Sunday, January 31, 2010

RCN Nursing Counts. Does the RCN believe in Nurses?

Look at what the RCN has come up with recently.

I would really like to see them do even more to get across to the public what it is that bedside registered nurses actually do.  But encouraging nurses to be politically active is a good place to start.

Many of the problems that we currently have with nursing care is that bedside nurses are not valued. They are abused, overwhelmed, exhausted and frustrated over not being able to even remotely do their jobs well.  They run away from hospitals and managment loves it because they don't want to pay them to be there.   People think that an airhead with a good heart can be a good nurse.  They don't understand why a bedside nurse needs a good education on top of vocational training.  It's well known amongst nurses that a nursing student is going to have to hit the books a lot more than many other university students.  It is also well known that when they qualify that they are going to have a level of responsibility that most people cannot even fathom. But people think that nurses hand out tablets and hold hands and clean up.  That statement on it's is such a sick oversimplification of what we do that it is actually quite distressing.  The Media is at fault for this and the main culprit is TV.

I would like to see the RCN really push a campaign to show the public what BEDSIDE nurses actually do, how complex their job is, how much life and death responsibility they have and how analytical they need to be to not kill anyone.  Then show how hellish it gets when they are trying to do all this for too many people.  I have some ideas about how to get this across.  No time to post it all today though.

I guess that maybe  Nursing Counts  is a very good start.

Check it out and let me know what you think.

If anyone reading this is from the RCN let me tell you something.  Your photo of the nursing helping a patient to stand up with her zimmer sucks.  Show a nurse standing over the bed of someone with multiple drips calculating IV rates and assessing for heart failure or something...then you should have little information boxes nearby explaining just what it is she is doing.  From head to toe, show everything that the nurse needs to keep on top of for that patient.  Everything from changes in mental status and associated causes to pressure care, IV rationales, hydration etc etc.  Oh wait, you muppets have been away from the bedside for so long that you don't even know.  Not only does the public need education about the value of a bedside RN but so does the RCN apparantly. Stop it with the hand holding "my only job is to wheel patients around and give them pills" fucking shit in your photos.  It is damaging.  This is better:

That pic is not of a doctor or a nurse specialist.  It is a picture of a bedside nurse. She is supposed to handle all those drips and a million other things for multiple multiple  patients.  She cannot restrict the number of patients that she has. She is expected to always hold their hands as well and clean the ward without making mistakes with those IV drugs.  Drugs such as that need constant checking and supervision. Mistakes with those drips kill, and she'll have charges brought against her if she makes a boo boo.

But instead of nurses being depicted by pictures like the one above, we get this fucking shit below:

No wonder people think that a moron with a good heart could be a good nurse.  No wonder they think that untrained teenagers staffing the wards are nurses. These kinds of images depict one small aspect of nursing while disparaging all of the other things that real bedside nurses do to keep their patients alive.

Stop saying that nurses are better these days because they can do all these things that doctors used to do.  Forget that rubbish.  Promote bedside nurses.  I once had an office job as a nurse years and years ago.  It is easier than bedside nursing mentally and physically but we had more respect than bedside nurses.  Most things are easier than bedside nursing but attract more respect.  We need to respect nurses at the bedside, not pretend that leaving the bedside is advancement.  It may get you more money to leave the bedside.  But the work is easier away from the bedside and the cognitive strain is less .  Why people who leave the bedside to sit in an office and  create rubbish like productive ward are deamed cream of the crop nurses is beyond me.

The strong, knowledgable and smart nurses are at the bedside getting shat upon from a great height.  The specialist nurses, the discharge  bed magnet specialist bullshit nurse etc can't handle the bedside.  And that has nothing to do with being too smart and educated to handle shit and piss.  It has everything to do with the fact that they cannot mentally handle all that information overload and quick thinking that one needs to have as a professional nurse on the ward.  That is why they leave.  They are not better nurses or super nurses.  Bedside nurses need more in the way of education and brains than a discharge planning specialist pen pusher nurse sat in an office does. The infection control special nurses have memorised a lot of misinformation that they have been spoon fed and they know how to regurgitate it and bully any dissenters who actually think..  But other than that, they are as dumb as a bag of rocks.  They have no ability for independent thought whatsover. They aren't bright enough or tough enough to handle ward nursing.  That's why they have an office job. 

Here's a pic of the chief nursing officer. 

She couldn't handle the stuff that the bedside nurse in the first picture above is handling.  If I am wrong I apologise but I would imagine that she has been away from proper bedside nursing for years.  Yet she is considered the higher level nurse?  WTF?  I have seen nurse specialists, nurse managers, and matrons come to the bedside.  It ain't pretty.  They'll make like 50 drug errors in 30 seconds.  The trust told them they had to do shifts at the bedside.  They did it once, ran away screaming, and never came to the bedside again. That was 5 years ago.  Why they are the nurses who get respect is beyond me.  Why they are held up as an example as to why nurses need an education is beyond me.

If you listened to the RCN bleat on about nurse education you would actually believe that a nurse needs an education only to leave the wards and "advance".   The RCN is making out that we need smart nurses merely for these advanced roles. That is wrong. They need an education to work on the wards, and tend to stop thinking or needing their brains when they move off of the wards into these silly posts. The wards are where you will fry your brain.  We just have a hard time demonstrating our knowledge because we have to take short cuts and move fast.  Specialist nurses don't have that problem.  They can take all the time they want to perform a task.

These devalutation of bedside nursing is what has led to things like Staffordshire.  Society tells nurses that they only way that people are going to appreciate your brains is to get off the wards. The only way you deserve to be paid for the hours you work is to get off the ward.  Then managment refuses to even considering hiring registered nurses to work on the wards and replaces them with untrained non nurses on minimum wage.  The few nurses left on the wards are trying to do everything, since the untrained non nurses can do very little.  They burn out and they leave and managment loves it.  One of their favourite tricks is to lose bedside RN's through "natural wastage" i.e. retirement and burnout.  Then they bring in untrained carers leaving the nurses with even more patients to nurse.

This country is clinging to backward ideas about bedside nursing and it's killing the profession.  I hope that the RCN completely wakes up.  Right now they seem to be somewhere between fast asleep and the period you enter just before you wake up.  I hope that someone throws a glass of water over their heads and gets them completely awake before it is too late.

Oh my god. They just don't learn do they.

Years of research and numerous studies show that a lack of well educated registered nurses at the bedside not only causes patients to suffer and die but results in good nurses leaving the profession.  Years of research and numerous studies have also shown that the expensive complications and poor patient care that results from a lack of real nurses at the bedside are violently expensive and costs more money than investing in registered nurses. 

It doesn't matter how good your doctor is  at diagnosing and treating a disease process people. If the registered nurse at your bedside is not on top of his orders and your situation you will suffer and you can die. You will come out of hospital worse than you came in.  If your nurse has 15 patients and only untrained carers to help she will not be able to stay on top of your situation, your care, nor will she be able to implement and observe your doctor's plan of action.  Doctors are not at your bedside making sure that you get those IV drugs or that you are not becoming septic or bleeding out internally.  The nurse is looking for all that when she cares for you.  If the nurse doesn't pick up on those things then they don't get picked up fast enough.

So what are the fuckers going to do now?

Will someone buy my house so I can get out of here faster?  Thanks.

And don't be dumb enough to believe those stats about the number of  registered nurses at the bedside increasing under labour.  They. Have. Not.  Labour's policies led directly to things like staffordshire.  Read my post below this one to see what happened there and why.

New Article about Staffordshire.

Staffordshire is not alone guys.  Not by a long shot.  Could these managers be any more creepy?

Hospital trust branded the worst in Britain 'tried to gag whistleblowers'

A report into the management of hospitals in Mid Staffordshire will highlight a culture of secrecy about poor working conditions that may have contributed to more than 1,000 patients dying

Rajeev Syal, investigations editor The Observer, Sunday 31 January 2010

A hospital trust branded the worst in Britain by the NHS regulator actively discouraged staff from expressing fears about the safety of patients, an independent inquiry is expected to conclude.

Senior managers at Mid Staffordshire NHS Foundation Trust, where poor working conditions may have contributed to more than 1,000 deaths, will be accused of promoting a culture of secrecy, according to sources close to the inquiry.

The disclosure of a key finding of the report, expected to be released this week, comes as campaigners for patients who suffered neglect in Stafford and Cannock Chase hospitals call for a judicial review into the trust.

An official close to the inquiry told the Observer that it will conclude that staff were discouraged from bringing problems to the attention of managers and NHS authorities.

"Staff have known about the problems on the wards for many years, but there has been no means by which they can bring them up. Those who have tried to do so have been shot down. Some have been ordered to ­withdraw or hide their allegations," the official said.

The inquiry was launched in September by the health secretary, Andy Burnham, following a Healthcare Commission investigation that delivered the most savage indictment of any NHS organisation in the commission's five-year history. Its report condemned "appalling" standards of care at the trust's hospitals in Stafford and Cannock, particularly involving emergency admissions, which may have contributed to up to 1,000 deaths between 2005 and 2008.

The inquiry, chaired by Robert Francis QC, has heard evidence from a number of members of staff that they had been actively encouraged to ignore serious problems in frontline services.

One senior Stafford hospital official was suspended last week after documents from the inquiry allegedly showed that she tried to cover up damning comments about the care given to a 20-year-old who died just hours after being sent home from the accident and emergency department.

Kate Levy, board secretary and head of legal services at Mid Staffordshire NHS Foundation Trust, is being investigated over allegations that she encouraged a doctor to rewrite a report into the death of John Moore-Robinson.

Staff in accident and emergency failed to spot that the telecommunications worker had a ruptured spleen following a mountain bike accident on Cannock Chase in April 2006. He died at his home in Coalville, Leicestershire, less than 24 hours after being sent home with painkillers.

A report by Ivan Phair, an A&E consultant, into his treatment said: "The premature death of Mr Moore-Robinson in my opinion was an avoidable situation. I feel that an independent expert would criticise the management afforded to him by the staff. There is a high probability that the level of care delivered to Mr Moore-Robinson was negligent."

After reading the report, Levy wrote to Phair asking him to erase the comments. Her letter stated: "As reports are generally read out in full at the inquest, and press and family will be present, with a view to avoiding further distress to the family and adverse publicity I would wish to avoid stressing possible failures on the part of the trust."

The report was not presented to the inquest. Mr Moore-Robinson's parents only found out about Levy's letters when copies were given to them by a lawyer at the inquiry.

Frank Robinson, the dead man's father, told the Observer that there had been a "culture of cover-ups" at the hospital. "Nothing can distress us more than losing our son. So for this woman to claim that hearing the truth would distress us is a heartbreaking and cruel insult," he said.

"This is a hospital trust out of control. The place needs to be overhauled."

Staff have claimed that they have been intimidated into silence when they have raised concerns. Pradip Singh, a ­senior consultant who gave evidence to the inquiry, used the protection of the ­Commons all-party health committee last year to explain what went wrong at Stafford hospital after what he called a "savage reduction" in levels of nursing. "Over the years, many clinicians had noticed deterioration in the standards of patient care, which became particularly acute approximately three years ago when major cutbacks were made in staffing numbers. This included a ­savage reduction in the number of nursing staff," he wrote.

He means bedside Registered nurses.  You can't throw untrained kids at the wards and then say that you have lots of nursing staff.  But this is what management does because that is how badly they devalue bedside nursing........Anne

Singh, a gastroenterologist, said that he and other consultants had complained to senior medical managers and the trust's management, but those who complained had been ignored and branded as troublemakers. He said that a "palpable culture of intimidation" in the trust deterred others from speaking out publicly.

The culture of secrecy at the trust has been reinforced by a written "whistleblowers" policy that discouraged an open discussion of problems, according to one charity that made a submission to the inquiry.

Cathy James, deputy director of the charity Public Concern At Work, said she had found the written policy wanting. "In health, more than almost anywhere else, a closed culture will breed silence. Mid Staffs is a warning for all. I hope that this will push the other trusts to review their policies so that staff believe that it is safe and acceptable to speak up."

Whatever the final conclusions of the independent inquiry, campaigners whose family members have received poor treatment at the trust's hospitals believe that the parameters of the inquiry were too narrow.

Julie Bailey, founder of the patient group Cure the NHS, said that more than 100 families who support her organisation are now pinning their hopes on a judicial review.

"The inquiry was done in secret and seems to have gone through the same evidence as the Healthcare Commission report," she said.

"We need a judicial review to look at the failings of the regulatory bodies – where were the primary care trust, the strategic care authority, the Healthcare Commission, local MPs and the Department of Health while people were dying?"

Mid Staffordshire NHS Foundation Trust last night declined to comment until after the findings of the inquiry are officially released.

"We will be happy to comment on the conclusions, but wish to wait until it is out in the open," a Mid Staffordshire spokeswoman said.

A spokesman for the inquiry did not wish to comment.

Friday, January 29, 2010

RN Jobs Singapore

Filipino RN’s are again needed to fill a huge vacancy in this POEA approved RN Jobs Singapore. The job order for the said RN jobs Singapore was approved by the POEA last January 11 for a recruitment agency based in Ermita, Manila. For the said RN jobs Singapore, the POEA approved job order balance is 100 applicants to be recruited for the said RN Jobs.

If you are a registered nurse and wishes to apply for the said RN Jobs Singapore, just apply directly to the office of the recruiting agency. For a more detailed info regarding the qualifications and requirements for the said RN Jobs Singapore, you can contact the recruiting agency in their landline numbers which will be given upon request. Just leave your request and valid Email address at the comment section of this article.

Nursing Jobs Belgium

The beautiful country of Belgium is currently in need of Filipinos who are qualified to work in Nursing Jobs Belgium. The said nursing jobs Belgium has a job order that was approved by the POEA last January 8 for a recruitment agency based in Makati City. For the said nursing jobs Belgium, the POEA approved an Open Job Order balance which means that a lot of Filipino nurses will be given the opportunity to work in the said nursing jobs Belgium.

If you think you are qualified and wishes to apply for the said nursing jobs Belgium just proceed directly to the office of the recruiting agency and submit your application. If you want to know more details regarding the qualifications and requirements for the said nursing jobs Belgium, you can contact the recruiting agency directly through its landline numbers which will be provided upon request. Just leave your request and valid Email address at the comment section of this article.

Latest from the Daily Mail and more insanity on my ward.

Here's the latest from the Daily Fail.

Shock.  They actually mentioned the staff shortages.  They actually came close to recognising that one RN to 18 critically ill patients who need one to one monitoring may not actually be able to bed bath a patient without killing someone.

But their readers are still fucktwits.  Look at the comments sections.  "Nurses won't bedbath these days" "Can't be bothered".  Whatever.

Let me tell you what happened to me yesterday or  sometime thereabouts.  I was one RN to  WELL over 10 patients.  I had a student on his first placement, second day.  He worked as a retail manager before attending nursing school and holds a degree in English lit.  He is bloody marvelous for someone who is such a novice.  I had him on shift with me and a teenage carer.  It was her 2nd day on the job..  She has no training.  This was her induction. That was the ward staff.

Let me start by saying that degree students  ARE NOT FUCKING SUPERNUMERY.   Not really. They can't be.  This guy jumped straight in and did a hell of a job.  He had about 2 minutes to pick up how to do obs, blood sugars, and basic care. And he did it like a champ with a few minor fuck ups along the way.

My plans for the shift was to bring him around with me, show him a bed bath, let him watch me give meds etc.  The usual first placement stuff.

But of course reality got in the way of that. Details have been changed.  The following are not real patients.

I was running around like a headless chicken and the student had to work off his own initiative.  I had to do all the meds, interventions and treatments and orders for all those people.  The phone was constantly ringing.  Early in the shift they sent me a critically ill patient.  The ward he was on "couldn't handle" him.  There were no beds in ITU.  I had to take him.  I really kicked off with the "But it is so unsafe and I can't handle him either".  I had no choice in the matter, just total responsibility for any bad outcomes. After my shift ended I reported the manager who forced this transfer on me.  I'm in the process of complaining to high heaven.  This bullshit was not fair on the critically ill patient. the other patients, the student, or the carer.

This new patient was in a bad way. He needed one to one monitoring, and my arse parked at his bedside to survive the shift.  He needed multiple infusions, cardiac monitoring, suctioning, etc.  He was  going badly into CCF as they transferred him to me.  His 02 sats were in the shit long before that because of pnuemonia and COPD.  His observations  were a mess. I had to send the kids running around the hospital searching for those elusive IV pumps so we could deliver his medication to him.  The junior doctor on duty was having a pyshcotic episode/nervous breakdown  weepy moment in our staff room.   Had I not been so busy I would have hooked the doc up with some coffee and chocolate.  Some retarded specialist nurse had laid into doctor for no reason and was trying to dump a lot of rubbish onto the doc.  The poor doc was on his/her knees already because he/she was carrying that fucking bleep, trying to prioritize 1000 jobs..  Told doc not to worry about that cuntface who yelled at her because we all hate her. She yells a lot and is always barking up the wrong tree.

Our new patient was very elderly.  Very elderly.  Still for resus if he crashed and died however.

Guess who took care of all the other patients on their own with no supervision while I was up to my eyeballs in this?  Newbie one and Newbie 2 did.  I use the phrase "took care of my other patients" very loosely.  They are incapable of having anything to do with medication, IV's, NG's, catheters, noticing any real changes in condition etc.  They cannot answer questions from family. They couldn't even manage to change the bed linen for a large bedbound and incontinant patient because they didn't know who to react when she started biting, screaming and hitting and they couldn't move her around the bed.  Most of my patients are like that woman.  

The student was surprisingly on the ball and helpful and gracious even though he was thrust into a situation from hell when he is supposed to be learning.  He reported crappy vital signs, blood sugars etc.  He figured out that one patient was uncomfortable because she was in retention (I hadn't even laid eyes on that poor patient).  He must have done his homework because he picked up on stuff that I would have never picked up on during my very first placement.   I wanted him with me so that he could have some really good learning experiences.  He told me he had never even down a bedbath.   I was going to show him the right way to do one and how we assess patients and tie that information into their situation. I want to mentor people properly, not use them as free labour.  Not until they know what they are doing anyway. But he had to help me out by being my eyes and ears.  He certainly didn't think that he was above getting his hands dirty.  He ran right over to the little old lady who was wandering to the bathroom and pooing on the floor as she went.  He cleaned her, cleaned the floor and made her a drink.

Don't let anyone tell you that students are supernumery.  Don't let anyone tell you that they don't want to get their hands dirty.  In my opinion, that is not the case at all except for the rare bad apple.  I must be lucky because I have yet to get a bad apple student.

I'll tell you what I did accomplish during that shift.  I tore the cleaning schedule that identified all the things we were to dismantle and clean during that shift and I shoved it into the shit eating machine.  Had the infection control tickboxing lardo specialist nurse been around I would have shoved it up her bottom.


Hey readers! I'm up for the "Big D" award in med student blogging! Go vote for me (should you think my blog is the best!)

Thanks D! You rock!

Thursday, January 28, 2010

Quality of US Maternity Care on Track to Improve With or Without Legislation

by Melissa Garvey, ACNM Writer and EditorAs you may have already heard from ACNM Federal Lobbyist Patrick Cooney, health reform legislation has reached a startling, disappointing halt. We are not sure what this means for the numerous provisions that would increase access to midwifery and birth centers.In the face of this development, I’d like to take time out to raise everyone’s spirits and

Sex Addiction When Sleeping Beauty

Almelo, Bella Floor, a 32-year-old woman suffering from a strange disease addicted to sex when she was sleeping soundly. Bella always had sexual intercourse while asleep and not able to remember what happened when awake.

Behavior scared his girlfriend who was always embarrassed when he slept the night with him. Her boyfriend, Justin (47 years) is a construction worker, who can not accept the treatment of sex Bella, Bella own without knowing what he had done. Justin was finally broken up with Bella.

Bella women from Almelo, Netherlands was writing experience in a site which tells how 6 years ago not a single doctor who could diagnose his behavior.

Bella was later sentenced to suffer seksomnia or Sexual Behavior in Sleep (SBS) is having sex in a sleeping condition.

Some people who suffer from SBS had even entered the stage of addiction. And for his partner, it is very annoying, embarrassing and can lead to serious problems.

As reported by FOXNews, Thursday (10/12/2009), Bella initially suspected she could not control his behavior, but it did almost every night which makes his girlfriend very angry.

Bella had gone gone to many doctors and psychologists that they generally can not do anything because it had never heard of a case like this.

The doctor only offered drugs, in addition to hypnotherapy, sex and consultation brain scan to stop the disease's seksomnia.

According to Bella, the drugs are given only help temporarily, but he claims his life would not depend on these drugs.

In the International Classification of Sleep Disorders (ICSD-2), SBS categorized as a new sleeping sickness by practitioners sleeping medication and requires special diagnosis.

A person suffering from SBS usually know the habits of the couple's bed. Sometimes many of those who do not believe that this habit could happen to him.

This is usually the base of the conflict in the couple because the patient does not receive and feel ashamed to admit or accept this fact. Until now there has been no effective medicine that can cure this disease.

ARNP Nurse Practitioner Jobs

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Wednesday, January 27, 2010

New Abstract and Commentary

Effectiveness of an Aspiration Risk-Reduction Protocol (Authors’ Abstract)

BACKGROUND: Aspiration of gastric contents is a serious problem in critically ill, mechanically ventilated patients receiving tube feedings.
OBJECTIVES: The purpose of this study was to evaluate the effectiveness of a three-pronged intervention to reduce aspiration risk in a group of critically ill, mechanically ventilated patients receiving tube feedings.
METHODS: A two-group quasi-experimental design was used to compare outcomes of a usual care group (December 2002-September 2004) with those of an Aspiration Risk-Reduction Protocol (ARRP) group (January 2007-April 2008). The incidence of aspiration and pneumonia was compared between the usual care group (n = 329) and the ARRP group (n = 145). The ARRP had three components: maintaining head-of-bed elevation at 30 degrees or higher, unless contraindicated; inserting feeding tubes into distal small bowel, when indicated; and using an algorithmic approach for high gastric residual volumes.
RESULTS: Two of the three ARRP components were implemented successfully. Almost 90% of the ARRP group had mean head-of-bed elevations of 30 degrees or higher as compared to 38% in the usual care group. Almost three fourths of the ARRP group had feeding tubes placed in the small bowel as compared with less than 50% in the usual care group. Only three patients met the criteria for the high gastric residual volume algorithm. Aspiration was much lower in the ARRP group than that in the usual care group (39% vs. 88%, respectively). Similarly, pneumonia was much lower in the ARRP group than that in the usual care group (19% vs. 48%, respectively).
DISCUSSION: Findings from this study suggest that a combination of a head-of-bed position elevated to at least 30 degrees and use of a small-bowel feeding site can reduce the incidence of aspiration and aspiration-related pneumonia dramatically in critically ill, tube-fed patients.
Metheny, N. A., Davis-Jackson, J., & Stewart, B. J. (2010). Effectiveness of an aspiration risk-reduction protocol. Nursing Research, 59, 18-25.

Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator

This fascinating study exemplifies excellent translational research. Translational research involves moving research findings into practice with a rigorous and systematic evaluation of adherence to the new practice and patient outcomes.
Description of elements in the care bundle being “tested” follow along with the rationale for the use of each practice.
1. Keeping patients who receive tube feedings in an elevated head-of-bed position (at least 30°); this practice has been found to decrease pneumonias caused by aspiration of tube feedings. The likelihood that patients are kept in the elevated positions has been found to increase when physician orders include this practice.
2. Feeding patients in the distal small bowel; this practice reduces the likelihood of gastroesophageal reflux, and the risk of microaspiration. Small bore feedings tubes can be placed in the distal small bowel by trained nurses.
3. Using an algorithmic approach to dealing with high gastric residual volumens (> 500 ml); this practice involves feeding disruptions, and can involve prokinetic drugs.
As can be seen from the results of the study, adherence to the bundle was good for elevated positioning and tube placement. Only 3 patients qualified for use of the algorithm for high residual volume; none received care based upon the algorithm. Thus, the findings show significantly improved patient outcomes given use of 2 of the 3 bundle elements. Nurses caring for critically ill, mechanically ventilated patients who receive tube feedings may want to consider use of the 2-factor bundle (HOB ↑ 30°; feeding tube placement in distal small bowel).

Find it Fast!! Video Tutorial series from Yale University on EBM

Find it Fast! is a series of 10 video tutorials which highlights a variety of resources used in Evidence Based Medicine including The Cochrane Library, Clinical Evidence, Clinical Queries in Medline and more. In addititon, these video tutorials also cover  issues such as "how to ask a clinical question" using the PICO framework. This video series is easy to understand and lends a valuable perspective on the basics of EBM. While specifically oriented to Medicine, much of the information applies equally well to Evidence Based Nursing. Thank you Harvey Cushing/John Hay Whitney Medical Library at Yale!!

Sports, Main Lock Waist Pain Medicine

Do not rush medication if the pain started to hit your body, especially at the waist. The medicine is not just the only savior to overcome pain. Could be, sports spur dynamic body movement is the best therapy.

dr. KRT. Lucas Meliala, SpKJ, SpS (K) reveals that to the Persian Data Center on the sidelines of a new paradigm symposium organized Pain Management Hospital Center for Air Force (RSPAU) Halim Perdanakusuma in Jakarta last weekend.

Meliala revealed, almost 90% of pain that occurs in the human body, especially the waist under conditions triggered by the use or lack of motion. Lack of movement can trigger muscle stiffness so that when the body is conditioned to lift heavy objects or move around, the pain arises.

"Therefore, unnecessary drugs, drugs terutam drunk. If you want to use ointment or patch it. Take care, chemical drugs can affect it negatively. Instead, just rest your body. Look for the development, if the pain is relatively mild unnecessary drugs whatever. It's just a sign, in the future must be more diligent you are moving to train your muscles, "said Meliala.

Meliala asserted, the best key to dealing with pain is exercise. However, be careful too, too much body movement or over-use can also backfire.

In addition, said Meliala, position your body as well as right and just in time to lift the load, especially heavy burden. "Do not indiscriminate lift up. Position your body properly with the burden that will be appointed. If you can, do not use just one hand, use two hands to share the load evenly across the body," said Meliala. (IIS)

Translated from the source : PdPersi

Nursing Care Plan Nephrotic Syndrome

Nephrotic Syndrome

Nephrotic syndrome is a group of symptoms including protein in the urine (more than 3.5 grams per day), low blood protein levels, high cholesterol levels, high triglyceride levels, and swelling.


Nephrotic syndrome is caused by various disorders that damage the kidneys, particularly the basement membrane of the glomerulus. This immediately causes abnormal excretion of protein in the urine.

The most common cause in children is minimal change disease, while membranous glomerulonephritis is the most common cause in adults.

This condition can also occur as a result of infection (such as strep throat, hepatitis, or mononucleosis), use of certain drugs, cancer, genetic disorders, immune disorders, or diseases that affect multiple body systems including diabetes, systemic lupus erythematosus, multiple myeloma, and amyloidosis.

It can accompany kidney disorders such as glomerulonephritis, focal and segmental glomerulosclerosis, and mesangiocapillary glomerulonephritis.

Nephrotic syndrome can affect all age groups. In children, it is most common from age 2 to 6. This disorder occurs slightly more often in males than females.

  1. Perform physical examination including assessment of the extent of edema.

  2. Get your medical history carefully, particularly those associated with weight gain this time, renal dysfunction.

  3. Observation of the manifestation of nephrotic syndrome :
    • Weight gain
    • Edema
    • Face puffy :
      • Especially around the eyes
      • Arising in the morning when you wake up
      • Reduced daytime
    • Swelling of the abdomen (ascites)
    • Difficulty breathing (pleural effusion)
    • Swelling labial (scrotal)
    • Intestinal mucosal edema that causes :
      • Diarrhea
      • Anorexia
      • Intestinal absorption of poorly
    • Pale skin extreme (often)
    • Be sensitive excitatory
    • Easily tired
    • Lethargy
    • Blood pressure is normal or slightly decreased
    • Susceptibility to infection
    • Change the urine :
      • Decrease the volume
      • Dark
      • Smelly fruit
      • Help with diagnostic and testing procedures, such as urine analysis will be a protein, cylinders and red blood cells; analysis of blood for serum proteins (total, ratio of albumin / globulin, cholesterol), the number of red blood, serum sodium.

Nursing Diagnosis

Excess fluid volume (total body) associated with the accumulation of fluid in the network and the third space.


The patient showed no evidence of accumulation of fluid (patients receive the appropriate volume of liquid)

  • Review input relative to output accurately.
    Rational : need to determine kidney function, fluid replacement needs and reducing the risk of excess fluid.

  • Weigh weight per day (or more often if indicated).
    Rational : assess fluid retention

  • Review the change of edema: abdominal circumference measured at the umbilicus and Receptions edema around the eyes.
    Rational : to assess because of ascites and edema are common side.

  • Set the input fluid carefully.
    Rational : that does not get more than the amount needed

  • Monitor the intra-venous infusion
    Rational : to maintain the prescribed input

  • Provide appropriate provisions corticosteroids.
    Rational : to reduce the excretion of proteinuria

  • Give diuretic if instructed.
    Rational : to provide temporary disappearance of the edema.

Source :

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Tuesday, January 26, 2010

Care in a catastrophe

“Nothing in my life prepared me for what I saw,” says Debbie Abraham of Haiti’s earthquake destruction, seen here in a previous trip to Haiti, assisting an orthopedic patient.

When you land in a third world country to assist with nursing care, you might expect to be surprised here and there. You don’t expect a surprise of a 7.0 magnitude. That is what happened to Debbie Abraham, ’95 MSN, RN five hours after landing in Haiti on Tuesday, January 12, 2010 for what she thought would be another routine service trip to Hôpital Albert Schweitzer (HAS) in Deschappelles, 70 km north of the capital city of Port-au-Prince.

Abraham, a former critical care nurse and nurse educator in the Philadelphia region, resides in Havertown, Pa. with her husband and two children who are in college and high school. She recently returned to Villanova University College of Nursing to earn a post-master’s certificate as an adult nurse practitioner (NP)—she already held a master’s degree from the College in nursing education. Since finishing her preparation as an NP she has been readying for this trip to Haiti before studying for her NP certification exam and seeking a new NP position.

In 2002, Abraham learned of an opportunity to teach CPR to staff at HAS, which serves 300,000 impoverished people in the Artibonite Valley in central rural Haiti. Within days of her arrival seven years ago, she knew she would return. She has done so once or twice a year to do staff education on nursing and health issues as well as assist with patient care in the hospital and its more remote clinics. She is self-taught in Kreyol, the native language, but also uses a translator when teaching. This January trip was to be a two-week stay, involving more teaching and patient care, her first as a new advanced practice nurse. She did not know she would be delivering care and utilizing her fresh skills in the midst of the worst humanitarian crisis in recent memory in the poorest country of the western hemisphere.

Abraham first traveled to the house of friend Zulta, a midwife, in Tabarre, 10 minutes outside the capital, for a two-day visit. She describes the onset of the quake while standing in the kitchen talking about dinner, “I recall hearing a very loud boom, like an explosion, and then literally shaking…as the amplitude got worse, we got the kids and ran out.” Initially unsure of what was happening, she stood outside with her friend and her husband and two small children as people were running, screaming, looking to the sky and singing, praying or chanting. “It was chaotic,” she says. Miraculously, Zulta’s house did not collapse. Abraham became concerned, realizing she was far from family and essential services were wiped out, “The total isolation for me was pretty incredible.” The car radio was operational so they got confirmation from French radio that it was a significant earthquake. They lived through “tremendous aftershocks,” trying to sleep in the car for safety. It is estimated that the earthquake affected approximate three million people and that the dead will number in the hundreds of thousands.

At the request of another friend, Zulta and Abraham set out the following morning to deliver a few supplies from the home to a neighboring area, Delmar, a section of Port-au-Prince that was nearly razed. They brought gauze, sterile gloves, suture material, betadine, ampicillin, ibuprofen, Benadryl, and some food. “The first injury we saw was a partially amputated foot…then a spinal cord injury and a skull fracture,” notes Abraham. Not being equipped for the more serious cases, they began treating abrasions and other wounds, soon reprioritizing how to treat certain injuries and improvising with their quickly diminishing supplies, for instance using the paper from gauze packaging to wipe a wound instead of the gauze itself. After two hours they returned home. As she reflects on that experience, Abraham notes “In 30 years of nursing I never felt so helpless.”

On Thursday, Abraham saw firsthand the situation in Port-au-Prince as they sought members of Zulta’s family. “It was absolutely unbelievable to see the destruction of the buildings, people staking out areas to sleep, and thousands and thousands in the road, walking,” she recalls vividly, along with the odor from the countless dead bodies covered in the street. Later that day she made the long journey to HAS in Deschapelles as scheduled. Largely unscathed, the town had more operational services than the capital and she was able to make an Internet call to her husband following up on a simple one-way text message she sent from Zulta’s house earlier that said “I am ok.”

At HAS, Abraham again pulled on her NP knowledge and skills to triage patients for two days. While the hospital had more resources than most, she still had to be judicious in ordering x-rays and other tests. She would admit patients and write their orders, or prescribe needed medications and discharge them. She estimates 90% of the cases were orthopedic or trauma, especially among those who had arrived from Port-au-Prince. Essentially this was her “first day on the job” she notes, saying she felt confident in her assessment skills but still unsure about some of her decisions since she was unfamiliar with the paperwork and protocols. She did have physicians to call on for consultation, though stuck with her assessment of one woman whom she thought had a collapsed lung, a situation which can quickly become dire. The staff disagreed. Abraham’s suspicions were confirmed by a chest x-ray and the patient was treated appropriately.

Abraham discusses how nursing knowledge and education translate into various situations. “I certainly felt prepared as I had been given the appropriate information (at Villanova) to use; I used my physical assessment course, no doubt about it!” She acknowledges that setting priorities and assessing patients is part of all nursing. She delivered care and medications on the wards to about 150 people a day in her second week in Haiti though she fears she lost count. Abraham recalls it being difficult having people pull on the hem of her scrub pants for help as she stepped around them on the floor to get to someone else. “I went back to them,” she offers. She remains affected by the people “We can’t fathom their daily life…Despite the horrible living conditions and ineffective leadership in Haiti, to see the grace, dignity and resolve with which they live their lives is overwhelming….everyone had someone in their family who was dead.”

With her two weeks completed, Abraham was able to depart Haiti and fly home from the Dominican Republic. She has great respect for the endeavors of HAS and is acutely aware of their need for funding. This is why she tells her story even before getting much rest since her return to the United States just over 36 hours ago. “I felt conflicted about leaving,” she admits. Determined to return to HAS and Haiti, Abraham says firmly “It is my privilege to be able to work there and it will continue. This will not stop me.”

To learn more about Hôpital Albert Schweitzer and its critical needs, visit


It hasn't been confirmed, but I would put money down that I just failed my biochem exam. Lots of money.

Nurse practitioner student serves the underserved in India

Soon to be a nurse practitioner, Robin Herb conducts a physical assessment on an elderly Indian woman complaining of stomach pain. “They have it right. They take care of each other.”

"Life transforming” is how Robin Herb, B.S.N., R.N. describes a 14-day trip to Puttur, India. From December 27, 2009 to January 9, 2010, the graduate student from Villanova University College of Nursing used her winter break to serve the underserved with a Christian church group based in Mohnton, Pa. to assist the Good Shepherd Mission in Puttur. Puttur is in the southeast area of the peninsula about 2 hours inland from the Bay of Bengal, in the state of Andhra Pradesh. As Herb triaged local residents to be seen by physicians, handed blankets to grateful members of a leper colony who traveled long distances, and helped dedicate a new HIV/AIDS center, she saw the impact on this agricultural community.

Herb is wife and mother from Reading, Pa. where she is also a nurse in a cardiology practice. She is earning her master of science in nursing degree as an adult nurse practitioner (NP). In 2009, friends connected her to the Calvary United Methodist Church which organized the trip with 10 volunteers from all walks of life. She was later struck by how each member of the team was critical to the effort in aiding the Indian population.

Since mission work has been of interest to Herb, she soon began her immunizations against typhoid and hepatitis A, in addition to preventative malaria medication, for the experience. She packed her stethoscope, a blood pressure cuff and an intrinsic sense of cultural acceptance that served her as well as the nursing tools. Herb says one of the reasons she came to Villanova and the College of Nursing was the overall sense of acceptance she felt on campus. “I took that with me,” she says, along with knowledge gained from a recent lecture on cultural sensitivity to NPs by Elise Pizzi, M.S.N., CRNP, assistant professor. Herb said it helped her comfort level while interacting with a community dealing with serious health and poverty issues. “I was not going to try to change hundreds of years of culture,” she explains. She appreciated the balance the people achieved between the Hindu and Indian traditions. “It reminded me of what the College does. No matter what someone’s background, we accept them,” she offers.

One of three nurses in the group, Herb was in constant motion. The Mission has established a hospital with just over a dozen beds. Herb triaged patients there and visited with those who calmly and pleasantly waiting for extended periods of time while sitting on the lobby floor. Women would watch each other’s babies without fear of strangers. “No baby was crying” remembers Herb, as each child was attended by another woman if the mother was unavailable. She also gathered with children from the orphanage on the grounds. Fifty girls sleep on the floor, keeping all of their belongings in a tiny footlocker. As they and their male counterparts get older, they are encouraged to assist the Mission. Many of the staff members there were supported by the Mission earlier in life and stay to give back to the community.

Herb and the group moved out of the compound to make and lay bricks for the Mission’s HIV/AIDS Support Center on the outskirts of town, the closet parcel of land that the community would offer for these stigmatized patients. At the same site, they celebrated the dedication of the facility with music, prayer and colorful decorations provided by area residents.

Herb traveled with others to three remote villages to triage patients for five Indian physicians. One day there were 800 patients who had waited in line. Each was seen. “There were all types of physical complaints,” notes Herb, though many were musculoskeletal problems related to their life of hard labor in the local rice paddies or peanut fields. Many walked for miles when they heard of the scheduled arrival of the medical team. Because of language and resource barriers, Herb was especially grateful for her NP physical assessment skills and the ability to listen (via a translator who spoke the native Telugu) as she obtained a patient’s medical history. Patients were also able to get a few simple medications such as mild analgesics, antibiotics, antacids and skin creams.

“I had not a clue what life was like for them,” states Herb of the Puttur residents who now have a hold on her heart. “They are the most gracious, appreciative people and they have nothing.” After meeting the people with leprosy (a bacterial disease causing, ulcerations, severe infections and deformities) who are considered to be the lowest caste or level in the society, she recalls “They were so thankful for a $2.00 blanket.” What was her key lesson from the people of India? “They have it right. They take care of each other.”

How to Help Women and Children in Haiti

by Eileen Ehudin Beard, CNM, FNPACNM Senior Practice AdvisorThe tragic situation in Haiti continues to send shock waves around the world. When you look at a picture of a young mother holding her newborn in the midst of chaos, you can’t be depressed about the economy or your 401K anymore. Those things don’t matter.The knee-jerk reaction is to drop everything and hop a plane to Haiti, but, as we’ve

Nursing Care Plan Asthma Bronchiale

Asthma Bronchiale


Asthma bronchiale (or simply Asthma) is a common disease that makes it hard for people to breathe. Attacks happen when the tubes that go to the lungs get irritated. They then become tight and inflamed. This makes the tubes thinner than it should be, which makes it harder to get air into the lungs. This is called an "asthma attack". Sometimes attention from the hospital is needed. When a person is having an asthma attack usually they will wheeze, breathe more frequently, and sometimes cough. Asthma attacks can be caused by many things like exercise, cold air, allergies, and inhaling certain chemicals.

Asthma attacks are most commonly caused by the airways reacting to so-triggers. Many people show allergic reactions to things like aspirin or the hair of certain pets. A good thing to do to reduce the risk and level of the asthma attack is to identify those triggers and remove them from the environment of the person suffering from asthma.

Some asthma attacks can be dangerous. The worst-case scenario, known as status asthmaticus, can be life-threatening.

Asthma can be controlled most often by avoiding contact with triggers and by using certain drugs.

Hospitals have other options they can use in an emergency when the usual treatment fails:

* Oxygen
* Certain drugs that act like an asthma spray, but are much stronger
* Certain drugs that can be given intravenously
* Steroids
* Breathing aids (including tubes, and valves in very severe cases)

Source :

  1. Past medical history :
    • Review personal or family history of previous lung disease.
    • Review a history of allergic reaction or sensitivity to substances / environmental factors.
    • Review the patient's employment history.

  2. Activities
    • The inability to perform activities because of difficulty breathing.
    • The decline in the ability / improvement needs help doing daily activities.
    • Sleep in a high sitting position.

  3. Respiratory
    • Dipsnea at rest or in response to activity or exercise.
    • Breath worsened when the patient lies on her back in bed.
    • Using drugs to help breathing, for example: raising the shoulders, widen the nose.
    • The existence of wheezing breath sounds.
    • The recurrent coughing.

  4. Circulation
    • The increase in blood pressure.
    • The increase in the frequency of heart.
    • The color of skin or mucous membranes normal / gray / cyanosis.
    • Redness or sweating.

  5. Ego integrity
  6. Nutrition
    • The inability to eat due to respiratory distress.
    • Weight loss due to anorexia.

  7. Sosial Relations
    • The limited physical mobility.
    • It's hard to talk or stammering.
    • The existence of dependence on others.

  8. Sexuality
    • The decrease libido.

Nursing Care Plan Patients Bronchial Asthma

Ineffective breathing pattern associated with a reduction in lung expansion.

The pattern of breath again effective.

Results Criteria :
  • Effective breathing pattern
  • The sound of normal breathing or clean
  • Vital sign in the normal range
  • Cough decreased
  • Expansion of the lungs inflate.

Intervention :
  • Review of respiratory depth and frequency of chest expansion. Note the respiratory effort, including the use of respiratory muscle aids / nasal dilation.
  • Auscultation of breath sounds and record the sound as crekels breath, wheezing.
  • Elevate the head and help change the position.
  • Observation of the pattern and character of cough secretions.
  • Encourage / assist the patient in breathing and coughing exercises.

Source :

A belated Valentine's Day gift

With Valentine's Day fast approaching, have a heart and offer three people you don't know a gift they desparately need. Participate in the Feb. 16th blood drive sponsored by the College of Nursing's Undergraduate Nursing Senate!

Tuesday, February 16th

11am to 5pm
Dougherty Hall-West Lounge
Appointments preferred (sign up at and enter sponsor #2031)

For 25 years, the Undergraduate Nursing Senate has been sponsoring blood drives on campus with the American Red Cross. That's a lot of lives saved by the Villanova community.

What happens to your blood? Blood may be used for whole blood transfusions or it is separated into its components including red blood cells, plasma, platelets, and cryoprecipitated AHF (antihemophilic factor). Each component can be transfused to different individuals with different needs. Therefore, each donation can be used to help save as many as three lives.

Who are you helping? Premature infants in NICUs, babies having open heart surgery, people with hemophilia, and trauma, cancer and burn patients among countless others.

You can help three people and give hope to their families and friends by being there February 16th!

Monday, January 25, 2010

Julie's picks for January from the nursing lit

Here's one New Years resolution you can easily keep!! Catch our monthly picks from the EBN nursing literature! Staff at St. Joseph Hospital , Orange or Children's Hospital of Orange County may be able to access many of these articles through Burlew Medical Library's website or ask library staff to obtain the full text for them.
1. Thrombolysis administration by nurses: an evolving UK evidence
base?(includes abstract); Sloman M; Williamson GR; International Emergency Nursing, 2009 Oct; 17 (4): 193-202 (journal article - research, systematic review, tables/charts) ISSN: 1755-599X PMID: 19782332 CINAHL AN: 2010453128

2. Exploring perceptions of a learning organization by RNs and relationship to EBP beliefs and implementation in the acute care setting.(includes abstract); Estrada N; Worldviews on
Evidence-BasedNursing, 2009 4th Quarter; 6 (4): 200-9 (journal article) ISSN: 1545-102X CINAHL AN: 2010504911

3. The latest evidence on the effectiveness of behavioral counseling interventions with adults.Melnyk BM; Worldviews on Evidence-BasedNursing, 2009 4th Quarter; 6 (4): 250-4 (journal article)
ISSN: 1545-102X CINAHL AN: 2010504917

4. Factor V Leiden: impact on infusion nursing practice.(includes abstract); Weinstein SM; Journal of Infusion Nursing, 2009 Jul-Aug; 32 (4): 219-23 (journal article) ISSN: 1533-1458 PMID: 19606001 CINAHL AN: 2010352064

5. Sleep in adolescence: a review of issues for nursing practice.(includes abstract); Vallido T; Peters K; Brien L; Jackson D; Journal of Clinical Nursing, 2009 Jul; 18 (13): 1819-26 (journal article - research, systematic review) ISSN: 0962-1067 PMID: 19638045 CINAHL AN: 2010314625

6. Nursing resources and patient outcomes in intensive care: a systematic review of the literature.(includes abstract); West E; Mays N; Rafferty AM; Rowan K; Sanderson C; International Journal of Nursing
Studies, 2009 Jul; 46 (7): 993-1011 (journal article - research, systematic review, tables/charts) ISSN: 020-7489 PMID: 17964577 CINAHL AN: 2010351654

7. Evaluating central venous catheter care in a pediatric intensive care unit.(includes abstract); Hatler C; Buckwald L; Salas-Allison Z; Murphy-Taylor C; American Journal of Critical Care, 2009 Nov; 18 (6):
514-20 (journal article - research, tables/charts) ISSN: 1062-3264 PMID: 19880953 CINAHL AN: 2010464302

8. Hourly rounds: what does the evidence indicate? Halm MA; American Journal of Critical Care, 2009 Nov; 18 (6): 581-4 (journal article - research, systematic review, tables/charts) ISSN: 1062-3264 PMID:
19880960 CINAHL AN: 2010464309

9. Acute confusion/delirium.Sendelbach S; Guthrie PF; Schoenfelder DP; Journal of Gerontological Nursing, 2009 Nov; 35 (11): 11-8 (journal article - pictorial, review, tables/charts) ISSN: 0098-9134 PMID:
19904851 CINAHL AN: 2010471514

10. Lessons learned while conducting a clinical trial to facilitate evidence-based practice: the neophyte researcher experience.(includes abstract); Brim CB; Schoonover HD; Journal of Continuing Education in
Nursing, 2009 Aug; 40 (8): 380-4 (journal article) ISSN: 0022-0124 PMID: 19681576 CINAHL AN: 2010368156

11. Glycemic control in the hospital: how tight should it be?(includes abstract); Kessler C; Nursing, 2009 Nov; 39 (11): 38-44 (journal article - CEU, exam questions, pictorial, tables/charts) ISSN:
0360-4039 PMID: 19859000 CINAHL AN: 2010464169

12. Metasynthesis: a goldmine for evidence-based practice.(includes abstract); Beck CT; AORN Journal, 2009 Nov; 90 (5): 701-2, 705-10 (journal article - tables/charts) ISSN: 0001-2092 PMID: 19895928 CINAHL AN: 2010470525

13. ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia.Hooper VD; Chard R; Clifford T; Fetzer S; Fossum S; Godden B; Martinez EA; Noble KA; O'Brien D; Odom-Forren J; et al.; Journal of PeriAnesthesia Nursing, 2009 Oct; 24 (5): 271-87
(journal article - algorithm, tables/charts) ISSN: 1089-9472 PMID: 19853810 CINAHL AN: 2010471997

14. Review summaries: evidence for nursing practice. Brief interventions for heavy alcohol users admitted to general hospital wards.Jayasekara R; Journal of Advanced Nursing, 2009 Dec; 65 (12): 2511-2 (journal
article - abstract) ISSN: 0309-2402 CINAHL AN: 2010502042

15. A review of cohort study design for cardiovascular nursing research.(includes abstract); Hood MN; Journal of Cardiovascular Nursing, 2009 Nov-Dec; 24 (6): E1-9 (journal article - abstract) ISSN:
0889-4655 PMID: 19858946 CINAHL AN: 2010464140

The best medical iphone apps for nurses and doctors

Check out this great compilation of the best iPhone and iPod apps for nurses from  go student nurse  .

Also, see this  categorized list of 55 apps for doctors and medical students brought to you by

Kresge Library at Scripps Clinic and Green Hospital has a wonderful, ongoing compilation of medical app links for Apple, Android, Palm, and Blackberry Devices. Also, just come across a post from Kevin Pho, MD who runs the popular medical blog This post opines "Why doctors should choose Google Android over the iPhone for medical apps"

Admissions Interviews

I'm on the student admissions committee, and today I'm interviewing a med school applicant. Like I mentioned before, at my school the student vote counts for 1/3 of the admissions decision. So if you're interviewing today, good luck!

Sunday, January 24, 2010

Tips Brighten Face

There are many ways to brighten the skin. Some of the girls who started a teenager confused choose what works for their skin. But careful now .. many many products contain harmful substances. or if you can instead use a natural way to brighten skin.

His face brightens skin Natural Way:

* Clean the face with a cleanser ngolesin milk or milk cleanser evenly over the face.

* Remove the milk cleanser with a special soft cotton face've soaked with water and squeezed.

* Do not wipe away the skin with too much pressure on cotton, because it can make the skin stretch.

* After that, wash again with a refreshing face that dripped on cotton for ngilangin diwajah remaining oil.

Tips Eliminate Mouth Odor

Tips How to Eliminate, Overcoming and Preventing Mouth Odor:

1. Brush my teeth every diligent and clean after every meal for at least 2 minutes.
2. Not eating foods and beverages that usually make up the smell.
3. Avoid candy that cause bad breath after the candy out.
4. Treat your teeth at the dentist and check ups at least twice a year.
5. Minumn a lot of water and sufficient.
6. Clean your tongue with a brush of the tongue bacteria, spoons, toothbrushes, etc..
7. Use a mouth spray odor remover.
8. Diligently rinse the mouth with a special cleaning fluid for mouthwash.
9. Smoking habits was left alone.
10. Avoid eating lots of greasy food when meal.
11. Eat fibrous foods such as vegetables and fresh fruits.
12. Yogurt drink, eat high doses of vitamin c and chewing the leaves of plants such as coriander, eucalyptus, taragon, and so forth.

Hopefully you have bad breath can suffer loss of at least 100% or less smell.

Healthy Living Tips

In the living of everyday life we should always prioritize the health of our body and soul because it was delicious and healthy there is a saying that a person will not value their own health when he was still healthy. Once the importance of health so that there are people who are willing to pay billions of dollars for their own health when he was sick.

The following tips are examples of activities that we live in our everyday world. Activity or the activity into a healthy lifestyle applications, namely:

1. Dodge / Stop The Habit Fool It's disgusting

Activities stupid for some people who thought / considered as an activity that cool, macho and slang is like smoking, drinking, using drugs / narcotics / other additive substances that cause addiction.

Just imagine if it was hit by one of the above activities so stupid someone could spend a lot of money to buy opium, to the cost of future medical treatment, waste time trying to buy and consume goods is illegitimate.

Using these disgusting things, of course, increase our sins doubly because the impact / effect is not just us who feel alone, but also others such as parents, friends, family, boyfriend, and so forth.

2. Do not Make Free Sex Relationships Outside of Marriage

Sex is good for the Part of those. But it would be honorable and commendable if sex is done responsibly and with the blessing of many people. Most sex is underrated for couples who are used to do or for people who easily aroused without a strong faith.

The effects of free sex premarital sex is such as:
* Pregnant out of wedlock and the man ran away from responsibility.
* Infectious diseases like AIDS that there is no cure.
* Sin to God
* Excluded from social and community
* Raided police / Civil Defense
* Killed his own girlfriend, raped, etc..
* Addicted to orgasms, and develop into a dangerous phase.
* Beginning from number 1 silly activities above.
* Hard to get a mate when he wanted a serious marriage.
* Lied to parents, families, relatives, friends, etc..
* And much more from the bad.

The purpose of sex to get the climax / orgasm much deified by many people who are lost and they will find another victim to be taken and dragged into the black valley. If contact with the opposite sex or same-sex without marriage should not see the course if ngesex enaknya, but see the negative side very much. You will be disgusted to do.

3. Eat Healthy Food And Match Rules

Good food is not necessarily healthy. Many foods and drinks dangerous and unhealthy if consumed. Examples such as the use of borax and formaldehyde as a food and beverage should digonakan to preserve corpses / bodies / carcasses.

If you snack do not haphazardly. Purchase food and drink in places that can guarantee cleanliness / hygiene of food drink. Be careful and always alert to anything that would we put in our mouths because it could have a drink or food we buy and ready to eat has been mixed with hazardous toxic substances like arsenic, sleeping pills, seangga poison, rat poison, pengewet not for food and beverages, and so forth. See also cleaning the place and the processing and selection of raw materials food / beverage.

Do not be easily tempted by ads on TV, radio, newspapers, magazines, sales, and so forth. Sometimes the producers lied to get one big advantage and cooperation with government actors to shut up.

Eating foods and nutritious beverages tailored to the condition of the body, and the activity of our age. Eat before you are hungry and stop eating before you are full is a good habit. Do not ever forget the fourth of five perfectly healthy we often hear from first time. Eat a balanced nutritional intake because of what we eat will represent us in the future.

4. Keeping Yourself Hygiene And Environment Around Us

Self cleanliness need to be considered and carefully maintained because related / closely related to our appearance in public. kerapihan and hygiene such as hair loss, nails, face, eyes, ears, skin, mouth, teeth, hands, feet, etc. can give the effect on overall body health. Avoid exchanging toiletries, toilet, health, personal clothing with other people because it may be a dangerous disease.

Just imagine if somebody acute dental pain can cause he does not enter the office for days because the pain is unbearable. People who have the appearance and style of dirty be shunned from the everyday interactions and will be difficult to make friends, boyfriend, mate, work, trust and others.

Keep the environment clean of trash and environmental disease because the environment can affect the health of our bodies. Garbage is piled and rotting able to remove the unpleasant smell / bad, shabby scenery / dirty, the sound of flies flying, curses voice who was nearby, and so forth.

Garbage can also be a nest of rats spread diseases such as leptospirosis is spread through urine penyekit rats and Tipes / typhoid. Mosquitoes can also spread the seeds of which can result in plasmodium melaria and dengue fever in a person. flies that spread bacteria and viruses that cause gastrointestinal diseases such as beri-beri, diarrhea, diarrhea, and so on.

Pollution such as rubbish and toilet waste household, factory waste, noise pollution, and other pollutants need to be resolved with swift and well coordinated among the members of the community in an environment that produces results clean and comfortable environment good.

5. Exercise and health checked regularly to doctor

Exercise regularly to stimulate the heart, breathing and blood circulation becomes better. Get used to exercise every day with a light activity such as walking, gymnastics, fitness, jogging, biking, or full exercise like playing badminton, soccer, marathon running, tennis, basketball, and others.

In addition there is another sport that is not less important to the sport of regular health check regularly to the doctor. Medical examination in order to be programmed is a disease or disorder which can occur more quickly detected so that treatment will not eat a lot of cost, time and energy.

6. Avoid Stress Which sucks a Healthy Way

To avoid the stress necessary strategies for each individual. Find the best way to relieve stress in your own way that is easy, can be done everywhere, cheap, healthy, kosher, and delicious made. Examples of activities such as the removal of stress is by listening to personal music pleasant and eliminates the burden of the mind that is, playing video games, music music, sports, talk ama temen closest friend, vent, non-gambling card maen, healthy dating, eating, doing conjugal relationship / sex with a legitimate partner, hanging out in the loo, a walk in the mall, singing, playing small toys, gardening, fishing, shouted at the quiet, sleeping and so on.

The point in your life is totally at ease with all the existing problems. Why should hard (stress), hard it was useless. Your emotions must not become evil and control yourself, karna uncontrollable emotions and sometimes resentment, hurt, and others who look stupid to others. There are issues / problems that can make you depressed cool aja lah, like there is not just a job laen.

Enough sleep, bonding with the Almighty God according to religion and beliefs of each origin is not evil, and to implement healthy lifestyle programs to prevent stress and depression, which if severe and chronic mental disorders can be, and mental illness that makes your taste depressed and ashamed of the people. Consult with a psychologist if you have psychiatric problems or other people who you trust if you are shy. Open your heart to accept criticism, feedback and suggestions from others and change your lifestyle if necessary for the health of the soul / mind you.

Tips Educate Children Become Smart

Being a smart child who is not a gift given by God alone. But there are several factors or how to educate a child who makes a thin brain than others. Here are a few things about MSNNews delivered by education should be acquired children.

Education is what I call here is not formally in school. But that must be done at home parents. Here are some ways that makes children can become more intelligent than others:

Play music
This can stimulate the growth of the right brain. And from studies conducted by universities of Toronto, this can increase the IQ and academic value of children.

Develop a child's curiosity
Successful education for bright kids will always want to know new things. So from the childhood habit that you as parents should always show the curiosity of the children.

That way you do not need to send these children to learn it. Because he himself would wonder. Automatically with the more he learned to make it smart.

Reading culture
With reading activities will increase knowledge and cognitive development of children. Then how to do it? Read stories to children can be one way out. Alternatively, give children the gift of a book that can attract attention.

Especially now the internet era, why not use that weapon in educating? Internet has proven an effective way to get people to read. Of course, since this for the education of children to be smart, must remain accompanied by Parents.

Educating children is a good smart-confidence and made him always optimistic that he can do something. One way is to participate in sports or social activities can membantunya.Dan not even educate children so that he became less confident.

One example is when a mother criticized her picture because the sky is red instead of blue. It seems trivial. But it's not a good education. Because children become afraid to do something because it is wrong. And people who never do anything how would be smart.

Some other things that can make a smart child is of course the benefits of breastfeeding, eliminate fast food and providing healthy food, get exercise. Hopefully, if you educate with education as a way above, children can become more intelligent.

Saturday, January 23, 2010

Eliminate Acne Tips

It was common knowledge that the presence of acne (especially in the face) will greatly affect the confidence of people who are suffering. Thus everyone would have breakouts desperately trying to spot the creature's name can be immediately expelled from the face or other body parts.

For those who are heavy purse mah eliminate acne is not a difficult problem. Stay away to the hairdresser expensive skin care, follow treatment, use the product, finished. But what about those who purse thin (like myself for example)? Is there no hope for eliminating acne with little cost?

Of course, there were many in fact. Here are some ways traditional / natural that you can try to help eliminate acne:

1. Garlic

There are two options in using garlic to get rid of acne. First with the grind of two or more garlic until soft enough then applied to the facial acne. Let stand for 10 minutes then rinse. The other is to take one or more of garlic every day.

Many say these two efekktif enough, but for you who do not like the smell of garlic may be better to take the other way. Do not worry there are many other natural ways which I will explain below.

2. White Eggs

How? Easy. Separate the egg yolks and egg whites take it. Whisk briefly then apply to face and let stand for 15 minutes. This egg white will help reduce the oil in the face of often cause acne.

3. Toothpaste

One thing to note here that used toothpaste is shaped pasta (such as Pepsodent) rather than a gel form (such as Close Up). Almost the same way the second premises of the above. Apply toothpaste to acne and other parts around the pimple before bed. Let the night / until the morning and then rinse with clean water.

4. Aloe Vera

Take a leaf aloe vera, cut into several parts, peel the outer skin, apply at the emerging pimples, and repeat do this every morning and afternoon. If you are patient enough, acne may be dried and peeled off for 3 days. Also Aloe vera is also able to remove a stubborn acne scars. Once again the key is only one, persevering!

5. Tomatoes

This one fruit but good for the eyes is also quite effectively eliminate blackheads black (blackheads). The first thing to do is to slice the tomatoes in half and rub all over the pimpled face and leave for 15 minutes - 1 hour and then rinse.

6. Lemon / Lime + Water Rose

Lemon, lime and countrymen fruits contain citric acid which is very rich, where citric acid is very good to move the skin cells that die can cause acne. The way is by mixing the juice / lemon juice with rose water and apply on face and leave for 10-15 minutes. After that, rinse with warm water. Application of this therapy regularly and consistently for 15 days will give results quite remarkable (so many have proved, including me).

The six natural way to eliminate acne that I mentioned above you do not have any. Kalo you include lazy (like me), choose only one way that you think is most easily performed. Run for a minimum of 15 days on a regular basis, if no new change try another way. So, Good Try ...

International Osteopaths

One thing I constantly hear from pre-meds is that they don't want to go to DO school because they won't be able to practice internationally. This is just a nasty rumor... perpetuated for reasons unknown to me. DO's currently have FULL privileges in 44 countries and partial privileges in another 8. Additionally, the AOA has advocates to help DO's apply for full licensing in countries who lack full privilege.

The AOA confirms this, and Wiki has a list... See for yourself...

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Friday, January 22, 2010

Not Heartless

If you think I'm heartless for not writing about Haiti, I'm not. It's just that I despise American sensatio-journalism...and I refuse to contribute to the nonsense. Frankly, I don't have anything legit to write about, as I am not there. So I won't. Unlike most journalists, who are willing to drag some poor Haitian guy off the street on the promise of sending word to his family in Miami that he is ok, and then tricking him into discussing things on camera which they promised they wouldn't ask him. I've been through a natural disaster, and I can safely say you should never, ever believe the media. Their truth to false ratio is about 1:1000.

That being said, I think about Haitians every moment... and wish I had a real way to help. In a few years I will. Until then, I will wait. Bless Haiti.

Things That Suck in Med School

1. 600+ emails per day, all recruiting for trips, clinics, conferences, retreats, volunteer projects, parties, political movements, etc. which all sound oh-so-nice... but I don't even have time to read the freakin' email let alone actually participate. That, and I have to sort through these 600 daily emails to make sure I read the important shit... Like at 10:24 pm two nights ago I received an email informing us of a mandatory 8:30 am class and a reading assignment for the morning. Nice.

2. Endless Facebook updates from my 180 classmates verifying the 100 biochem concepts that I, indeed, have not yet studied, looked at, nor have even heard of.

3. A little class we have called Foundations in Medicine (FIM). In theory, this class should be great. Teaching future docs about ethics, death and dying, nutrition, alternative medicine, exposing them to the community, volunteering, etc. In reality, it is the biggest bane of my existence and the hugest time-waster ever. This class has hundreds of "points" you have to get in order to pass. Yet you don't get them the normal way... like 30 points for an exam. You earn your points POINT BY POINT. For instance, attending a lecture might be 1/3 of ONE POINT. An essay might be 2 points. Going on an ambulance ride is 1 point. Attending an intubation simulation is 1 point. OH GOD oh god. I'm FIM's bitch.

Thursday, January 21, 2010

Former Eliminate Acne Tips

Acne is the most common problems associated with beauty. Acne that never lost self-confidence can make us down, especially if the tainted scar face. Many cosmetic products that are sold in the market which is said to be able to eliminate traces of acne spots. But we must be careful before using the product of chemicals, because one-one rather than beautiful skin, but we got side effects that sometimes make us even more damaged skin.

Here are some tips to deal with acne and remove acne scars without the use of drugs. Simply using the natural materials that most probably in your home.

Ice Stone
Apply ice to the surface of the face to close up the pores so that the outer particles pertikel cause acne does not go into the skin.

Sliced Tomatoes
Tomato slices rubbed on acne scars can prove annoying stain.

Cucumber juice
Cucumber juice is a natural skin toner that can improve skin texture. Cucumber can reduce inflammation, smoothing the skin and heal wounds caused by acne.

White Eggs
Egg white easily obtained and effective enough to overcome acne. Apply egg white on the pimples and leave overnight so that your acne improves.

In the eastern hemisphere turmeric has thousands of years known as beauty products. Khasiatnya One is to reduce acne scars ..

Aloe Vera
Aloe vera is a potent healer, including to remove acne scars. The way he lives inside lenders apply aloe vera to the skin regularly.

Water Lemon
Apply lemon juice on the acne spots and allow some time before washing with water. Lemon has a content that can lighten skin color. Lemon can also remove dead skin cells and make skin more elastic.

Olive Oil
Besides making a delicious dish, olive oil can also remove acne spots. Gently massage your face with acne, especially the oil contained in the acne spots.

Honey is a natural moisturizer. Honey mask has long been believed to also make skin look brighter and shine.

You could say water is a method of treatment is best face we can get from nature. Drink enough water to remove toxins from the body. Water can also help shed the skin cells to die.

Fruits and Vegetables
Expand the consumption of fruit and vegetables to make the skin healthier.

There is no harm to try Tips2 above, since all ingredients are natural and possible side effects is very small. Good luck.

Tips Overcoming Sleep Disorders Hard

You'll never feel nervous because she could not sleep even though it was already shown at midnight? Despite trying to close my eyes, your mind kept drifting to no sleep. As a result, the body was limp in the morning and my head felt dizzy because of the condition of the body is less to break. This is the symptom of insomnia that you should be aware.

Insomnia can be defined as a condition where a person having difficulty sleeping or can not sleep well. Average everyone has experienced insomnia once in his life. There are even more extreme mentions 30 - 50% of the population experiencing insomnia.

Insomnia Causes
Insomnia can be caused to attack all age groups. However, the incidence of insomnia increases with age. This may be caused by the stress that often descend those older. In addition, women more often said to suffer from insomnia than men.

Besides due to stress, insomnia may also occur because there is a problem in your food. Another thing that can cause insomnia is the atmosphere of a room that does not support, anxiety, until the excess caffeine consumption.

Tips Overcoming Sleep Disorders Hard :

1. Regular exercise
Exercise regularly. Some studies say that regular exercise can help people who experience problems with sleep. Exercise should be done in the morning and not a few minutes before sleep. With exercise, your health becomes more optimal, so the body can fight stress that comes with the better.

2. Reduce consumption kaffein
Minimize your intake of caffeine such as tea or coffee. If you want to consume them, do it in the morning, or at least 4 hours before bed at night. Caffeine is consumed too close to bedtime will only hinder the arrival of sleep.

3. Notice meal
You should consider a meal, give a minimum time of two hours before bed after the last meal for dinner. Distance eating too close to bedtime it will increase metabolism and body temperature, making sleep more difficult. In this way, you can maintain your weight, remember to sleep after a big meal will save a lot of fat.

If you really hungry, choose snacks like cereal grains that are mixed milk, tofu, oatmeal, or bread sprinkled with sesame seeds. But still, give a minimum of one hour before bed because tryptophan is also needed time to stimulate the brain.

4. Eat carbohydrate foods before bed
To be able to sleep well, your body needs trytophan or substance often called sleeping pills. Trytophan, which is a type of fatty acids, producing serotonin function can relax nerves in the brain centers. When the brain is relaxed, you will more easily fall asleep with a good quality.

Trytophan many carbohydrates are in foods lightly. Muffins, crackers, or fruit can be a solution. But do not be too full, your digestion will be overwhelmed because they have to work hard to digest, so you can not break up.

5. Do the activities that make you comfortable to sleep
You can start by pouring oil on the diffuser aromatherapy, hot shower, set your favorite song or cover the bed with a comfortable blanket. At bedtime, turn off the lights, turn off the menimbulan it sounds, make sure you are comfortable with the temperature of your sleeping room. Keep the clock of your eyes because it can make you anxious because of not able to sleep while the clock so late.

6. Bed only for sleeping
If you want to read or watch tv do better elsewhere, so when you go to bed, 'alarm' in your body quickly reminded that it is time to sleep. This will help your body adjust to the environment in which to sleep. When you lie in bed, then the stimulus will come to bed.

7. Clear mind
Clear your mind. Away with all the worries that descend your mind. One way to do this is to write down all your thoughts through the media blog.

8. Sleep and wake up in a regular period
Sleep and wake up in the regular time period every day. Chaotic bedtime will disrupt your sleep later.

If these tips are not able to also give positive results for you, contact your doctor immediately.

Restricting food and drink in labor is not justified

by Amy Romano, CNM (Originally published on Science and Sensibility for Lamaze International)Listen to this great podcast about the new Cochrane review showing that the policy of restricting food and drink in labor is not justified. It’s a nice summary of how and why the research was conducted. In addition, I particularly liked these tidbits: 1. Rather than asking “is eating and drinking in

Attention, ACNM Members! Who Will You Choose to Lead Your Profession?

We interrupt our regularly scheduled posts to remind ACNM members that the 2010 election forum is live now through February 5. This is your chance to choose who will lead the profession of midwifery into the future. Now is the time to pose questions to the candidates. You can even read their responses to other members’ questions.Up for election are:Region II representativeRegion III

Nursing Jobs UK

The United Kingdom opened up another door of opportunity for Filipino nurses to work in Nursing Jobs UK. The job orders for the said nursing jobs UK were approved last January 8 for a recruitment agency based in Del Monte Avenue in Quezon City. The said nursing jobs UK are for the position of Critical Care Nurse and General Nurse and have a corresponding job order balance of 30 and 10 nursing jobs UK respectively.

For the said nursing jobs UK, applicants must submit their application to the office of the recruiting agency. For more info, you can call the recruiting agency’s landline numbers which will be available upon request. Just leave your request including your valid Email address at the comment section at the end of this article.

Wednesday, January 20, 2010

Raise Weight Loss Tips, Be Ideal

Many of us are experiencing problems in raising the ideal weight. Ideal body weight can be added to increase muscle mass, not body fat. Many are often wrong meaning with increasing weight means increasing the amount of fat. Besides the way it is the wrong way, the way it is also very unhealthy because it means increased fat we consume more energy than we need for our activities.
Usually after trying for months, eating as much as possible, fitness exercise 'he' was heavy, but still not entirely fruitless, we are getting desperate and saying that our bodies are thin or have a genetic destiny. If in 2-3 weeks there has been no result, there is something wrong SURE.

Please check the tips below for the muscle during the 2-3 weeks have not got:
1. Have we eat 5-6x a day, moderate, and reducing junk food? Eating junk food, not only adds unhealthy fats, but also can slow metabolism makes the body can not work as well.

2. Eat carbs and protein after exercise DIRECT. This is needed to replace glycogen or sugar in the muscles that run out when we exercise. And protein needed by the muscles that we have just 'broken' with heavy exercise.

3. Eat real food (not supplements) MAX 1 hour after exercise

4. Drink multivitamin (this requirement will make the weight loss supplement, because vitamin B in particular, helps to digest the nutrients that we eat.'ll Eat lots of food waste, but our bodies can not digest it well).

5. Strength training is NOT EXCEED 1 hour. And reduce your cardio. Exercise more than 1 hour will waste your calories. You still need calories to build your muscles.

6. Not the same muscles more than 2x a week

7. It was followed 9-12 sets per muscle per session. Do not train the chest muscles with all the equipment in the gym with the assumption that the more complete the better. Use only 3-4 instruments each about 3-4 sets and use only basic compound movement. No Isolation Movement.

8. 6-8 reps is a must, not be up to 12 reps. Was 6-8 reps failure tuh.

9. Use negative reps. After the failure, assisted by a friend / spotter to lift, and we stand to fall. Vary this negative reps for 2-3 weeks.

10. Already using High Intensity training for weight training. Which means, short break between sets, about 1.5 - 2 minutes. And lifting as heavy as possible. Example: for a high of about 160-165, jgn said bench press 10kg weight left and right already. Such would not be able to increase your muscle time. Chased a target of at least 25-30kg left and right. If blm able, perlahan2 increase each week until you are able, if necessary, ask the help of friends.