Cirrhosis of the Liver

by Laura Kowalk Rogge RN, BSN & Carlyn Husbands RN, BSN

Cirrhosis of the liver is a disease in which the hepatic cells become damaged and scarred. The two most common causes are excessive alcohol use and viral infections of the liver such as hepatitis. Other causes can be autoimmune disorders, disorders of the bile duct and obesity, uncontrolled hyperlipidemia and diabetes. 

The liver has a few very important functions: 1) metabolizes, 2) detoxifies, 3) stores and 4) produces. An interruption is any of these hepatic functions can cause the cells in the liver to die and become fibrous, leading to irreversible liver damage called cirrhosis. In addition, this fibrous scar tissue interferes with the blood flow of the liver resulting in portal hypertension. Portal hypertension is a serious complication of cirrhosis that can lead to splenomegaly and bleeding varices within the stomach, esophagus and/or rectum which can be potentially fatal.

During metabolism the liver will break down waste products and convert them into something that the body can use. An example of this is when the body metabolizes ammonia into urea. Ammonia, a by-product of protein metabolism, will go to the liver to be metabolized and is converted into urea which is then excreted via the kidneys as urine. In cirrhosis, the liver will be unable to convert the ammonia into urea leading to dangerous levels of elevated ammonia causing toxic hepatic encephalopathy.

The liver is responsible for detoxifying all substances we ingest, such as alcohol and medications, deciding what can pass through safely into our bloodstream and throughout our body. It does this with the help of the Kupffer cells.

Glycogen is an accumulation of glucose and is stored in the liver. When the body has an excess of glucose such as from eating a heavy meal, it will store all this extra glucose as glycogen. When the body requires energy, it will tap into this storage of glycogen and convert it to glucose for the body to use as energy. In cirrhosis, both of these storage functions can be impaired causing hyperglycemia when the liver is unable to take in and store the excess glucose. Hypoglycemia will occur when the liver is unable to convert the glycogen back to glucose when the body requires it. The liver also stores the vitamins A, C, E, D, K, B12 and iron. In cirrhosis, the liver is unable to absorb these necessary vitamins.  

Albumin, bile and coagulation factors are produced in the liver. Albumin is a necessary protein in that is attracts fluids and drugs and brings them into the vascular system. It also is bound to calcium and is important for bones. Bile is the substance that transports old red blood cells (bilirubin) to the spleen, and also transports cholesterol, flushing it out of our body via the stool. Coagulation factors such as PT, PTT, INR are produced in the liver and are responsible for the clotting of our blood.

When in the early-stages, cirrhosis symptoms can often go undetected. Frequently, cirrhosis is first discovered via routine blood work. To help substantiate the Dianosis, both lab and imaging tests are done. Liver function tests include enzymes that are found in the liver ALT AST ALP and bilirubin. Coagulation tests PT, and hepatitis antibodies are also used. An ultrasound, Ct, or MRI of abdomen may also be done. 

 Treatment for cirrhosis varies according to the cause and extent of the liver damage. The goals of treatment are to slow the progression of scarring by prevention or treating symptoms and problems cause by cirrhosis.

• If you have cirrhosis caused by excessive alcohol use, try to STOP drinking. Alcohol  in cirrhosis is toxic to the liver.

• Weight loss. People with cirrhosis caused by nonalcoholic fatty liver disease could become healthier if they lose weight and control their blood sugar levels.

• Medications may limit further damage to liver cells caused by hepatitis B or C via specific Tx.  of the viruses.

Staff, M. C. (2018, December 07). Cirrhosis. Retrieved from mayoclinic.org: https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487

Edited by Shirley Comer DNP, RN, JD, CNE, ACNS-BC, APN

Irritable Bowel Syndrome by Artria Alexander RN BSN

Irritable bowel Syndrome (IBS) is a common gastrointestinal disorder characterized by a cluster of signs and symptoms that effects the process of digestion in the large intestine. The process of food absorption and water absorption is compromised. IBS triad of signs and symptoms include; cramping, abdominal pain, and altered bowel habits (constipation/diarrhea). 

Signs of IBS include abdominal distention, food intolerance, and occasionally weight loss. 

Factors that contribute to IBS are linked to muscle contractions in the intestine, abnormalities in the nervous system including poor coordination between the brain and intestine, inflammation of the large intestine, and severe infections caused by bacteria or viruses. The symptoms of IBS can be triggered by food, stress and hormones. 

Those who are at an increased risk of developing IBS include; females, individuals under age 50, those with a family history of IBS, and those who have preexisting mental health problems such as anxiety and depression.

To diagnosis and treat IBS, a comprehensive health history and physical exam are done. Diagnostic criteria include; X-ray, CT scan, colonoscopy, sigmoidoscopy, lactose intolerance test, upper endoscopy, and stool test. Treatment options are geared toward lifestyle and diet modifications consisting of high fiber foods, the intake of plenty of fluids, rest and adequate sleep, and exercise. Other options for treatment include medication management such as fiber supplements (Metamucil), laxatives (Miralax), anti-diarrheal medication (Imodium), anticholinergic medications, (Bentyl), tricyclic antidepressants and pain medications (Neurontin).

Reference:

Chang, L. (n.d.). Irritable Bowel Syndrome (IBS). Retrieved November 23, 2019, from https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome.

Edited by Shirley Comer DNP, RN, JD, CNE, ACNS-BC, APN

Acute Bronchitis 

Written by Judith Ose RN, BSN, MSNc and Nwachukwu Nkechi RN, BSN, MSNc, Edited by Shirley Comer 

In general, Acute Bronchitis is a viral infection whose predominant symptom is a cough which can last up to three weeks (Hart, 2014, p. 34). Moreover, this viral infection can present like a mild cold. In addition, an individual with acute bronchitis can also present with wheezing, especially if there is an underlying disease process of asthma (Hart, 2014, p. 34).

            Antibiotics are usually not needed in the treatment of acute bronchitis unless cases of high fever, high pulse rate, and respiration are involved.

Risk factors of acute bronchitis

• Close contact with someone who has a cold or acute bronchitis
• Failure to get age-appropriate immunizations
• Exposure to tobacco smoke, fumes, dust, and air pollution

Diagnostic criteria and treatments. 

History is one of the main steps in diagnosing acute bronchitis. The following symptoms may help in the diagnosis of acute bronchitis; CBC with differential, procalcitonin to rule out a bacterial infection, blood culture if bacterial is highly suspected, chest x-ray in elderly patients or if physical findings are suggestive of pneumonia.

The most debilitating complication of this disease process is the actual cough and therefore the treatment focuses primarily on suppressing the cough The treatments for acute bronchitis include Dextromethorphan 20 mg PO, q4hrs or 60 mg extended-release liquid BID for the cough, inhaled bronchodilator albuterol 2.5 mg TID/QID by nebulizer, for wheezing, and Benzonatate  200mg and Guaifenesin 600mg PO q6hrs, for the mucus production (Hart, 2014, p.36). 

References 

Hart, A. (2014). Evidence-based diagnosis and management of  acute bronchitis. The Nurse Practitioner 39(9), 35-36 doi: 10.1097/01.NPR. 0000452978.99676.2b

Kinkade, S., & Long, N. (2016). Acute bronchitis. American Family Physician, 94(7), 560-565. Retrieved from https://www.aafp.org/afp/2016/1001/p560.pdf

Fayyaz, J. (2018). Bronchitis essential practice, background, pathophysiology. Retrieved from: https://emedicine.medscape.com/article/297108-overview   

Knutson, D., Braun, C. (2015). American family physician. Diagnosis and management of acute bronchitis retrieved from:  https://www.aafp.org/afp/2002/05/15/p2039.html           

Gout

By Kimberly Lopez RN, BSN, MSNc 

and Mia Watkins RN, BSN, MSNc

Edited by Shirley Comer

Gout is a type of arthritis that predominately affect older males, but can affect women too.  It is more common in African Americans (5%) than whites (4%) (ncbi.nlm.nih.gov).  It is caused by a build-up of uric acid in the blood; which comes from ingesting purine-rich foods and drinks such as red meat, seafood, fish, poultry, bacon, organ meats, alcohol, and chocolates (arthritis.org).  Someone affected by gout should limit their intake, if not abstain, from these foods and drinks to keep flare ups at bay. 

Risk factors for developing gout are: 1. excessive daily use of purine diet; 2. excessive alcohol usage; 3. male gender; 4. obesity; 5. hereditary; and 5. being African American.

Diagnosis is made based on symptoms, which may include, inflamed joint, (particularly the big toe), pain, and tenderness to attached limb; elevated uric acid in the blood, and synovial fluid analysis.  However, the symptoms of gout are not always obvious.  For example, a person may present with pain in the joints, but no inflammation.  The key is to look at the bigger picture, i.e. diet, lifestyle, history, and risk factors, before making a diagnosis. Aspiration and examination of synovial fluid and blood test for uric acid are done to confirm the diagnosis of gout. 

Treatment for gout includes limited purine diet, NSAIDs, and the prescription drug, colchicine.  Patients should also maintaining adequate fluid intake, reduce alcohol intake, and lose weight if obese.

References

Safe Foods for Gout. (2019). Retrieved April 25, 2019, from https://www.arthritis.org/living-with-arthritis/tools-resources/expert-q-a/gout-questions/food-for-gout.php

Singh, J. A. (2013, February). Racial and gender disparities among patients with gout. Retrieved April 15, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3545402/

Dunphy, L., Winland-Brown, & J., Porter, B.O. (2015). Endocrine and metabolic problems. Primary Care: The Art and Science of Advanced Practice Nursing. Zycowicz, M., South, T., Martin-Plank, L., & Dunphy, L. (Eds.). (4^th ed., pp. 840-919). Publisher: F.A. Davis Company.

Perry, G, Castellani, R., Moreira, P., Lee, H., Zhu, X., and Smith, M. (2008). Pathology’s new role: Defining disease process and protective response. International Journal of Clinic & Experimental Pathology. 1(1):1- 4.

Pharmacotherapies for smoking cessation in the elderly

by Kathleen Zanlocki RN

Every year in the U.S. over 392,000 people die from tobacco caused diseases, making it the leading cause of preventable death. Another 50,000 people die from exposure to secondhand smoke ("Stop smoking," 2011). The most common causes for smoking related mortality in patients over age 60 are lung cancer, cardiovascular disease, and chronic obstructive pulmonary disease (Mauk, 2010). Today’s elderly population grew into adulthood when smoking was socially acceptable by most adults and even some teenagers (Elhassan & Chow, 2007). Smoking was allowed in physician offices and even hospitals, and until 1969 elderly patients in nursing homes were still being given free cigarettes on the annual “respect for the aged” holiday (Elhassan & Chow, 2007). However, awareness of the addictive properties of tobacco spead, and smoking cessation became a recognized public health effort as more research data and evidence accumulated. (Elhassan & Chow, 2007).
The use of pharmacotherapy can be a key part of various methods used in assisting patients with their tobacco dependence (Mauk, 2010). According to the FDA, there are 2 first-line therapies used to treat withdrawal symptoms from smoking cessation; Wellbutrin XL and nicotine replacement therapy (Fiore, Jaen & Baker, 2009). Nicotine replacement therapy is the most widely used form of pharmacotherapy for managing nicotine dependence and withdrawal. These therapies include the transdermal patch, nasal spray, gum, lozenges, and nicotine inhalers. All have been shown to be effective in comparison with placebo (Fiore, Jaen & Baker, 2009). Wellbutrin XL is an antidepressant unrelated to selective serotonin reuptake inhibitors or tricyclic antidepressants. This drug’s mechanism of action related to smoking cessation is unknown. Side effects may include insomnia and loss of appetite (Fiore, Jaen & Baker, 2009). Second-line pharmacotherapies that are not approved for use for smoking cessation by the FDA are: clonidine and nortriptyline. The side effects of clonidine may include hypotension, rebound hypertension, dizziness, constipation, and agitation. The side effects of nortriptyline may include a risk of arrythmias (Fiore, Jaen & Baker, 2009).

All of these therapies may or may not be effective, but the first step in treating tobacco dependence is the patient's willingness to quit(Mauk, 2010).

References

Elhassan, A., & Chow, R. (2007). Smoking cessation in the elderly. Clinical Geriatrics, 15(2), 38-45. Retrieved from http://www.sbggpr.org.br/artigos/Como on 10/28/2011.
American Lung Association, (2011). Stop smoking. Retrieved from http://www.lungusa.org/stop-smoking
Fiore, M. C., Jaen, C. R., & Baker, T. B. US Department of Health and Human Services, Office of the Surgeon General. (2009). Treating tobacco use and dependence: 2008 update. Retrieved from http://www.surgeongeneral.gov/tobacco/tobaqrg2.htm
Mauk, K. L. (2010). Gerontological Nursing (2nd Ed.). Valpraraiso, Indiana: Jones and Bartlett Publishers.

NOTE: This blog post reflects the work of a Registered Nurse 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.

Saw Palmetto as Treatment for BPH

by Angelique Todd, RN

Benign prostatic hyperplasia, more commonly known as BPH is a non-cancerous enlargement of the prostate gland. This can be due to long- term stimulation of male sex hormone androgen. Microscopic appearance of BPH occurs typically by age 30 and is present in 50 percent of men by the age of 50 and 80 percent of men by age 80 (Burnett, 2006). It is said that, with longevity, every male will experience some level of this condition (Mauk, 2010). Symptoms may vary, but usually include urinary frequency, urgency, or inability to urinate.

Saw palmetto comes from a palm- like plant found in the southeast part of the U.S. It has been used to relieve symptoms related to BPH. Supporters claim that it has an anti-androgenic effect that with long-term use can reduce prostate cell proliferation, therefore minimizing symptoms. Some side effects include: nausea and vomiting, diarrhea, and bad breath. It is also believed to have anti-inflammatory and anti-platelet effects, and may be useful in chronic pelvic pain, bladder disorders, decreased sex drive, hair loss and hormone imbalance (Margaret A. Fitzgerald, December 2007). Finasteride is also a commonly used drug in the treatment of BPH. Effects are similar to those of saw palmetto and results of both are evident in PSA levels. In contrast the side effects are considerably different. Impotence, abnormal ejaculation and loss of sex drive are just a few. Older adult males may consider this to be more of a disadvantage when deciding whether to use a more traditional method of treatment.

As with most herbal supplements, safety, effectiveness or purity is not governed by the FDA making its use risky. When weighing the pros and cons of both a more holistic approach is needed it is the responsibility of the nurse to be knowledgeable about the modalities the client may be using and contraindications involved with other medications (Mauk, 2010). Basic knowledge in this area will give the nurse the tools necessary to help the patient make the most informed decision possible.

References

Burnett, A. W. (2006). "Benign Prostatic Hyperplasia in Primary Care: What you need to know.". Journal of Urology Issue75 , 19-24

Margaret A. Fitzgerald, D. A.-C. (December 2007). Herbal facts, herbal fallacies. Amercan Nurse Today , 27-32.

Mauk, K. L. (2010). Review of the Aging of Physiological Systems. In K. L. Mauk, Gerontological Nursing : Competencies for Care (pp. 150-151). Sudbury: Jones and Bartlett Publishers.

NOTE: This blog post reflects the work of a Registered Nurse 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.

Screening for Prostate Cancer

by Mikayo Streeter, RN

Should men get screened for Prostate Cancer?

Prostate cancer is the second leading cause of cancer death in U.S. males, with an estimate of over 186,320 new cases and 28,669 deaths in 2008” (Mauk 2010, p. 418) This cancer is known for its unusual behavior because the patients can go asymptomatic for awhile before the cancer has spread throughout the body. “The incidence of disease varies according to race, with Americans black having the highest risk in the world” (Granville 2006, p.53) According to the American Cancer Society, men especially African Americans should get screened at the age of 40. They often go to say that men who have a family history should consider discussing the option with their doctor. “Men with one close relative affected have more than a two-folded increased risk, and men with two close relatives affected have more than an eight-fold increased risk” (Granville 2006, p. 53). Studies have shown that it increases with age for the older population of men. “Over half of men 70 and older show some histologic evidence, though only a percentage die from this disease” (Mauk 2010, p. 418).

According to Mauk, she mentions that it is highly suggested that older men get screened because they are normally asymptomatic. Most men complain if symptoms are present that there is pain in the lower back, difficulty urinating, painful ejaculation, or blood in the urine/semen. There is two ways a screening can be done to detect prostate cancer: digital rectal exam (DRE) and PSA blood test. During the digital rectal exam the doctor inserts a glove fingered thru the rectum to feel for anything unusually hard or enlarged prostate that may exhibit lumps. The PSA test is used to detect a higher level of prostate cells thru the blood stream. “A PSA of less than 4ng/ml is considered normal for ages 60-69 years, whereas 7ng/ml may be normal in the 70-79 age group, because PSA rises with age” (Mauk 2010, p.418).

When the cancer is detected, it depends on the stages and growth of the cancer and the severity of the disease. The doctor discusses several options with the family and patient: surgery (radical prostatectomy), radiation/chemotherapy, or watchful waiting. “Surgery is considered the best option when the cancer is caught early; however, because a radical prostatectomy is major surgery and carries some inherent risks, all options should be considered with the older patient” (Mauk 2010, p. 143). The nurse responsibility after surgery is to explain the potential side effects to the patient: inform the patient they may experience urinary incontinence, loss of interest in sex, hot flashes, and impotence. “Sometimes, radiation is suggested where x-rays are passes through an external machine or through radioactive isotopes inside the body” (Moore 2007, p.1) Watchful waiting is recommended for the elderly men because of the complications after surgery. It is also recommended if they have other medical comorbidities. Older men should take a holistic approach by including a “low fat diet and the addition of vitamin E, selenium, and soy protein” (Mauk 2010, p. 418). The nurse should encourage the patient to consult with doctor before taking a holistic approach.

Prostate cancer is known as a chronic disease. That if it occurs in older men watchful waiting is the best decision for these patients. These patients need frequent monitoring but no treatment is needed. “Most prostate cancers are slow-growing and unlikely to be a cause of significant morbidity and mortality in older men” (Mauk 2010, p. 372). The pro of doing the screening is to early detect prostate cancer before it metastasize to other organs of the body. For older men, it will help to decrease the altered mental status changes if these men frequently develop urinary tract infections, urinary incontinence, or inability to urinate. The con is that majority of the older men that is diagnosed with prostate cancer usually die from the other medical comorbidities. “The greatest controversy regarding screening for prostate cancer is the inability to accurately predict which cancers will be aggressive and require treatment, and which are unlikely to metastasize” (Mauk 2010, p. 372).

References

Ginger, L. (2007). The Importance of cancer screening. Retrieved October 29, 2011, from http://cancerawarenesscenter.com
Granville, L. J. (2006). Prostate disease in later life. Chronic conditions in later life, , 51-56. Mauk, K. L. (2010). Gerontological nursing competencies for care (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers. Moore, K. (2007). Prostate cancer. Retrieved October 29, 2011, from http://cancerawarenesscenter.com

NOTE: This blog post reflects the work of a Registered Nurse 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 & It’s Harmful Affects!

by Shanta Spurlin, RN

Hypertension, known as high blood pressure is prevalent in the elderly population today. Many people in the world today have Hypertension and are unaware. Hypertension is a silent killer, and many diseases are caused secondary to it. HTN is characterized by an elevated blood pressures measuring 140/90 or greater.HTN increase the risk for the elderly to have heart disease, stroke, kidney or renal problems which can cause patient’s to go on dialysis if it goes untreated. This disease can be deadly. Risk factors for hypertension include family history, ethnicity, poor, diet, being overweight, excessive alcohol intake, a sedentary lifestyle, and certain medications (Mauk, 2010, p.384).
As healthcare providers we should teach our patients and raise awareness to this disease and its harmful affects. It is important to diagnose and treat hypertension to reduce the incidence of cardiac disease (Mauk, 2010, p.368). Blood Pressure screenings should be done regularly to assess for ones risk for this disease and to properly diagnosis it. Diagnosis of hypertension should be based on several readings at different times or visits to the primary healthcare provider (Mauk, 2010, p.384).

The Pros of HTN is that it can be treated, controlled and even prevented, by lifestyle changes and modifications. Exercising, weight loss and management, reading food labels to reduce sodium intake, and diet change can help prevent and control HTN.
There are also medications that can be prescribed by a physician to help lower ones blood pressure and manage HTN. Some examples are Diuretics, Beta-blockers, and Ace inhibitors. The Goal of medical treatment in older adults is to lower blood pressure to 120/80 or below (Mauk, 2010, p.385).

References
Mauk, K. L. (2010). Gerontological Nursing (2nd Ed.). Valpraraiso, Indiana: Jones and Bartlett Publishers.

NOTE: This blog post reflects the work of a Registered Nurse 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.

Preventing Obesity via CAM''s

by Lakeisa Perry, RN

It’s no secret that eating right and exercising are the best methods for shedding the pounds. They may also be the two most inexpensive ways to a healthier weight and state of mind. Obesity is defined as a medical condition where a surplus of body fat has gathered in a position where it can have an unfavorable effect on an individual’s health (Wikipedia, 2011).

When we speak of obesity there has to be a greater rationale for the crisis. The use of complementary and alternative medicine (CAM) has become widely used in our current population (Mauk, 2010). As healthcare professionals, when we are performing assessment we should also asses for the use of CAM (Mauk, 2010). Obesity is a disease that affects over 60 million people in the country (Ezine, 2011) and has a particular affect on women. Looking deeper into the issue of obesity there has to be a multifaceted underlying problem. Healthcare professionals should look to the subterranean explanations for this growing epidemic. In addressing the issue we should first remember that being overweight is different than being obese. To combat the dilemma we should address the psychosocial aspect of the problem i.e. depression, low self-esteem, lack of control or a possible fundamental health issue like thyroid anomalies or osteoarthritis. I would like to believe as Americans we do not wake from bed uttering “today is the day that I will do all I can to remain obese and unhealthy”. We’ll examine some interventions to oppose the problem of obesity.

When attempting to defeat your own personal demons I believe that the battle starts in your mind. Prepare yourself mentally to defeat the problem whether you have to say a chant or read a text to start your day. You also need to rate the importance of the CAM therapy in your life and believe that it will be effective to help fight your obesity. When exploring alternative modalities to weight lose some CAM’s that can be helpful are herbs, relaxation techniques (such as mediation and deep breathing exercise) and acupuncture. Acupuncture can be used to fight obesity by suppressing food cravings, appetite and boosting an individual’s mood (Kent, 2010). Acupuncture can help by increasing the stomachs smooth muscles tone and once the muscle tone has improved the hypothalamus then triggers the hypothalamus’ satiety center and stimulates the vagal nerve to increase the serotonin level (Kent, 2010) and as healthcare professionals we all know that an amplified serotonin level will cause a diminished desire to eat. It also can have a dual benefit because it alters our mood by fighting depression. Another alternative for fighting obesity can be the ingestion of herbs. Herbs can work in your body by improving your metabolism or suppressing your appetite. To name a few, Bee Pollen can stimulate metabolism and satisfy your cravings, Chromium can help the body use fat for energy and Brewer’s Yeast has been known to reduce various cravings for food and drink (Ezine.com, 2011). Herbs are not designed to replace your diet and there are some drawbacks to these alternative methods. For instance Bee Pollen should only be used for a short period of time (WebMD, 2011) and can cause an allergic reaction if taken without the knowledge of an allergy to the product. It has also been reported that Chromium can cause DNA damage (About.com, 2011) and should be used short term.

The benefit can sometimes out way the risk when attempting to combat obesity and by addressing the predicament known as obesity one can improve cardiovascular function, diabetes mellitus, kidney disorders, depression and hypertension.
Obesity can be precluded and is one of the major principles to death prevention for most individuals (Center for Disease Control and Prevention, 2011).

Always consult with your physician before attempting an alternative treatment.

References

Center for Disease Control and Prevention. (2011). Four specific health behaviors contributing to a longer life. Retrieved 10/30/2011 from http://cdc.gov/Features/LiveLonger/.
Kent, L.T. (2010). Acupuncture for obesity. Retrieved 10/30/2011 from http://www.livestrong.com/article/107364-acupuncture-obesity/
Mauk, K.L. (2010). Gerontological nursing competencies for care (2nd ed.).Sudbury, MA: Jones & Bartlett. Nick, D. (2007). Herbs to fight obesity. Retrieved 10/30/2011 from http://health.ezine9.com/herbs-to-fight-obesity-1381ca599f.html
WebMD. (2011). Bee pollen benefits and side effects. Retrieved 10/30/2011 from http://www.webmd.com/balance/bee-pollen-benefits-and-side-effects
Wikipedia. (2011). Retrieved 10/30/2011 from http://en.wikipedia.org/wiki/Anti-obesity_medication
Wong, C. (2007). Chromium pilcolinate side effects. Retrieved 10/30/2011 from http://altmedicine.about.com/od/herbsupplementguide/a/chromiumsideeff.htm

NOTE: This blog post reflects the work of a Registered Nurse 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.

Polypharmacy and the Elderly

by Patricia Elder, RN

Although the elderly population constitute on 12.7% of the U.S. population, they consume 34% of all prescription medication and 40% of all non prescription medication. The average person 65 to 68 years of age has an average of 14 prescriptions per year. (Mauk, 2010). Medications are meant to improve the health and well being of the elder person, by relieving pain, discomfort and treating underlined disease processes. When the elderly have many medications to take it results in non compliance due to medication regiment or expense. (Smeltzer, 2008). Polypharmacy occurs when multiple medication are taken, which increases medication interaction, multiple medication effects and incorrect dosages are used. With each medication a person takes it increases the drug interaction which is responsible for many emergency room and doctors visits. Some of the side effects of drug interaction are nausea, constipation, gastrointestinal bleedings, urinary incontinence, muscle aches, sexual dysfunction, and confusion. Dizziness and increase risk for falls (Mauk, 2010).

When patients come in it is imperative to see all medications, dosage and supplements to identify potential problems and identify medications that contraindicated. In addition to teaching intervention to enhance the elderly compliance with medication by:

1. Explain medication, purpose, adverse effects and proper dosage
2. Write medication schedule
3. Teach and show how to use medication dispenser
4. Destroy or remove old unused medication
5. Instruct patient to report over the counter medications, including herbal products
6. Instruct patient to keep list of all medication, over the counter and herbal supplements
7. Recommend the use of only one pharmacy to prevent duplications and contraindications in medication regiment
8. Remind the patient of the importance of taking medication as prescribed

It is imperative that we provide patient teaching on medication as a preventive measurement and to continue to add onto there knowledge base. The cost of non compliance often leads to morbidity and mortality among the elderly(Smeltzer, 2008).

References

Mauk, K. (2010) Gerontological Nursing 2nd Edition, Jones and Bartlett Publishers, Massachusetts
Smeltzer, S. (2008) Textbook of Medication- Surgical Nursing 11th Edition, Lippincott Williams and Wilkins, Pennsylvania

NOTE: This blog post reflects the work of a Registered Nurse 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.

Gingko Biloba and Dementia

by Carrington Carrington, RN

Dementia is a syndrome who signs and symptoms may be the result of several acquired, progressive, life-limiting disorders that erase memory and the person’s usual way of being in the world. (Tabloski, 2010, p. 740) The person with dementia has both a chronic illness and a terminal illness. Person’s with dementia losses the ability to perform activities of daily living and progressively become completely dependent in all aspects of care. There is no predictability of how or when the disease will progress. The greatest risk for developing dementia is older age even though a younger person may develop dementia as well. Although it is more common in older adults than in younger persons, dementia is not considered a normal part of aging.(Mauk, 2010, p. 531)

There is no cure available at the present time for dementia. Treatments for dementia are directed towards improving functioning and slowing down the progression of the disease. There are a number of pharmacological agents that are used to treat cognitive impairment but I will be focusing on a complementary and alternative therapy (CAM) form to treat dementia.
Complementary and alternative therapy according to Mauk is a group of diverse medical and healthcare systems, practices, and products that are not presently considered part of the conventional medicine in the United States. However there are many people who use herbal therapies they hear about along with their regular routine prescribed medications. Gingko Biloba will be our herbal therapy of choice for dementia.

Gingko biloba is one of the oldest living tree species and its leaves are among the most extensively studied herbs in use today. In Europe and the United States, ginkgo supplements are among the best-selling herbal medications. It consistently ranks as a top medicine prescribed in France and Germany. (University of Maryland Medical Center). Ginkgo has been used in traditional medicine to treat blood disorders and enhance memory. Scientific studies throughout the years have found evidence that supports these claims. Although not all studies agree, ginkgo may help prevent or treat dementia (including Alzheimer's disease). It also shows promise for enhancing memory in older adults. Because ginkgo inhibits platelets activation factor it is presumed to improve blood flow to the brain as well. (Tabloski, 2010, p. 747) Further studies suggest it may directly protect nerve cells that are damaged in dementia. (University of Maryland Medical Center)
Ginkgo biloba comes in tablets, capsules, and in liquid extracts. Dosages range from 120 to 240 mg daily.

Positive benefits of Ginkgo in a person with dementia are:
· Improvement in thinking, learning, and memory (cognitive function)
· Improvement in activities of daily living
· Improvement in social behavior
· Fewer feelings of depression
Negative benefits are:
· Inhibits platelet activation factor and can cause bleeding
· Increased blood pressure with thiazide diuretic
· Increased sedation with trazadone
· Can increase blood sugar
· Can cause headaches, dizziness, GI disturbances
Contraindicated in people who are:
· Diabetic
· Pregnant or breast feeding
· Have epilepsy
· Bleeding disorders

If you take gingkgo, you should stop taking it at least 36 hours before surgery or dental procedures due to the risk of bleeding. Tell your doctor or dentist that you take ginkgo.

Nursing considerations for Dementia
Dementia is a chronic illness and may require 20 years or more of home care, assisted living, or long term institutional care. The demented person will need acute care services to maintain independence, prevent excess disability, ensure safety, and manage medical complications. The family should be informed that even with the finest efforts of caregivers, the dieses will progress and create dependency in activities in daily living and ultimately result in death.

References
Mauk, K.L. (2010). Gerontological Nursing Competencies for Care, (2nd edition). Sudbury, MA:Jones and Barlett Publishers.
Tabloski, P. A. (2010). Gerontological Nursing, (2nd edition). Upper Saddle River, NJ: Pearson Education INC.
University of Maryland Medical Center. (2011). Ginkgo biloba. Retrieved from
http://www.umm.edu/altmed/articles/ginkgo-biloba-000247.htm

NOTE: This blog post reflects the work of a Registered Nurse 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.

Epidemiological surveillance and the Community Health Nurse

BY Frank Ejechi RN
Epidemiological surveillance is one of the methods in which the public health nurse use in collecting, recording, analyzing and dissemination of data or information on the current health status of a community. In the beginning, the public health nurse uses the epidemiological surveillance in monitoring and intervening in areas of infectious diseases. But now, the success of the methods has made it possible for the community health nurse to apply the same methods in observing and monitoring chronic diseases, premature death, injuries, environmental factors and other social factors that influence a community health needs.

Epidemiological surveillance can occur in three ways. The first is the passive surveillance which can occur when information is obtained without actively searching for the information. For example, if a school nurse is teaching a student proper hand washing, and he comes across bruises that indicates abuses. He is mandatorily required to report the case. Secondly, active surveillance occurs when a public health nurse is actively looking for information why a particular community has lots of in his students with a particular infectious disease, example, tuberculosis or a particular community is filled with childhood criminal activities. Thirdly, surveillance can occur through reporting of a particular disease by selected individual or institutions.

The benefits of epidemiological surveillance are creating a data base of a particular infectious disease, and the group of individuals that at mostly at risks. This will include identifying the causes, the extent of the spread, and plan for intervention. It also serves as a blue print if such problem should occur in another community, and it is way of reducing duplication of efforts by different agencies. Through it, the public nurse can itemize intervention based on priorities, it also helps in evaluation outcomes, and spreading information on how to prevent or intervene when there is an outbreak of diseases.

References

Encyclopedia of Public Health. (2011). Epidemiologic Surveillance. Retrieved on August 5, 2011, from http://www.enotes.com/public-health-encyclopedia/epidemiologic-surveillance

NOTE: This blog post reflects the work of a Registered Nurse 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.

Ensuring a Safe Food Supply

BY Rene Foster-McFarlan RN

The safety of the nations food supply may be in jeopardy if proposed budget cuts are enacted. Last week Cargill was forced to recall 36 million pounds of ground turkey from a plant in Arkansas due to a Salmonella outbreak. The recall is the third largest recall in our nations history and is already linked to one death and 55,000 reported cases of Salmonella. The United States Department of Agriculture (USDA) is responsible for ensuring that the U.S. meat, poultry and egg supply is safe for consumers. The Food Safety and Inspection Service (FSIS) is the public health agency in the USDA that takes on the task of food inspections and in spite of the recent recall will face certain budget cuts that could hamper their ability to quickly respond to outbreaks of food-borne diseases. The recent debt debate while highly politicized does not focus enough attention on the threat that our food supply could face if the proposed cuts take place. The latest recall by Cargill is a clear indication that more attention needs to be given to the role this agency plays in preventing the spread of food-borne infections. Since 1862, when President Abraham Lincoln founded the Bureau of Chemistry, the early precursor of the FSIS, the threat of contamination and the spread of disease have been reduced due to the efforts of the United States Department of Agriculture (USDA) Food Safety Committee. The Daily Times reported the "recent Salmonella outbreak was discovered after five months of investigations by federal food inspectors". Investigating and tracking the source of food-borne illnesses is complicated and requires sometimes hundreds of inspectors, scientist, and public health officials to prevent widespread infections. Reducing the number of food inspectors could have a devastating effect on the amount of time needed to track the source of infection and will only lengthen the rate of response times. More attention is needed to this vital public health department and we must all work to ensure that when program cuts are made that they do not place the health of the nation at risk.

References:

The United States Department of Agriculture, Food Safety and Inspection Service, About FSIS., 2011. retrieved from http://www.fsis.usda.gov/About_FSIS/Agency_History/index.asp

NOTE: This blog post reflects the work of a Registered Nurse 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.

The Role of the Public Health Nurse- Primary Prevention

BY Blair Gifford RN

An important aspect of public health nursing is education and prevention. There are three levels of prevention primary, secondary, and tertiary. This post focuses on primary prevention. Primary prevention aims to prevent certain diseases from occurring (Stanhope and Lancaster, 2008). This type of prevention includes educating populations who are at risk for certain illnesses on lifestyle changes they can do to prevent these diseases (Stanhope and Lancaster, 2008). Primary preventions can only occur before the person has the disease and not after they have already been diagnosed. Primary prevention can include things such as educating an African-American male about lifestyle changes he can make to reduce his risk of developing hypertension, such as eating a healthy diet low in salt and cholesterol, daily exercise, limiting stress, eliminating smoking and alcohol use. There are non-modifiable risk factors that this patient would not be able to control, however if he is aware of the modifiable risk factors and can eliminate them he may reduce his risk of hypertension. Another example of primary prevention includes immunizations, which can prevent certain diseases (Stanhope and Lancaster, 2008). The community needs to be aware of what diseases there are immunizations for and when they should receive them. Education is a very large part of primary prevention. Providing people with the tools to protect themselves make them able to reduce the risk of getting certain diseases. Taking daily supplements such as vitamin C or a multivitamin to prevent illness is another example of primary prevention. The most important emphasis a nurse can place when it comes to primary prevention is on maintaining a healthy lifestyle and taking the necessary precautions to protect yourself from illness. Public health nurses have the tools to educate the community about what they can do to decrease their risk of illness and primary prevention is the most efficient way to decrease illness and disease in the community.

Reference
Stanhope, M. & Lancaster, J. (2008). Public Health Nursing: Population-Centered Health Care in the Community. St. Louis, Missouri: Mosby Inc.

NOTE: This blog post reflects the work of a Registered Nurse 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.

The Role of the School Nurse

BY Erin Gifford RN
School nursing has been in effect since the 1800s in England (Stanhope & Lancaster, 2008). In the early 1900s, school nursing was in full effect in the United States to assess school aged children for the spread of infectious diseases (Stanhope & Lancaster, 2008). In today's world, school nurses hold a variety of roles. The school nurse is responsible for the direct care of school aged children during the hours of school. This entails assessing injured children, providing care to ailing children, or administering medications to children with disease processes such as diabetes mellitus. Nurses can also be employed in a boarding school setting, where they are responsible for the care of children 24/7 (Stanhope & Lancaster, 2008). The school nurse is also responsible for education. The school nurse educates students on a wide array of subjects ranging from hand washing to safe sex. The school nurse also functions as a case manager. For example, school nurses help to arrange health care for children with many comorbidities or complex health issues (Stanhope & Lancaster, 2008). The school nurse also acts as a consultant. The school nurse is responsible for providing health information to school administrators, teachers, and parent-teacher groups (Stanhope & Lancaster, 2008). The school nurse also acts as a counselor to troubled youths, or just students with health concerns. Nursing is viewed as a trustworthy occupation. School nurses also participate in community outreach. This entails community health fairs or festivals, immunization programs, health education fairs, blood pressure screenings, or local charities to promote education (Stanhope & Lancaster, 2008). The school nurse must also function as a researcher to ensure that the care she is providing to the students is evidence based. As you can see, clearly school nurses function in a wide array of roles, and are a very important asset to the community.

References
Stanhope, M. & Lancaster, J. (2008). Public Health Nursing: Population-Centered Health Care in the Community. St. Louis, Missouri: Mosby Inc.

NOTE: This blog post reflects the work of a Registered Nurse 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.