

What is atrial fibrillation? Atrial fibrillation is the two atria of the heart quivering instead of beating effectively. Because the blood isn’t pumped out of the atria effectively, it may pool and form clots (American Heart Association, 2011). Visualized on an EKG rhythm strip, it is an irregular, narrow complex rhythm with no discernable P-waves.
What’s the worst that can happen that can happen with atrial fibrillation? The worst is a blood clot breaking free and lodging in the brain causing a cerebral vascular accident (CVA). While some patients may recover from a CVA with few deficits, the sooner the treatment the better, others suffer deficits that range from motor activity to speech and other senses. Whatever the effect, it is detrimental to a person’s well-being.
Although not all patients with atrial fibrillation experience blood clots and CVA’s, symptoms they may experience include palpitations, shortness of breath, dizziness, chest pain, and syncope. Although none of these cause harm on their own, they cause discomfort and may lead to other illness or injuries.
Treatment for atrial fibrillation ranges from treating underlying causes, such as a thyroid condition, to prescribed medications. Anticoagulant therapy, such as Coumadin, is used to prevent blood clots. Beta blockers and calcium channel blockers are used to slow the heart rate (American Heart Association, 2010).
If medications do not control heart rates, a procedure called radiofrequency catheter ablation can be performed. Multiple catheters are inserted through bilateral veins in the groin, up through the right atrium, and into the left atrium through a transeptal puncture. The pulmonary vein is burned to cause a scar around it to eliminate the abnormal electrical signals sent by the atrial node (Johnson, Jadick, & Knippers, 2011).
Patient education provided by the nurse should include signs and symptoms; when to seek medical attention; medication information; and education regarding any underlying causes or associated chronic illnesses. Equipped with education and encouragement by the nurse, the patient should be able to follow a medication regimen and control his atrial fibrillation, minimizing symptoms and the risk of blood clots.

References
American Heart Association. (2011). Atrial Fibrillation. Retrieved February 23, 2011, from
American Heart Association: http://www.americanheart.org/presenter.jhtml?
Identifier=4451

American Heart Association. (2010, August 11). Treating Atrial Fibrillation. Retrieved February 23,
2011, from American Heart Association: http://www.heart.org/STROKEORG/LifeAfter
Stoke/HealthyLivingAfterStroke/UnderstandingRiskyConditions/Treating-Atrial-
Fibrillation_UCM_310778_Article.jsp

Johnson, T.W., Jadick, E.A., & Knippers, L. (2011). Atrial Fibrillation Ablation. American Journal of
Nursing, 58-61.

Note: This blog post reflects the work of Lisa Lemenger 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.

Colorectal Cancer

By Margaret Duffy-Chodl RN

Colorectal cancer is found in the colon or the rectum that develops slowly over a period of 10 to 15 years. The cancer usually develops from polyps in the inner lining of the colon or rectum. These polyps can either be benign or malignant. When the polyps are malignant, they invade the wall of the colon or rectum and grow into the blood or lymph vessels which metastasize to other parts of the body. Most colorectal cancers are adenocarcinomas which account for 95% of this type of cancer (ACS).
Diagnosis of colorectal cancer is usually made in the advanced stages of the disease. The diagnosis is made through a biopsy of the tissue in the colon or rectum. The major symptoms of this cancer are a change in bowel habits, rectal bleeding or black tarry stools, abdominal pain, fatigue, or weight loss. It is very important to have colorectal screenings after age 50 to detect this treatable disease. The screenings to detect this disease are flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, CT colonoscopy, or a fecal occult blood test (ACS).
The symptoms can be effectively addressed by having the recommended screenings starting at age 50 and knowing the risk factors. The one major risk factor is age, most colorectal cancers are diagnosis after the age of 50. Other risk factors are history of polyps, inflammatory bowel disease, and family history of colorectal cancer, inherited gene defects, and racial & ethnic background. African Americans and Jews of Eastern European descent have the highest rate of colorectal cancer (ACS).
The prognosis is based upon when the diagnosis is made. Since the symptoms are vague, diagnosis is normally made in advance stages of the disease. This is why screening for this disease is so important and knowing the risk factors (ACS).
The recommended prevention of this disease is to maintain a healthy weight, be physically active, eat a healthy diet with fruits and vegetables, and limit the amount of alcoholic beverages. This along with knowing risk factors and screenings for the disease after age 50 helps with early diagnosis (ACS).

References

American Cancer Society. (2011) Colorectal Cancer Early Detection. Retrieved from http://www.cancer.org/Cancer/ColonandRectum


Note: This blog post reflects the work of Margaret Duffy-Chodl 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.

Anorexia Nervosa

By: Candice Willingham RN

In today’s society, there seems to be a desperate need to be skinny or to look like the girls on television. Eating disorders have become quite common due to this need. Anorexia nervosa is an eating disorder that compels women to starve themselves in order to lose weight. These women may have an unrealistic body perception and a major fear of becoming fat. Nearly 4% of women now suffer from anorexia (Clark, 2009, p432). The disease typically develops near or during puberty. Anorexia is characterized by excessive dieting, a marked loss of body weight, purging, excessive exercise, and amenorrhea. According to Clark (2008), Anorexia results in mortality rates nearly 12 times higher than the annual death rate for all other causes among women 15-24 years of age.

Primary prevention should be aimed at teaching parents and young girls what the appropriate body size is for their age, promoting proper exercise, giving examples of a healthy diet, promoting adequate rest, explaining the harms of smoking and drinking, helping young girls to develop a strong self image and build self esteem.
Secondary prevention would be promoting annual physicals and pap smears. This will help health care providers notice sudden loss of weight and be able to intervene accordingly. The amount of weight loss determines how aggressive the treatment should be (Harvard, 2009). Women's health care providers are able to assess normal menstrual cycles and explain normal outcomes.
Tertiary prevention would come by helping the female and her family get their lives back together after battling an issue like this. Proper counseling is very important. The counselor can help the patient and the families develop a plan to prevent a relapse.

Clark, Mary Jo. (2008). Community Health Nursing: Advocacy for Population Health (5th Ed.). New Jersey: Pearson
Harvard Mental Health Letter. (2009). Treating Anorexia Nervosa: A Multidisciplinary approach is best, but relapses are common. Harvard Mental Health Letter. 26(2), 1-4.

Note: This blog post reflects the work of Candace Williamson 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.

Addressing Attention Deficit Hyperactivity Disorder in Children

By: Stephanie Johnson

Does your child have trouble paying attention at home or school? Does he or she exhibit impulsive behaviors? He or she may have a disorder known as Attention deficit hyperactivity disorder (ADHD) formerly known as ADD. ADHD is a chronic condition that affects adults and approximately 5-8% of school age children (NRC, 2009).
Signs and symptoms include excessive talking, difficulty paying attention, losing things, easily distracted, running about or climbing excessively, blurting out answers before question completed, and difficulty remaining seated (NRC, 2009). Children with ADHD tend to perform poorly in school or may be perceived as a nuisance or abnormal.
Primary interventions are focused on educating the public especially caregivers, educators, and families about the disease eliminating the “bad child” stigma that is attached to the condition. Early recognition and diagnosis with parents’ awareness of social disruptions, poor performance in school, and depression may prevent drop out and strained relationships early.
Secondary interventions are aimed at coping with and treating the disorder. ADHD workshops at behavioral health centers offer help with peer adjustment, behavior difficulties, and social and family relationships. Continued parent/child education, behavior management techniques, and stimulant medications are elements of the comprehensive treatment plan (NRC, 2009). The most common stimulant medications used to treat ADHD are Concerta, Adderall and Ritalin. These medications are effective in lessening symptoms and dose adjustments may be necessary.
Tertiary interventions include emotional support for parents, caregivers. The diagnosis of ADHD causes some parents to have feelings of guilt or shame (Clark, 2008).ADHD is chronic and 1/3 of people outgrow the symptoms (NRC). Working with a mental health practitioner, community nurse, ongoing education and support groups aid in maximizing full mental health abilities while attaining a healthy level of well being.

References
National Resource Center on ADHD (NRC).Retrieved from http://www.help4adhd.org/en/about/what.
Clark, M.J. (2008). Community Health Nursing: Adovcacy for Population Health.(5th ed.) Upper Saddler River, New Jersey:Prentice Hall

Note: This blog post reflects the work of Stephanie Johnson 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.

Lead Poisoning

By Krystle Banzuela RN

Lead is both one of mankind’s most useful metals and an environmental health hazard to children 6 years and younger. Lead can be ingested, inhaled, or absorbed through the skin ("Lead in industry," n.d.). Young children are highly susceptible to lead exposure because their nervous systems are not fully developed (Clark, 2008), and because they put everything in their mouth. Lead is in paint, dust, drinking water, and dirt.

Lead poisoning is defined as too much lead in the body that is seen as elevated lead blood level of > 10 mcg/dL (Hockenberry & Wilson, 2009). There is no safe level of lead in the body. At low levels, there are no obvious signs and symptoms of lead poisoning, but it can cause developmental delays, learning problems, and lower attention span. Moderate and high levels can lead to constipation, abdominal pain, poor appetite, anemia, poor appetite, vomiting, irritability, or lethargy. Damage is permanent and non-reversible, however, referral to a child development or speech-language specialist may improve mental abilities.

Below are the suggested lead poisoning prevention activities at the primary, secondary, and tertiary levels, as provided by the Illinois Lead Program (Fokum, Simpson, & Churchill, 2009, p. 26):

Primary Prevention
• Avoid exposure to lead
• Identify sources of lead poisoning like houses with lead based paint
• Focus on high-risk indicators
• Fix highest risk housing
• Evaluate and control hazards
• Educate

Secondary Prevention
• Early detection and intervention prevents progression and emergence of lead poisoning symptoms
• Increase testing rates
• Intervene to reduce risk of long-term damage
• Encourage home visits by public health nurse for case management
• Initiate environmental inspections for lead poisoned cases

Tertiary Prevention
• Damage caused by lead poisoning is irreversible
• Chelate or use chemical compounds that bind to lead to remove toxic metal from the body
• Aim at improving quality of life of lead poisoned children through education
• Eat foods rich in iron and calcium

Lead poisoning has been steadily declining since 1997 from 18.7 % of children in Illinois to 1.7% in 2008 (Fokum, Simpson, & Churchill, 2009), a more than 50% decrease! While this is good news, we should try to get all the lead out and provide a hazard free physical environment for our children. They are the future, and it is our responsibility to provide a safe environment in which they can grow to their fullest potential.

Check out this Get Lead Out Brochures about intervention, prevention, and renovation:
http://www.idph.state.il.us/envhealth/pdf/Lead_Intervention.pdf
http://www.idph.state.il.us/envhealth/pdf/Lead_Prevention.pdf
http://www.idph.state.il.us/envhealth/pdf/Lead_Renovation.pdf

Sources used:
Clark, M. J. (2008). Community health nursing. (5th ed.) New Jersey: Pearson Prentice Hall.
Fokum, F, Simpson, E, & Churchill, S. Illinois Department of Public Health, Illinois Lead Program. (2009). The impact of lead: Illinois lead program annual surveillance report. Springfield, IL.


Note: This blog post reflects the work of Krystle Banzuela 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.

Seasonal Allergies

By Janella Schroeder RN

It is spring time! Oh the glory! Time to head outside and mow the grass plant your garden, water the flowers, go to the baseball games, and go for a long evening walk after being cooped up all winter long…but what if you have seasonal allergies? This beautiful and magnificent time of year can be miserable for your patients with chronic allergies, 1 in 6 patients to be exact. The multiple symptoms that are associated with allergies such as sneezing, nasal congestion, wheezing and watering of the eyes and dermatitis and/or eczema are the second most reported medical complaint (WOOTEN, 2000).

Do you know what allergies are and how to help?
What are allergies?
Seasonal allergies are an abnormal or over exaggerated response to a substance (dust, mites, pets, mold, pollens, grass…) that most others tolerate without difficulty. When an allergen enters the body the immediate hypersensitivity reaction happens on the surface of mast cells reacting with IgE causing histamine to be released. Histamine causes spasms of smooth muscle, dilation of blood vessels, and increased production of mucus leading to the cascade of allergy symptoms. (WOOTEN, 2000)

How are allergies diagnosed?
• History: The Who, what, what, when, where and how.
WHO: Who all has these symptoms?
WHAT: What causes the symptoms and what are the symptoms?
WHEN: When are the symptoms the worst?
WHERE: Where are the symptoms the worst?
WHY: Why are they seeking treatment now, are they worse?
HOW: How long have they had these symptoms?

• Physical Exam: A complete physical exam should be performed with special attention to eyes, ears, nose, mouth, throat, and chest.

Common Symptoms: allergic shiners (dark circles under eyes), allergic salute (constant wiping of the nose as if saluting), chronic sniffling, halitosis, postnasal drip, lingering colds, sinusitis, cough, asthma, chronic throat clearing, nasal congestion, snoring, fatigue, rhinitis (Pickett, Hamel, Weaver, & Timmons, 2003). Sneezing, runny nose, watering eyes, itchy eyes, ears, nose (Lillis, 2007).

• RAST Testing: (Radioallergosobent Teasting) A blood allergy test that measures IgE in the patients serum.
• Skin Testing: There are two types of skin tests, the prick and intradermal where very diluted concentrations of allergens are injected into the patient to see if there is a reaction inflected. A patient is considered to be allergic to the allergen if there is a 3mm or larger red wheal on the skin as a reaction (WOOTEN, 2000).

How can I help my patients manage the symptoms?
Environmental Control:
o Watch the weather and pay attention to pollen, grass, weed and mold levels before going outside (hot, dry, windy weather equals more allergens)
o Limit time outside, especially gardening or mowing-wear a mask if you must do these
o Keep windows and doors to house and car closed
o Install an air purifier and a heap-filter on the heater and air conditioner
o Shower and wash clothes daily to remove allergens from clothing and hair
o Vacuum carpet, curtains, and upholstery often
o Wash bedding often and in the warmest water setting on washer

Provide education of medications:
• Antihistamines- can block the effects of the histamine release. Best when taken before exposure to allergen. Available both over the counter and prescription.
• Bronchodilators-given for asthma symptoms associated with allergies, can alleviate bronchospasms.
• Corticosteroids- can be used topically or as a nasal spray to relieve inflammation. Available both over the counter and prescription.
• Decongestants – can reduce congestion in the nasal airway by vasoconstriction. Available both over the counter and prescription.
• Allergy Shots- can help decrease histamine and IgE over time by actually giving small doses of allergen

References:
Lillis, K. (2007, January). Surviving Seasonal Allergies. Advance for Nurses .
Pickett, ,. A., Hamel, ,. V., Weaver, ,. J., & Timmons, C. (2003). Pediatric Allergies. Advance for Nurses , 5 (1), 29.
WOOTEN, L. (2000, October). Diagnosis & Management of Environmental Allergies. Advance for Nurses ,11.

NOTE: This blog post reflects the work of Janella Schroeder, 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.

Whose afraid of Hepatitis C?

By Kathleen Jacobs-McLoyd RN


ONE INSTANT AND YOUR LIFE CAN BE CHANGED. Do you know to protect yourself? “HEPA”-means liver….”IT IS” means inflammation.
In July 1988, Massachusetts Nurses Association president Karen Daley, MPH, RN, went from being an emergency room department nurse to being a lifelong patient. Karen got stuck with a needle. Six months after being stuck and after reporting the accident she learned that she had been infected with HIV and Hepatitis C. She states “the moment I reached my gloved hand over a needle box to dispose of the needle I had used to draw blood-has drastically changed my life”.
Approximately 170 million people worldwide are infected with the hepatitis C virus; at least four million reside in the United States. The CDC (Centers for Disease Control) predicts that in the next 10 years the hepatitis C death toll will triple, eclipsing that of AIDS. Although the rate of HCV infection is declining, those infected decades ago now face complications. Hepatitis C is one of the many types of hepatitis caused by a virus that damages the liver. It’s mainly a blood borne virus, which means that it’s passed from person to person when infected blood comes into contact with non infected blood. It’s also possible to contact hepatitis C from infected body fluids such as IVDU past or present, tattooing, body piercing, needle sticks, dialysis equipment, and transmission from mother to child, and sexual activity that involves contact with infected body fluids. In 10 out of 100 cases of hepatitis C, the risk factor is unknown.
Hepatitis C can be either acute or chronic. Acute infection (1st stage liver is inflamed) typically remains asymptomatic or produces mild symptoms 60%-70% have no discernible symptoms. The most common symptom is fatigue, some people have muscle and joint pain, fever, nausea, vomiting, loss of appetite or stomach pains….this sounds like the flu. Sometimes, the liver is able to get rid of the virus and go back to normal. A person infected with hepatitis C can carry the virus 20 years or more and not have symptoms. Chronic infection in up to 85% of hepatitis C cases doesn’t go away when that happens it’s called chronic or long lasting. If liver damage caused by the virus is left untreated, it can sometimes lead to cirrhosis- a serious condition in which normal cells are replaced by scar tissue.
Treatments for HCV are improving medications used to treat hepatitis C. The treatment is a combination of two antivirals- interferon and ribavirin. About 40% of patients with HCV who undergo this therapy become clear of the virus. Self care for patients would include:Inform anyone who may come into contact with your blood that you have hepatitis C. Don’t share any personal hygiene items i.e. razors, nail files, tooth brushes . Carefully toss any items that may contain your blood or body fluids. Clean cuts and wounds with disinfectants and cover with bandages. Avoid sexual practices that may cause contact with blood.
Handle contaminated needles with care, ensure the safety of sharps disposal containers, wear protective equipment, demand hypoallergenic gloves if you’re allergic to latex, consider all human blood as a source of infection, demand safer devices in your workplace.

References:Who’s Afraid of Hepatitis C? American Journal of Nursing Volume 100 (5) May 2000, pp26-32
www.liverfoundation.orgwww.cdc.gov/hepatitis
www.hepc-connection.org

NOTE: This blog post reflects the work of Kathleen Jacobs-McLoyd 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.