Thursday, September 30, 2010

Top Furniture Design Schools

Following are the top schools offering Furniture Design Programs:

Northern Michigan University (USA)
- The School of Art and Design offers four-year B.S., B.A. and B.F.A. degrees in Furniture Design.
- The woodworking and furniture design majors concentrate on woodworking process, although students are encouraged to become familiar with the adjacent foundry and smithing facilities. The product

Fall Issue!




It has finally arrived! The Fall issue is now available to buy via Magcloud and will be up for downloading in a short while. Enjoy! Order it here!

NP jobs PA jobs Nurse Practitioner jobs




NP jobs PA jobs Nurse Practitioner Jobs, Physician
Assistant jobs, Advanced Practice Jobs, ARNP jobs, Nurse Practitioner
Resumes, Nurse Jobs, Physician Jobs, CRNA jobs, Advanced Registered
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NRC Rankings 2010

The 2010 NRC (National Research Council) study compares 4,838 individual research doctorate programs in 62 subject areas across 212 surveyed institutions. The survey did not assign a single rank to any program, but rather placed programs within a range. Following are the top performers in the NRC rankings released on 28 September 2010:

University of California, Berkeley - Based on the NRC's

Nursing Care Plan | NCP Hepatitis B

Hepatitis B is a viral infection of the liver transmitted through the blood or body fluids of someone who is infected. It is the most common serious liver infection worldwide. The disease has two forms: an acute form that lasts a few weeks, and a chronic form that can last for years and can lead to cirrhosis, liver failure, liver cancer, and even death. Acute hepatitis B has a 5 percent chance of leading to the chronic form of the infection in adults; however, infants infected during the mother’s pregnancy have a 90 percent chance of developing chronic hepatitis B, and children have a 25–50 percent chance. About two-thirds of people with chronic HBV infection are so-called “healthy” carriers of the virus. They may never get sick themselves but they can transmit the infection to others. The remaining one-third of people with chronic hepatitis B develop liver disease that can lead to permanent scarring of the liver. Between 15 and 25 percent of people with chronic hepatitis B eventually die of liver disease.

Hepatitis B has an incubation period of one to six months. About 50 percent of people with the acute form of the disease have no symptoms at all; the others experience loss of appetite, nausea and vomiting, and jaundice around twelve weeks after getting infected. Some patients may also have joint pain, itchy skin, or abdominal pain. Many of these patients assume that they have influenza. Patients with chronic hepatitis may have no symptoms at all. The one-third who do eventually fall ill have the same symptoms as patients with the acute form of the disease. People who have been infected by HBV and have recovered from theinfection are protected against hepatitis B for the rest of their lives. People can also be protected by receiving a vaccine against the virus.
Nursing Care Plan | NCP Hepatitis B
There are about 200,000 new cases of hepatitis B in the United States each year; it is estimated that 1–1.25 million people carry the disease. Hepatitis B causes about 5,100 deaths in the United States each year. In the rest of the world, as many as a third of the population are chronic carriers of the disease. The age group most commonly affected by hepatitis B in the United States is adults between the ages of twenty and fifty. African Americans are more likely to be infected than either Hispanics or Caucasians; however, Alaskan Eskimos and Pacific Islanders have higher rates of carrier status than members of other racial groups. More males than females are infected with hepatitis B in all races and age groups.

Risk factors for hepatitis B include:
• Having unprotected sex with a partner regardless of sexual orientation.
• Having a large number of sexual partners.
• Being infected with another sexually transmitted disease (STD), particularly gonorrhea or chlamydia.
• Sharing needles with other intravenous drug users.
• Having a family member with chronic HBV infection.
• Having had a blood transfusion or use of blood products before 1972.
• Needing hemodialysis for kidney disease.
• Frequent travels to parts of the world with high rates of hepatitis B. These include the Middle East, southern Africa, Southeast Asia, Brazil, and the Pacific Islands.
• Working in a hospital, clinic, or other facility requiring frequent exposure to blood, open wounds, or other body secretions.

Nursing Care Plan Signs and Symptoms

Hepatitis B is caused by a virus. It is primarily a bloodborne infection, but can also be transmitted through contact with the semen or saliva of an infected person. The virus enters the body through injection, a break in the skin, or contact with the mucous membranes, tissues that line the mouth, genitals, and rectum. People cannot get hepatitis B from food or from shaking hands, sneezing or coughing,
breastfeeding, or casual contact with an infected person.

The symptoms of acute hepatitis B infection include:
• Loss of appetite
• Feeling tired
• Muscle and joint aches
• Low-grade fever
• Abdominal pain in the area below the rib cage
• Yellowish discoloration of the skin and whites of the eyes
• Tea- or cola-colored urine
• Grayish or clay-colored stools A few people develop a severe form of hepatitis B known as fulminant hepatitis. This form of the disease appears rapidly and can cause death. Its symptoms include:
• Sudden collapse
• Mental confusion, hallucinations, or extreme sleepiness
• Jaundice
• Noticeable swelling of the abdomen

Nursing Care Plan Diagnosis

Hepatitis B is diagnosed by one or more blood tests, since patients may not have any apparent symptoms. In a number of cases, the person is diagnosed following a routine blood test given as part of an annual health checkup. The most common clue is abnormal liver function results. To confirm the diagnosis, the doctor will take one or more blood samples for testing:
• A test of liver function, if this has not already been done.
• Tests for antibodies to the hepatitis B virus. A positive result means that the person has either been effectively vaccinated against HBV or has been infected at some point in the past and has recovered.
• Tests for the surface antigen of the hepatitis B virus (HBsAg). The surface antigen is the outer coating of the virus. A positive HBsAg test means that the patient is currently infected and may be able to pass on the virus to others.
• Hepatitis B DNA test. This blood test measures the levels of virus in the patient’s blood. Patients with chronic active hepatitis B may be given a computed tomography (CT) scan or ultrasound of the liver to see whether the liver has been damaged by the infection. The doctor may also perform a liver biopsy. This test involves inserting a long hollow needle into the patient’s liver through the abdomen and withdrawing a small amount of tissue for examination under a microscope.

Nursing Care Plan Treatment

Patients who know that they have been exposed to the hepatitis B virus can be treated by administering an immune-boosting injection and three shots of the HBV vaccine to prevent them from developing an active infection. Those who have already developed symptoms of the acute form of the disease may be given intravenous fluids to prevent dehydration or anti-nausea medications to stop vomiting. To date, there is no medication that can prevent acute hepatitis B from becoming chronic once the symptoms begin. There are few treatment options for chronic hepatitis B. If the patient has no symptoms and little sign of liver damage, the doctor may suggest monitoring the levels of HBV in the patient’s blood periodically rather than starting treatment right away. There are five different drugs used to treat hepatitis B, but they do not work in all patients and may produce severe side effects. Most doctors will wait until the patient’s liver function begins to worsen before administering these drugs. If the patient develops fulminant hepatitis B or their liver is otherwise severely damaged by HBV, the only option is a liver transplant. This is a serious operation with a lengthy recovery period; its success also depends on finding a suitable donor liver.

Prognosis
Patients with acute hepatitis B usually recover; the symptoms go away in two to three weeks, and the liver itself returns to normal in about four months. Other patients have a longer period of illness with very slow improvement. Chronic hepatitis leads to an increased risk of cirrhosis and liver cancer, and eventual death in about 1 percent of cases.

Nursing Care Plan Prevention

Hepatitis B can be prevented by vaccination with a vaccine called Engerix-B. The person receives the first two doses of the vaccine a month apart and the third dose six months later. The vaccine is recommended for all persons under the age of twenty; it can be given to newborns and infants as part of their regular vaccination series. Others who should be vaccinated include health care workers, military personnel, firefighters and police, people who travel frequently to countries with high rates of hepatitis B, people with hemophilia, people who must be treated for kidney disease, people who inject illegal drugs, and men who have sex with other men.

Other preventive measures include:
• Practicing safe sex
• Not sharing needles, razors, toothbrushes, or any other personal item that might have blood on it
• Avoiding getting a tattoo or body piercing, as some people who perform these procedures do not sterilize their needles and other equipment properly
• Getting tested for HBV infection if pregnant, as the virus can be transmitted from a mother to her unborn baby
• Consulting a doctor before taking an extended trip to any country with high rates of hepatitis B

The Future
The rate of hepatitis B in the United States began to drop after 1992,
when vaccination of infants became routine, followed by vaccination of adolescents in 1995. Public health doctors expect the decline to continue for the foreseeable future. Researchers at the National Institutes of Health (NIH) are presently looking for medications that will be effective in treating all patients with chronic hepatitis B with fewer side effects.

Nursing Care Plan | NCP Hepatitis A

Hepatitis A is an infectious disease of the liver caused by the HAV virus. The disease is usually transmitted by food or water contaminated by human wastes containing the virus or by close human contact. As far as is known, only humans and some primates can get hepatitis A; it is not carried by other animals.

Hepatitis A is an inflammation of the liver caused by the HAV virus. It differs from hepatitis B and hepatitis C in that it does not cause long-term liver damage. Even though people can take several weeks or months to recover completely from hepatitis A, they have lifelong immunity afterward. Complications from hepatitis A are rare and usually limited to people with chronic liver disease or who have received a liver transplant.

Hepatitis A varies in severity. Children and younger adults may have no symptoms at all, although they can still spread the disease. In general, adults are more likely to have noticeable symptoms than children or teenagers. The symptoms begin between two and six weeks after the person has been infected with HAV. The most common symptom is loss of energy and overall tiredness. Some people develop a mild flu-like illness with diarrhea, low-grade fever, nausea, vomiting, and muscle cramps. People with more severe symptoms may have pain in the abdomen in the area of the liver (below the rib cage on the right side of the body); they may notice that their urine has turned dark brown or that they have jaundice—yellowing of the skin and the whites of the eyes. Some have itchy skin. Most people feel better within four to six weeks after the symptoms begin, although about 15 percent of patients may take up to nine months to completely regain their energy and feel normal again.

Hepatitis A is much more common in Africa, Asia, and South America than in the United States. The rates of hepatitis A in North America have been steadily dropping since the 1980s. In 1988 the Centers for Disease Control and Prevention (CDC) reported 32,000 cases in the United States; in 2003, 7,653 cases were reported. In developing countries, children below the age of two account for most new cases of hepatitis A; in the United States, the age group most often affected is children between the ages of five and fourteen. Males and females are equally likely to get hepatitis A, as are people from all races and ethnic groups in the United States. Some groups of adults are at increased risk of hepatitis A:
• People who travel to parts of the world with high rates of the disease and poor sanitation
• Male homosexuals
• People who use illicit drugs, whether injected or taken by mouth
• Medical researchers and laboratory workers who may be exposed to HAV
• Child care workers
• Homeless people

Nursing Care Plan Signs and Symptoms

Hepatitis A is caused by a virus that is transmitted by close personal contact with an infected person, by needle sharing, and by eating food or drinking water contaminated by fecal matter. After the virus enters the body, it multiplies in the cells of the liver, causing inflammation of the liver and a general response from the immune system that leads to most of the symptoms of the illness. The HAV virus is shed from the liver into the bile (a digestive fluid secreted by the liver) and then into the person’s stools between fifteen and forty-five days before symptoms appear. That means that people can spread the virus through their feces before they know that they are sick. In the United States, hepatitis A is most commonly spread by food handlers who do not wash their hands properly after using the bathroom;
by childcare workers who do not wash their hands after changing a baby’s diaper; by
anal sex; and by eating raw shellfish harvested from sewage-polluted waters. In very rare cases the virus can be transmitted through blood transfusions.

In addition to fatigue, the most common symptoms of hepatitis A include:
• Low-grade fever (101°F [38.3°C])
• Nausea, vomiting, and diarrhea
• Loss of appetite and weight loss
• Swelling of the liver and pain in the area of the abdomen over the liver
• Tea- or coffee-colored urine
• Jaundice
• Generalized sensation of itching
• Pale or clay-colored stools
• Muscle pains

Nursing Care Plan Diagnosis

The doctor may suspect that a patient has hepatitis A during a physical examination by feeling the area over the liver for signs of swelling and pain; and checking the skin and eyes for signs of jaundice. A definite diagnosis is provided by a blood test for certain antibodies to the HAV virus. The doctor will also have the sample of blood checked for abnormally high levels of chemicals produced in the liver.

Nursing Care Plan Treatment

There is no specific drug treatment for hepatitis A, as antibiotics cannot be used to treat virus infections. Most people can care for themselves at home by making sure they get plenty of fluids and adequate nutrition. People whose appetite has been affected may benefit from eating small snacks throughout the day rather than three main meals and eating soft and easily digested foods. Patients with mild vomiting may be prescribed antiemetics (drugs to control nausea). Those with severe vomiting may need to be hospitalized in order to receive intravenous fluids. Patients with hepatitis A should avoid drinking alcohol or taking acetaminophen (Tylenol), which make it harder for the liver to recover from inflammation. Patients should also tell their doctor about any other over-the-counter or prescription drugs they are taking, because the drugs may need to be stopped temporarily or have the dosages changed.

Nursing Care Plan Prognosis
Most people recover fully from hepatitis A within a few weeks or months. Between 3 and 20 percent have relapses (temporary recurrences of symptoms) for as long as six to nine months after infection. About 1 percent of patients develop liver failure following HAV infection, mostly those over sixty or those with chronic liver disease. In these cases liver transplantation may be necessary for the patient’s survival. There are about 100 deaths from hepatitis A reported each year in the United States.

Nursing Care Plan Prevention

Hepatitis A can be prevented by a vaccine called Havrix that is given before exposure to the HAV virus. The vaccine is given in two shots, the second given between six and eighteen months after the first. It confers immunity against hepatitis A for at least twenty years. Those who should receive the vaccine include people in the military and those who travel abroad frequently; men who have sex with other men; people who use intravenous drugs; people with hemophilia who must receive human blood products; and people who have chronic hepatitis B or C infection.

People who have been exposed to the HAV virus and children under the age of two should not be given Havrix, but they can be given another type of drug to protect them against HAV. Everyone can reduce their risk of hepatitis A by observing the following precautions:
• Practice good personal hygiene; wash hands frequently, especially after using the toilet or changing a child’s diaper.
• When traveling, drink only bottled water, avoid raw or undercooked meat or shellfish, and avoid eating fresh fruits or vegetables unless you have washed and peeled them yourself.
• Avoid sharing drinking glasses and eating utensils. If someone in the family has hepatitis A, wash their glasses and utensils separately in hot, soapy water.
• Avoid sexual contact with anyone who has hepatitis A.

The Future
The rates of hepatitis A in the United States and other developed countries are likely to continue to drop, given the availability of an effective vaccine against the disease. Hepatitis A is, however, likely to continue to be a major health problem in developing countries, and travelers will need to protect themselves against it for the foreseeable future.

Nursing Care Plan | NCP Heat Stroke

Heat stroke is the most severe of the three forms of heat-related illness. In heat stroke, a person’s body temperature rises to 104°F (40°C) or higher. Unlike heat cramps and heat exhaustion, however, heat stroke is a life-threatening condition. It has two forms: exertional heat stroke (EHS), related to work or exercise in the heat; and nonexertional heat stroke (NEHS), which is not caused by working or exercising outside and primarily affects the elderly, chronically ill persons, and infants during heat waves.

Heat stroke is a medical emergency that develops when a person’s body can no longer get rid of excess heat through sweating and evaporation of the sweat. As a result, the body’s core temperature rises, damaging the proteins and cell membranes in the body tissues and leading to organ failure, destruction of muscle tissue, the collapse of the cardiovascular system, and eventually death.

According to the CDC, over 8,000 people died in the United States from heat-related illness between 1979 and 2003. People over the age of sixtyfive account for 44 percent of heat-related deaths. Heat stroke affects people from all races and ethnic groups. Men and women are equally affected by heat stroke; however, men are twice as likely as women to die from heat stroke because more men than women are employed in occupations that require working outdoors in hot weather.
Nursing Care Plan | NCP Heat Stroke
Some groups of people have a greater risk of heat stroke:
• Newborn infants. The body of a baby cannot adjust to changes in temperature as efficiently as an adult’s. In addition, babies have a limited ability to exit a hot environment.
• Elderly people. As with infants, the bodies of elderly people do not regulate internal temperature as effectively as those of younger adults. In addition, elderly people may have underlying illnesses or take medications that make them more vulnerable to heat stress.
• Workers whose jobs require working outdoors in hot weather or near ovens, blast furnaces, or other sources of heat.
• People who are not physically fit or have not undergone a conditioning program to get their bodies used to work or exercise in the heat.
• People who take certain types of medications, including diuretics, drugs that regulate blood pressure, tranquilizers, antihistamines, and drugs given to treat people with schizophrenia.
• Homeless people.
• Obese people.

Nursing Care Plan Signs and Symptoms

Like heat exhaustion, heat stroke is caused by the loss of water and salt from the body due to sweating during exposure to heat or vigorous physical exercise in hot conditions. High humidity makes it harder for the body to regulate its internal temperature through sweating, which is its normal way to get rid of heat when the outside temperature is 95°F (35°C) or higher. As sweat evaporates, it carries body heat with it.

In addition to losing water through sweating, however, the body also loses electrolytes, which are minerals that are necessary to proper body functioning. In heat stroke, the body’s cooling mechanisms are overwhelmed, and the body’s internal temperature starts to rise uncontrollably. Other factors that can impair the body’s ability to regulate its temperature in hot, humid weather include drinking alcohol, which leads to losing more water through the urine, and wearing tight clothes or clothes made of fabrics that do not allow sweat to evaporate easily. Heat stroke is often preceded by the symptoms of heat exhaustion, which include nausea and vomiting, headache, muscle cramps, dizziness, and difficulty breathing. The symptoms of heat stroke itself usually include:
• Hot, flushed, dry skin
• Changes in level of consciousness, including hallucinations, confusion, and irrational behavior
• Rapid heartbeat, sometimes as high as 130 beats per minute
• Rapid, shallow breathing
• Blood pressure may be either normal or low
• Body temperature above 104°F (40°C) or rectal temperature above
106°F (41.1°C).

Nursing Care Plan Diagnosis

The diagnosis of heat stroke is usually obvious from the patient’s situation and previous activities. In addition to taking the patient’s temperature, doctors in the emergency room may also take a urine sample to check kidney function or a blood sample to check the level of the patient’s electrolytes and blood sugar. A blood test can also be used to evaluate whether the patient’s liver has been damaged. In addition to these laboratory tests, the doctor may also order a muscle function test to see whether the patient’s muscle tissue has begun to break down.

Nursing Care Plan Treatment

Immediate treatment for heat stroke is essential as death or permanent brain damage can occur within minutes. Emergency treatment is focused on cooling the patient as quickly as possible to a core body temperature of 102°F (38.9°C). Cooling may be done by spraying water on the body, covering the patient with sheets soaked in ice water, or placing ice packs in the patient’s armpits and groin area. The patient’s temperature is not lowered further because they may start to shiver, and shivering will raise their internal temperature again.

If the patient is conscious, they may be given additional oxygen to breathe and intravenous fluids to restore their blood volume. In most cases these fluids will contain sugar in order to lower the risk of liver failure. Patients who are having muscle cramps or convulsions are usually given benzodiazepine tranquilizers, which relax the muscles and reduce the risk of damage to muscle tissue. The patient will be kept in the hospital for at least forty-eight hours after emergency treatment and monitored for brain damage, signs of liver failure, or other complications. This period of observation is necessary because heat stroke can damage almost all major body systems.

Nursing Care Plan Prognosis
Although people have survived body temperatures as high as 114.8°F (46°C), any temperature above 106°F (41.1°C) is potentially fatal. People who receive prompt treatment for heat stroke have a 90 percent chance of survival; without prompt treatment, 80 percent will die.

Nursing Care Plan Prevention

Heat stroke is largely preventable by taking time to adjust to hot weather and dressing sensibly for local weather conditions:
• Most people in temperate climates need time to acclimate to seasonal temperature changes. People should work up gradually to sports and other outdoor activities during the first few warm days of summer rather than overdoing. The same is true of visiting a country with a tropical or hot climate; it is best to keep one’s activity level moderate for a few days rather than crowding in too many activities. It can take people between seven and fourteen days to adjust to a hot climate; marathon runners generally take two weeks to acclimate to training in the heat.
• Wear loose-fitting and light-colored clothing; choose fabrics that absorb sweat, such as cotton; wear a hat outdoors.
• Drink fluids before exercising or working outside in hot weather. The American College of Sports Medicine recommends drinking about 20 ounces (0.6 liter) of water or sports drink two to three hours prior to exercise, and 10 ounces (0.3 liter) of water or a sports drink ten to twenty minutes before exercise. Do not use thirst as a guide to fluid intake; a person can become dehydrated before feeling thirsty enough to want a drink.
• Use sunscreen generously, as sunburn lowers the body’s ability to get rid of excess heat.
• Avoid caffeinated beverages and alcohol; they cause the body to lose additional fluid through the urine.
• People who must take prescription medications for allergies, high blood pressure, heart conditions, or certain types of mental disorders should ask their doctor whether any of their medications affect their response to hot weather.
• Exercise during the early morning or late evening, when the temperature is cooler and the humidity lower. Workers in occupations that require them to work in hot environments should take rest breaks during periods of hot weather. Some companies also provide rest areas where workers can cool off.
• Consult a heat stress index like the one printed in the American Council on Exercise fact sheet listed below or the National Weather Service’s heat index to help decide whether it is safe to exercise outdoors. There are times when the heat and humidity are so high that exercise should be avoided. Heat stroke is likely to occur when the heat stress index (the apparent temperature) is over 105°F (40.5°C) and the person is exposed to it for a long period of time; if the heat index is 130°F (54.4°C) or higher, heat stroke is highly likely even with short exposure.
• People with elderly friends or relatives should check on them
during summer heat waves. Heat waves that last longer than two
days put the elderly at risk of heat exhaustion.
• People who do not have air conditioning in their homes should go to a library, shopping mall, or other public building that is air-conditioned during a heat wave. Even a few hours in a cooler location can help to lower the risk of heat stroke.

The Future
Heat stroke is a common hot-weather disorder; it is often a consequence of exercising or working outdoors without proper conditioning or precautions. Heat stroke can be prevented in normally healthy individuals by dressing appropriately for hot weather, drinking enough fluids, consulting the local heat index before outdoor activity, and knowing when to slow down and cool off. It is possible that heat stroke may become more common in some parts of the United States in the summer time because of the growing size of the elderly population and others who do not tolerate heat well because of chronic illness. One problem is geography: most parts of the United States have uncomfortably high temperatures for at least part of the summer, and some areas have temperatures at or above 90°F (32.2°C) for weeks on end. In addition, large cities tend to be hotter than the surrounding areas.

Quote from a Newly Qualified Nurse

Found this quote on the Nursing article linked on the post below.

I am a newly qualified nurse working as an auxiliary on the bank when I am lucky enough to get shifts, there has been so much red tape to stop newly qualified nurses from getting a job in the NHS. It is very disheartening to go through all the studying and work to have nothing in the end. I am now looking to go in a new career direction as I need paid employment and that is not something I can find as a nurse sadly. When will they realise they need frontline staff and this is not something they can cut?


I keep hearing this over and over again from new Nurses.  Over and over again.

How can people blame  university (new) training for Nurses for the hellish conditions on the wards when our new RNs cannot even find jobs?  The vast majority of Registered Nurses practicing in the NHS trained under the old system and they are on their knees due to the lack of RNs.   We need RNs and we need new blood to replace an aging workforce.  What we don't need are more untrained unskilled minimum wage earning ward assistants. But that seems to be all that we are getting.

Wednesday, September 29, 2010

Top Pastry Chef & Baking Schools

Following are some of the top pastry chef and baking schools:

California Culinary Academy - It is one of the West's first culinary arts schools. The culinary programs are designed to prepare students for professional opportunities in the international culinary, p√Ętisserie and baking, and hospitality industries.

Le Cordon Bleu College of Culinary Arts in Chicago - Le Cordon Bleu is proud to have

SLEEEEPPPPP

Today the only thing on my mind is sleeping. Sleeping for about 25 hours. I MISS SLEEP SO MUCH. =( Damn these 5am mornings. They're driving me to the brink of insanity.

Trail-Blazing for Midwives: An Unexpected Encounter

by Michelle Grandy, CNM, MN, President, Washington ACNM State AffiliatePictured in center: Michelle Grandy, CNM, and Congressman Jay InsleeYou never know where opportunities will arise to support midwifery. My most recent unexpected opportunity happened as I was backpacking with my daughter in the great outdoors of Washington State.We heard a few men down the trail talking about taking a group

Top Pharmacy Technician Schools

List of top pharmacy technician schools and programs:

California State University, East Bay - The Pharmacy Technician Certificate prepares aspiring pharmacy technicians for entry-level positions in this fast-growing field. Students who complete the certificate will be ready to take the Pharmacy Technician Certification Board's (PTCB) National Certification Exam.

York College / CUNY - The

Nursing Care Plan | NCP Heat Exhaustion

Heat exhaustion is a condition in which the body is overwhelmed by exercising or working in a hot environment; it produces more heat than it can get rid of through evaporation of sweat or moving into cooler surroundings. Heat exhaustion is the intermediate form of heat-related illness, heat cramps being the mildest and heat stroke the most serious.

Heat exhaustion is characterized by thirst, headaches, muscle cramps, shortness of breath, and nausea. Most patients with heat exhaustion have a normal level of alertness, although some people become slightly confused or feel anxious.

Heat exhaustion is the most common form of heat-related illness seen by physicians, although the exact number of people affected every year is not known because people can be treated for heat exhaustion outside a hospital or doctor’s office. According to the Centers for Disease Control and Prevention (CDC), Arizona has the highest rate of cases of heat exhaustion in the United States. Heat exhaustion affects people from all races and ethnic groups. It affects males and females equally.
Nursing Care Plan | NCP Heat Exhaustion

Nursing Care Plan Signs and Symptoms

Like heat cramps, heat exhaustion is caused by the loss of water and salt from the body due to sweating during exposure to heat or vigorous physical exercise in hot conditions. High humidity makes it harder for the body to regulate its internal temperature through sweating, which is its normal way to get rid of heat when the outside temperature is 95°F (35°C) or higher. As sweat evaporates, it carries body heat with it. In addition to losing water through sweating, however, the body also loses electrolytes, which are minerals that are necessary to proper body
functioning.

Other factors that can affect the body’s ability to regulate its temperature in hot, humid weather include drinking alcohol, which leads to losing more water through the urine, and wearing tight clothes or clothes made of fabrics that do not allow sweat to evaporate easily. The symptoms of heat exhaustion are more severe than those of heat cramps; they may come on either gradually or suddenly. People suffering
from heat exhaustion may feel dizzy and faint as a result of the loss of body fluids and minerals.
• Skin is hot and moist; the person may develop goose bumps.
• Body temperature may be normal or a few degrees above normal.
• Nausea and vomiting.
• Rapid heartbeat and weak pulse.
• Blood pressure is low or drops lower if the person tries to stand up.
• Patient’s legs may be swollen.
• Urine is darker than normal.

Nursing Care Plan Diagnosis

In most cases the diagnosis is obvious from the weather conditions and the person’s level of activity before feeling ill. People can take care of heat exhaustion themselves by moving into a cooler location; by drinking cool (not cold) water or sports drinks; and by lying down with the legs propped on a pillow or cushion to raise them above heart level. If the person does not feel better in about half an hour; if they start to lose consciousness; or if their temperature goes above 104°F (40°C), they should be taken to an emergency room as soon as possible.

Nursing Care Plan Treatment

The most important aspect of treating heat exhaustion is to keep it from getting worse. Untreated heat exhaustion can develop into heat stroke, which is a much more serious condition. In some cases a doctor may give the patient intravenous fluids if he or she appears to be severely dehydrated and is vomiting or otherwise unable to take fluids by mouth.

Prognosis
Most people recover from heat exhaustion within two to three hours with no long-term effects.

Nursing Care Plan Prevention

Preventing heat exhaustion is largely a matter of taking time to adjust to hot weather or visiting a hot climate and dressing sensibly for local weather conditions:
• Most people in temperate climates need time to acclimate, or adjust, to seasonal temperature changes. People should work up gradually to outdoor activities during the first few warm days of summer rather than overdoing. The same is true of visiting a country with a tropical or hot climate; it is best to keep one’s activity level moderate for a few days rather than crowding in too many activities. It can take people between seven and fourteen days to adjust to a hot climate; marathon runners generally take two weeks to acclimate to training in the heat.
• Wear loose-fitting and light-colored clothing; choose fabrics that absorb sweat, such as cotton; wear a hat outdoors.
• Drink some fluids before exercising or working outside in hot weather. The American College of Sports Medicine recommends drinking about 20 ounces (0.6 liter) of water or sports drink two to three hours prior to exercise, and 10 ounces (0.3 liter) of water or a sports drink ten to twenty minutes before exercise. It is important to not use thirst as a guide to fluid intake; a person can become dehydrated before feeling thirsty enough to want a drink.
• Use sunscreen generously, as sunburn reduces the body’s ability to get rid of excess heat.
• Avoid caffeinated beverages and alcohol; they cause the body to lose additional fluid through the urine.
• People who must take prescription medications for allergies, high blood pressure, heart conditions, or certain types of mental disorders should ask their doctor whether any of their medications affect their response to heat.
• Exercise during the early morning or late evening, when the temperature is cooler and the humidity lower. Workers in occupations that require them to work in hot environments are often encouraged to take rest breaks during periods of hot weather. Some companies also provide rest areas where workers can cool off.
• Consult a heat stress index like the one printed in the American Council on Exercise fact sheet listed below or the National Weather Service’s heat index to help decide whether it is safe to exercise outdoors. There are times when the heat and humidity are so high that exercise should be avoided. Heat exhaustion is likely to occur when the heat stress index (the apparent temperature) is over 105°F (40.5°C).
• People with elderly friends or relatives should check on them during summer heat waves to make sure that they are in good health. Heat waves that last longer than two days put the elderly at risk of heat exhaustion.

The Future
Heat exhaustion is a common hot-weather health problem or a consequence of exercising or working outdoors without proper conditioning or precautions. It is dangerous only if it progresses to heat stroke, however. Heat exhaustion can be prevented by dressing appropriately for hot weather, drinking enough fluids, consulting the local heat index before outdoor activity, and knowing when to slow down and cool off.

Nursing Care Plan | NCP Heat Cramps

Heat cramps are the mildest of the three forms of heat illness that can develop when the body is exposed to heat. They are defined as brief, involuntary painful muscle spasms in the legs or other parts of the body involved in work or exercise outdoors in hot weather.

Heat cramps are painful but brief muscle cramps that occur during exercise or work in a hot environment. The muscles may twitch or jerk involuntarily. The cramping sensations may also be delayed and occur a few hours after the work or exercise.

Heat cramps can affect people of all ages who are not used to hot weather, are not drinking enough fluid, sweat heavily, or have not been properly conditioned (improved their level of physical fitness). The cramps are most likely to affect the parts of the body involved in heavy work, such as the calves, thighs, shoulders, and upper arms.
Nursing Care Plan | NCP Heat Cramps
Nursing Care Plan Signs and Symptoms
Heat cramps result when a person sweats heavily during work or exercise in hotweather. Sweating is the body’sway of regulating its internal temperature to get rid of heat. As sweat evaporates, it cools the body. In addition to losing water through sweating, however, the body also loses electrolytes, which are minerals that are necessary for the body to function properly. When the levels of sodium and other electrolytes in the blood fall too low, the painful sensations of heat cramps occur. Conditioning (improved physical fitness) reduces the risk of heat cramps by increasing blood volume; causing people to sweat more quickly, which helps the body get rid of heat; and making the sweat more dilute, so that fewer electrolytes are lost from the body in the sweat.

Nursing Care Plan Diagnosis
Diagnosis of heat cramps is usually based on their characteristics: the cramps are painful; they are involuntary; they come and go; they are brief; and they usually go away on their own. There are no blood tests or other diagnostic studies that can detect heat cramps.

Nursing Care Plan Treatment
Heat cramps are not usually considered a serious health problem even though the muscle cramps may be temporarily painful. They can be treated at home by stopping exercise or work; resting for a few minutes; and drinking fluids mixed with salt to replace the fluids and electrolytes lost through perspiration. People can have either a sports drink like Gatorade or clear fruit juice, or mix their own salt solution by adding one-fourth to one-half teaspoon of table salt to a quart of water. Salt tablets should not be taken because they upset the stomach.

To ease the cramping sensations, a person can practice gentle stretching or range-of-motion exercises to relax the muscles, or gently massage the affected parts of the body.

A doctor should be consulted when:
• The muscle cramps last longer than an hour.
• The affected person cannot drink the needed fluids because of nausea and vomiting.
• The person has more serious symptoms of heat-related illness, including dizziness, headache, shortness of breath, extreme tiredness, and a temperature higher than 104°F (40°C). The doctor may administer intravenous fluids and check the affected person for signs of heat exhaustion or heat stroke.

Nursing Care Plan Prognosis
Heat cramps usually go away by themselves once the person has cooled off and replaced fluids lost through sweating.

Nursing Care Plan Prevention
Preventing heat cramps is largely a matter of taking time to adjust to hot weather or visiting a hot climate and dressing sensibly for local weather conditions:
• Most people in temperate climates need time to acclimate, or adjust to seasonal temperature changes. People should work up gradually to outdoor activities during the first few warm days of summer rather than overdoing it. The same is true of visiting a country with a tropical or hot climate. It is best to keep one’s activity level moderate for a few days rather than crowding in too many activities. It can take people between seven and fourteen days to adjust to a hot climate. Marathon runners generally take two weeks to acclimate to training in the heat.
• Wear loose-fitting and light-colored clothing; choose fabrics that absorb sweat, such as cotton; wear a hat outdoors.
• Drink some fluids before exercising or working outside in hot weather. The American College of Sports Medicine recommends drinking about 20 ounces (0.6 liter) of water or a sports drink two to three hours prior to exercise, and 10 ounces (0.3 liter) of water or a sports drink ten to twenty minutes before exercise. It is important to not use thirst as a guide to fluid intake; a person can become dehydrated before feeling thirsty enough to want a drink.
• Use sunscreen generously, as sunburn lowers the body’s ability to get rid of excess heat.
• Avoid caffeinated beverages and alcohol; they cause the body to lose additional fluid through the urine.
• Exercise during the early morning or late evening, when the temperature is cooler and the humidity lower.
• Consult a heat stress index like the one printed in the American Council on Exercise fact sheet listed below to help decide whether it is safe to exercise outdoors. There are times when the heat and humidity are so high that exercise should be avoided. Heat cramps are likely to occur when the heat stress index (the apparent temperature) is between 90–105°F (32–40.5°C).

The Future
Heat cramps are a common consequence of exercising or working outdoors without proper conditioning or precautions. They are not dangerous by themselves, however. They can be prevented by dressing appropriately for hot weather, drinking enough fluids, and consulting the local heat index before outdoor activity.

Nursing Care Plan | NCP Heart Failure

Heart failure is a condition in which the heart cannot pump enough blood to meet the body’s needs. A healthy heart can pump out 60 percent of the blood it receives in one beat; a failing heart pumps only 40 percent or less. Heart failure is not the same thing as a heart attack or cardiac arrest. Heart failure may develop either suddenly, in which case it is called acute heart failure, or slowly over a period of time, in which case it is called chronic heart failure.

Though most cases of heart failure involve both sides of the heart, it can be classified as left-sided or right-sided heart failure, depending on which side of the heart is affected. Left-sided heart failure is more common. In left-sided heart failure, the heart cannot pump enough oxygenated blood from the lungs to the rest of the body, leading to fluid buildup in the lungs. This buildup is called congestion, which is why heart failure is sometimes called congestive heart failure. The patient typically feels short of breath with left-sided heart failure. He or she may tire easily with even small amounts of exercise and have trouble breathing at night when lying flat.

In right-sided heart failure, the heart does not pump enough blood to the lungs to be oxygenated. As a result, fluid may collect in the patient’s feet, ankles, and abdomen, causing swelling in the feet and ankles. In some cases the liver also becomes enlarged, and the veins in the patient’s neck swell up.
Nursing Care Plan | NCP Heart Failure
Heart failure can occur in children or adolescents but is usually a disorder of adults. In most cases the symptoms develop slowly over a period of months and years and are often attributed to aging. As the heart muscle gradually weakens—often as the result of a disease like diabetes or longterm high blood pressure, damage caused by a heart attack, or a congenital abnormality of one of the heart valves—the heart works harder to meet the body’s needs for the oxygen and nutrients carried by the blood. As the heart becomes less efficient, the person often feels tired or lacking in energy. Heart failure is often not diagnosed until the person begins to develop fluid buildup in their feet or legs, lungs, abdomen, or liver. As the heart muscle is weakened, the heart tries to make up for its loss of strength in one or more of three ways. It may enlarge, which allows it to fill with more blood and so have more blood to pump to other parts of the body. Second, it may acquire more muscle mass, which allows it to pump blood more forcefully, at least for a time. Third, the heart may simply speed up and pump faster. In addition to the heart’s attempts to make up for its growing weakness, the body may also respond, either by narrowing its veins and arteries in order to maintain blood pressure, or by redirecting blood away from less vital parts of the body to the brain and heart, which are the most vital organs. These responses help to explain why some people can go on for years without being aware that their heart has lost some of its ability to function.

Heart failure is a common disorder in the general American population, particularly among older adults. According to the Centers for Disease Control and Prevention (CDC), about 5 million people in the United States were living with heart failure in 2008, with about 550,000 new cases diagnosed annually. More than 287,000 people die each year from heart failure in the United States. The disorder costs the country $30 billion each year in direct health care costs. Heart failure is more common among people over 65 than among younger adults. It is the most common reason for hospitalization for patients on Medicare. Among children, congenital (inborn) heart defects are the most common reason for heart failure.

Other risk factors for heart failure include:
• Sex. Men are more likely than women to develop heart failure; however, among adults over the age of 75, more women than men have the condition.
• Race. African Americans are more likely than members of other races to develop heart failure, to develop it at younger ages, to get worse faster, and to die from heart failure.
• Obesity. Excess weight puts a strain on the heart muscle.
• Diabetes. Diabetes increases a person’s risk of coronary artery disease and high blood pressure.
• History of coronary artery disease (narrowing of the arteries) or high blood pressure. Coronary artery disease lowers the supply of oxygen to the heart muscle.
• Virus infections that may have weakened the heart.
• Heart attack. A heart attack weakens the heart’s ability to pump blood. According to the CDC, 22 percent of men with heart attacks and 46 percent of women will develop heart failure within six years of the heart attack.
• Alcohol abuse. Too much alcohol can weaken the heart muscle.
• Sleep apnea. Sleep apnea lowers the supply of oxygen to the blood during the person’s sleep time and increases the risk of developing irregular heart rhythms as well as weakening the heart muscle.
• Kidney disease. Disorders of the kidneys increase the risk of heart failure because they lead to fluid retention and high blood pressure.

Nursing Care Plan Signs and Symptoms
The causes of heart failure include a number of factors that can weaken the heart’s ability to pump blood, ranging from congenital defects in the structure of the heart to infections, lifestyle choices, or other diseases and disorders in later life.

The most common symptoms of heart failure are:
• Shortness of breath. The person may have trouble sleeping unless propped up on pillows, or may wake up suddenly feeling short of breath.
• Persistent coughing or wheezing, or coughing up bloody mucus. This symptom is caused by fluid building up in the lungs.
• Swelling of the feet, ankles, or abdomen. The patient may gain several pounds of weight very suddenly or notice that their shoes feel tight.
• Tiredness and fatigue. The person may find that even minor tasks or chores, such as shopping or carrying a small bag of groceries, leave them unusually tired.
• Nausea and loss of appetite. Fluid building up in the abdomen affects the digestive tract, causing the person to feel full or sick.
• Memory loss and confusion.
• Rapid heartbeat. The patient may notice that the heart is beating faster and experience it as a racing or throbbing sensation.
• Need to urinate at night. In some people with swollen feet or ankles, the body is able to dispose of some of the fluid at night through the urine.

Nursing Care Plan Diagnosis
The diagnosis of heart failure is complicated because many of the symptoms of the disorder are not unique. The doctor will usually begin with the patient’s history and note such risk factors as a previous heart attack, diabetes, or high blood pressure. The doctor will then listen to the patient’s heart and lungs with a stethoscope to detect evidence of congestion in the lungs or abnormal heart sounds.

If the doctor suspects that the patient has heart failure, he or she will order one or more laboratory or imaging tests:
• Blood test. This may be done to rule out kidney disease as the cause of fluid retention or to test for the presence of a hormone that is found in the blood when the heart is overworked.
• Electrocardiogram (ECG). This test measures the electrical activity of the heart.
• Chest x ray. This imaging test can identify fluid in the lungs and enlargement of the heart.
• Echocardiogram. This is an important test that uses sound waves to produce an image of the heart on a video monitor. It can be used to measure the percentage of blood pumped out by the left ventricle—the heart’s main pumping chamber—with each beat.
• Stress tests. In these tests, the patient is either asked to exercise on a treadmill or is given a medication that stresses the heart to determine whether there are blockages in the heart’s arteries.
• Computed tomography (CT) or magnetic resonance imaging (MRI) scans of the heart.
• Cardiac catheterization. In this type of test, the doctor inserts a thin tube called a catheter into a blood vessel in the groin or arm and threads it through the aorta into the coronary arteries. Radioactive dye injected through the catheter makes the arteries and the left ventricle of the heart visible on an x ray.

Nursing Care Plan Treatment
Except for cases of heart failure caused by damaged heart valves (which can be corrected by surgery), heart failure cannot be cured but only controlled. Patients may be given one or more medications or surgical treatments to control their symptoms and prevent further damage to the heart.

Medications that may be prescribed to treat heart failure include:
• Diuretics. Sometimes called water pills, these are drugs that help the body get rid of excess fluid through the urine.
• ACE inhibitors. These are medications that lower blood pressure, improve blood flow, and decrease the workload on the heart.
• Digoxin. Also known as digitalis, this drug increases the strength of the heart’s contractions and slows down the heartbeat.
• Beta blockers. These medications slow heart rate, lower blood pressure, and reduce the risk of abnormal heart rhythms.
• Aldosterone antagonists. These drugs enable the body to get rid of salt and water through the urine, which lowers the volume of blood that the heart must pump.

Patients with acute heart failure may require treatment in a hospital. Hospital care usually includes oxygen therapy and medications (most commonly diuretics and drugs to relax the blood vessels) given intravenously. Severe heart failure that cannot be controlled by medications requires surgical treatment:
• Implantable cardioverter defibrillator (ICD). ICDs are devices that surgeons implant beneath the skin and attach to the heart with small wires. They monitor the heart rate and correct heart rhythms that are too fast.
• Cardiac resynchronization therapy (CRT). In this type of treatment, a pacemaker sends timed electrical impulses to both ventricles of the heart to coordinate their rhythm.
• Heart pump. A heart pump, sometimes called a left ventricular assist device or LVAD, is a device implanted in the abdomen and attached to a weakened heart to help it pump blood more efficiently. Originally used to keep candidates for heart transplants alive while they waited for a donor heart, LVADs are now thought of as alternatives to transplantation for some patients.
• Heart transplant.

Nursing Care Plan Prognosis
The prognosis of heart failure depends on the person’s age, sex, race, lifestyle, and other diseases they may have that affect the heart. Heart failure usually shortens a person’s life expectancy by several years. Between 5 and 20 percent of people hospitalized for acute heart failure die in the hospital.

Nursing Care Plan Prevention
Some causes of heart failure, such as congenital malformations, cannot be prevented. People can, however, lower their risk of heart failure in adult life by watching their weight, avoiding heavy drinking or the use of illegal drugs, getting regular exercise, and eating a diet focused on fruits, vegetables, whole grains, low-fat diary products, and lean meat. People being treated for diabetes, high blood pressure, or coronary artery disease can lower their risk of heart failure by taking all medications prescribed by their doctor, following their doctor’s recommendations about diet and exercise, and having regular checkups.

The Future
Heart failure is expected to continue to be a common disease of older adults in developed countries because of increasing life expectancy. Until the 1990s, doctors focused on controlling patients’ symptoms. More recently, however, doctors are recommending preventive health care and lifestyle changes in the early adult years, before people develop the symptoms of heart failure or other disorders that increase the risk of heart failure.

Tuesday, September 28, 2010

Severe lack of a proper break.....

So, today after clinical I came home and did absolutely nothing. In fact I just woke up from a nap and thoughts of all my pending homework have been hovering around me. Granted it's not the workload of a regular semester since I only have one class but after taking 5-6 classes a semester from Jan-Aug, I'm VERY ready for a BREAK! In 3 weeks I will be home free for 2.5 months and trust me, it cannot come fast enough. I've been pretty good about keeping up with my work and finishing assignments but I find that at the end of the year I have no motivation to do my homework or anything at all! I've been SO LAZY lately. Totally not like me at all. I don't know what has brought upon this sudden laziness but hopefully it doesn't become too bad. I would hate to become so lazy that I can't get through 3 more weeks of CPE....that would be SUCH a fail. On a happier note, I have decided to start making youtube videos. About what you ask? I don't know yet...product reviews, haul videos, possibly tutorials, maybe some vlogs and DEFINITELY rants...I quite enjoy ranting and have been told I rant in an entertaining fashion. AWESOME. I've been an avid youtube watcher so I feel like it's time for me to start uploading. Hopefully by the end of today my first video will be recorded and if all goes well, edited as well...maybe even uploaded! I will post a link here as soon as I get that going! In the meantime, I'm going to take a stab at my homework again. Let's hope I don't fall asleep! Ugh. BLAH!!!
  
The many textbooks which make my life SO much more enjoyable..ugh..can you hear the sarcasm???
                                                       

For Nurses: Conducting an Advanced Literature Search


The latest issue of AORN Journal includes a really great article for nurses on advanced literature searching in PubMed. The author details the advantages of using PubMed’s advanced search features such as Medical Subject Headings (MeSH), search fields, and limits. The article also includes techniques for building an effective search by combining terms with AND, OR, & NOT.

Effectively conducting an advanced literature search.
Brusco JM.
AORN J. 2010 Sep;92(3):264-71.

Access to this article is available online or by request to all St. Joseph Hospital and CHOC employees through the Burlew Library Website.

Improving literature search skills is a good strategy for all nurses, but the process can be daunting. Staff at the Burlew Medical Library are available to help – whether you need training or prefer we provide you with a professional mediated literature search. St. Joseph Hospital and CHOC employees can contact us through the Burlew Library Website for more information.

Dental Nurse Jobs Kuwait

The POEA recently approved a job order that offers employment opportunities abroad to those who will qualify for Dental Nurse Jobs Kuwait. These dental nurse jobs Kuwait was approved for recruitment by the POEA last September 14, 2010 for Nonstop Overseas Employment Corp., a POEA accredited recruitment agency based in Malate, Manila and 10 office branches nationwide. For the said dental nurse jobs Kuwait, 46 applicants will be selected for dental nurse jobs abroad.

To apply for the said dental nurse jobs Kuwait, proceed directly to any of the offices of the recruiting agency and forward your resume and application. Or, you can click HERE and fill up their Online Application. For further details or inquiries regarding the said dental nurse jobs Kuwait, you can dial the agency’s landline numbers provided below.


Nonstop Overseas Employment Corp.
1712 A. Mabini St. cor. C. Alonzo St.
Malate, Manila
Tel Nos: 4005077 / 4005079
Email Add: nonstopcenter3@gmail.com
Website: www.nonstopoverseas.com

PROVINCIAL OFFICES

Cabanatuan Branch
Ms. Jolly Dela Cruz - Officer in Charge
419 Leonor Village Aduas Sur, Cabanatuan City
Telefax # (044) 464 - 7381
Email : nonstop_cab@yahoo.com

Cebu Branch
Ms. Sophia Espiritu - Officer in Charge
Rm. 306 Don Osena Bldg. Osmena Blvd. Cebu City
Telefax # (032) 253-6833
Email : nonstop_cebu@yahoo.com

Cagayan Branch
Ms. Loida Adtoon - Officer in Charge
2/F Cabalyero Building Serina St. Carmen Cagayan De Oro City
Telefax # (088) 857 6227
Email : nonstop_cagayan@yahoo.com

Davao Branch
Mr. Eric Agdon - Acting Officer in Charge
78 G/F Palamos Bldg. Magallanes St. Davao City
Telefax # (082) 225 0749
Email : nonstop_davao@yahoo.com

General Santos Branch
Ms. Evelyn Calibara - Officer in Charge
2/F Almar Bldg. Magsaysay Ave. General Santos City
Telefax # (083) 5529649
Email : nonstop_gensan@yahoo.com

Legaspi Branch
Ms. Roshiela Tupas - Officer in Charge
4/F Tita Go Bldg. F. Imperial St. Legaspi City
Telefax # (052) 480-8323
Email : nonstop_shieladimple@yahoo.com

Tacurong Branch
Ms. Carmie De Umania - Officer in Charge
2/F Uni Bldg. Magsaysay Ave. Tacurong City
Telefax # (064) 200-5158
Email : nonstop_tacurong@yahoo.com

Iloilo Branch
Ms. Heide Navisaga - Officer in Charge
4/F TCT Bldg. Iznart St. Iloilo City
Telefax # (033) 337 2177
Email : nonstop_iloilo@yahoo.com

Pagadian Branch
Ms. Dailyn Calo - Officer in Charge
2/F Ballesteros Bldg. Alano St. Cor. Rizal Ave. Pagadian City
Telefax # (062) 214 4835
Email : nonstop_pagadian@yahoo.com

Zamboanga Branch
Ms. Sherwina Romaro - Officer in Charge
Yoe Bldg. 42 Jose Rd. Zamboanga City
Telefax # (062) 992 5053
Email : nonstop_zambo@yahoo.com

Filipino Nursing Jobs in Jordan

A POEA accredited recruitment agency located in Malate, Manila and branch offices in Dubai and Jordan is currentlly seeking to recruit Filipino nurses for its POEA approved Filipino Nursing Jobs in Jordan. The job order for the said Filipino nursing jobs in Jordan was approved last September 16 for Skills International Company Inc. Together with the said job order is a job order balance fo 50 nursing job applicants to be selected for placement in Filipino nursing jobs abroad.

If you are interested and wishes to apply for the said Filipino nursing jobs in Jordan, kindly submit your updated resume and application directly to the office of the recruiting agency. For additional details or inquiries, you can contact the recruiting agency’s landline numbers or email address indicated below.


Skills International Company Inc.
2F Discovery Plaza Center
1674 A. Mabini Street, Malate
Manila
Tel Nos: 5268823 / 5268828
Fax No: 5268827
Email Add: info@skills-intl.net
Website: www.skills-intl.net

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Ivy League Engineering Schools

Ranking Profile for Ivy League Schools of Engineering:

Cornell University College of Engineering
- U.S. News and World Report has placed Cornell first in engineering science and engineering physics in its 2005 ranking of engineering programs at universities in the United States.
- Ranked 17th globally in Engineering/Technology and Computer Sciences (Academic Ranking of World Universities 2010).

Nursing Care Plan | NCP Heart Attack

A heart attack, also called a myocardial infarction or MI, is a potentially fatal health crisis caused by a loss of blood supply to the heart muscle. If normal blood flow is not restored within a few minutes, the tissue begins to die from lack of oxygen. Treatment should be started as soon as possible to prevent permanent damage to the heart. Heart attacks are not the same thing as heart failure. Heart failure is a condition in which the heart cannot pump enough blood to meet the needs of the rest of the body. It usually develops slowly over a period of years and produces early symptoms like loss of energy or fluid buildup in the feet and ankles rather than sudden chest pain. A heart attack can, however, lead to heart failure.

The classic symptoms of a heart attack are pain in the chest, shortness of breath, nausea, and breaking out in a cold sweat. The patient may feel the pain as pressure or squeezing, a sensation of fullness or tightness, a heavy weight on the chest, or a mild or strong ache in the center of the chest. The pain may move from one part of the body to another, or extend from the chest to the jaw, arms, neck, or back. The person may also feel dizzy or lightheaded. The pain lasts for twenty minutes or longer, or it goes away briefly and then returns. Not everyone with an MI has these classic symptoms. Some people may have a tight feeling only in the arms or upper back, feel mild indigestion or clammy skin, or may have trouble breathing. Women, people with diabetes, and the elderly are more likely than men to have mild or vague symptoms that can be easily missed; these are sometimes called silent heart attacks. Silent heart attacks are particularly dangerous because they are easy to ignore.
Nursing Care Plan | NCP Heart Attack
Heart attacks primarily affect adults. About 1.5 million Americans have heart attacks each year, and about half of them die within a year. Coronary artery disease, the major cause of heart attacks, is the leading killer of both men and women in the United States. Heart attacks are increasing worldwide, including the developing countries. In the United States, heart attacks affect all races and ethnic groups equally.

Risk factors for heart attacks include:
• Lifestyle issues. People who smoke, consume large amounts of alcohol, or are physically inactive are at increased risk of heart attacks.
• Cocaine use. Cocaine causes blood vessels to tighten, thus potentially cutting off blood supply to the heart. Heart attacks in young adults are often caused by cocaine abuse.
• Family history of heart disease.
• Age. The risk of a heart attack increases after age sixty.
• Sex. Men are more likely to have heart attacks than women up to age seventy, when both sexes have an equal risk.
• High blood pressure and high blood cholesterol levels.
• Obesity.
• Diabetes.
• High levels of emotional stress.

Nursing Care Plan and Symptoms
Heart attacks are caused by the loss of blood supply to the heart muscle, a condition known as ischemia. In about 90 percent of cases, blockage of the arteries that carry blood to the heart results from atherosclerosis, hardening of the arteries due to the formation of plaques along the walls of the blood vessel. Plaques are composed of a fatty material made up of dead white cells and cholesterol. If a plaque in one of the arteries supplying the heart ruptures, it can cause a blood clot to form in the artery and block it, thus starving the heart of blood.

The remaining 10 percent of heart attacks are caused by sudden spasms in the coronary arteries that shut down the flow of blood to the heart muscle. These spasms may result from cocaine use, a sudden emotional shock, or an abnormality in the shape of the coronary artery.

The major symptoms of a heart attack are:
• Pain in the chest, which may be experienced as an ache, tightness, weight, or a squeezing sensation. The pain may move to the back, neck, arms, or jaw
• Nausea and vomiting
• Shortness of breath
• Breaking out in a heavy cold sweat
Other symptoms of a heart attack may include lightheadedness or dizziness, intense anxiety, coughing, or a feeling that the heart is racing.

Nursing Care Plan Diagnosis
Most people having a heart attack will be taken to a hospital emergency room, where they will be asked to describe their symptoms. These questions help the doctor to rule out panic disorder, which is a type of anxiety disorder that can cause people to think they are having a heart attack. In addition to taking the patient’s personal and family history of risk factors for a heart attack, the doctor will also take the patient’s temperature, blood pressure, and pulse. Listening to the patient’s lungs and heartbeat through a stethoscope can help to rule out pneumonia or other diseases that might cause chest pain or difficulty breathing.

The next step is diagnostic tests, which include:
• Electrocardiogram (ECG or EKG). An ECG or EKG measures the heart’s electrical activity. Injured heart muscle makes unusual patterns or tracings on the paper printout produced by the ECG machine. If only a small amount of the heart muscle has been affected, the ECG may not show any abnormal patterns.
• Blood tests. These are done to confirm the diagnosis of a heart attack or to make sure that the electrocardiogram did not miss a small heart attack. Injured heart muscle leaks small amounts of enzymes into the bloodstream, which can be detected in a blood test. The emergency room doctor may repeat this blood test after several hours because it takes time for these enzymes to show up in the patient’s blood.
• Chest x ray. A chest x ray may be done to see whether the patient’s lungs are normal.
• Coronary angiography. Coronary angiography is a type of x-ray study in which the doctor threads a long thin tube called a catheter into the heart through an artery in the arm or upper thigh. A dye that will show up on x ray is injected into the bloodstream through the catheter. This test allows the doctor to find the location of the blockage in the coronary artery.

Nursing Care Plan Treatment
Treatment of a heart attack begins before the diagnosis is confirmed. The emergency room doctor will give the patient oxygen to help with breathing, aspirin to prevent further blood clotting, nitroglycerin to speed up the blood flow through the coronary arteries, and morphine or another pain reliever to make the patient comfortable. The next step is the administration of clot-busting and bloodthinning drugs. These drugs can improve the patient’s chances of survival and reduce the long-term damage to the heart. The patient may also be given beta-blockers, a group of drugs that slow down the heart rate and lower blood pressure; statins, drugs that lower blood cholesterol levels; or medicines to treat abnormal heart rhythms, which often develop after a heart attack.

In some cases the patient may need surgery. The two operations that are most commonly performed are coronary artery bypass surgery and coronary angioplasty. In bypass surgery, the surgeon takes a piece of a healthy artery from another part of the patient’s body and sews it in place to go around a blocked coronary artery. This procedure will restore normal blood flow to the heart. In a coronary angioplasty, the surgeon inserts a catheter with a special balloon tip into the coronary artery. When the catheter is in the proper position, the balloon is expanded, which reopens the blocked artery. The surgeon will then insert a stent, which is a tube made of metal mesh, to keep the artery open. Patients who survive their heart attack usually undergo rehabilitation after they leave the hospital. Rehabilitation includes lifestyle changes and psychological counseling as well as medications to keep the heart healthy.

Nursing Care Plan Prognosis
The prognosis for recovery from a heart attack depends on how quickly the patient is diagnosed and treated as well as his or her age and overall health. About 30 percent of people do not survive their first heart attack; another 5–10 percent die within a year after the event. About half of patients diagnosed with a heart attack will need to be rehospitalized within a year. A person who lives through the first two hours after the attack is likely to survive but may have complications like heart failure or blood clots in the lungs. Patients who do not have complications may recover completely.

Nursing Care Plan Prevention
People who have already had a heart attack can lower their risk of a second by taking a daily aspirin, other blood-thinning medications, cholesterol-lowering medications, beta-blockers, or other drugs that the doctor may prescribe to lower the strain on their heart muscle.

People who have not yet had a heart attack can lower their risk by:
• Quitting smoking or not starting in the first place.
• Getting regular medical checkups. This precaution is important because risk factors for heart attacks like high blood pressure, high cholesterol levels, and diabetes have no symptoms in their early stages.
• Avoiding using cocaine and drinking large quantities of alcohol.
• Keeping one’s weight at a healthy level and getting regular exercise.
• Controlling blood pressure.
• Learning how to manage emotional stress.
• Eating a low-fat diet rich in fruits and vegetables.

The Future
People are much more likely to survive heart attacks than they were in the 1960s because of the introduction of clot-busting drugs and improvements in heart surgery. New drugs to treat heart attacks are currently being studied as well as the effectiveness of using bone marrow or stem cells to help repair injured heart tissue.

Nursing Care Plan | NCP Hearing Loss

Hearing loss is a disorder in which a person begins to lose the ability to hear in one or both ears. It may come on suddenly or develop slowly over a period of years; it may be temporary or permanent, and vary in severity from mild hearing loss to total deafness. There are many possible causes of hearing loss ranging from birth defects and ear infections (common causes in children) to exposure to high levels of noise in the workplace and the aging process (common causes in adults). There are two major categories of hearing loss, defined by whether the loss results from problems in the structures of the outer or middle ear or whether it results from damage to the hair cells of the inner ear. The first type is called conductive hearing loss (CHL) and the second type is called sensorineural hearing loss (SNHL). CHL is often reversible while SNHL is not. People who have both CHL and SNHL are said to have mixed hearing loss.

Conductive hearing loss occurs when sound waves cannot move through the structures of the outer and middle ear. Ordinarily, sound waves are funneled into the ear by the pinna, the visible part of the outer ear. The sound waves then pass through the ear canal, where they cause the eardrum and three tiny bones called ossicles to vibrate. The vibrations of the ossicles cause the liquid inside a snail-shaped structure called the cochlea to move. The movement of the liquid in turn causes hair cells inside the cochlea to respond. The hair cells convert movement into electrical signals that are then relayed to the brain via the auditory nerve.

Conductive hearing loss can occur when the ear canal is blocked by wax or a foreign object, the ear drum is punctured, the ossicles are dislocated, or the ear canal is swollen shut due to infection. Sensorineural hearing loss is caused by damage to the hair cells in the cochlea or to the nerves that conduct hearing signals to the brain.
This damage can be caused by infections (measles, mumps, rubella, influenza, or mononucleosis); by trauma; by diabetes and other disorders that affect the circulatory system; by cancer drugs and some other medications; or by a tumor affecting the auditory nerve. SNHL is sometimes associated with such problems as tinnitus (ringing in the ears) or dizziness.

Hearing loss is a common problem in the general American population, particularly in older adults. According to the Centers for Disease Control and Prevention (CDC), most people over the age of twenty begin to develop a mild hearing loss. A third of adults over the age of seventy have trouble hearing. Hearing loss is more common in older men than in older women. About 24,000 children (three in every 1,000) are born with hearing loss in the United States each year. Causes include genetic disorders, infections before birth (particularly rubella), absence of ossicles or other abnormalities in the shape or inner structures of the ear, or low birth weight. Hearing loss is equally common in all racial and ethnic groups, as far as is known.

Nursing Care Plan Signs and Symptoms
The most common causes of conductive hearing loss are infections, trauma to the outer or middle ear, a buildup of earwax in the ear canal, foreign bodies in the ear, or dislocation of the ossicles caused by a blow to the ear. The causes of sensorineural hearing loss include noise-induced hearing loss (NIHL), which causes trauma to the acoustic nerve; changes in atmospheric pressure inside the ear during deep-sea diving; fracture of the bone at the side and base of the skull; drugs that damage the nerves involved in hearing (cancer drugs, some antibiotics, diuretics, and aspirin or ibuprofen); diabetes; tumors on the auditory nerve; infectious diseases (mumps, measles, syphilis, meningitis, mononucleosis, and herpes); and aging.

The symptoms of hearing loss depend partly on the person’s age. A baby who has not yet learned to talk or a child with hearing problems may have the following symptoms:
• Not responding to cooing or conversation from the parents or other family members
• Does not react to sudden loud noises
• Has trouble with certain word sounds
• Does not repeat words or phrases used by others
• Uses gestures to communicate with others
• Seems to watch people’s faces for clues to understanding what they are saying
• Has trouble paying attention in school
• Turns up the radio or television louder than other members of the family

In adults, the symptoms of hearing loss may include:
• Problems hearing over the telephone
• Having trouble following conversations, particularly if two or more people are talking
• Having to ask others to repeat what they have just said
• Having difficulty hearing higher-pitched sounds, such as the voices of women and children
• Failing to hear the doorbell or telephone ring
• Having difficulty telling the direction of a sound

Nursing Care Plan Diagnosis
Diagnosing hearing problems in babies or toddlers is critical because the period from birth to three years of age is when children learn to use language. Hearing difficulties during this period can affect a child’s ability to speak normally. To test hearing in infants and small children, an audiologist (hearing professional) can perform a variety of tests. In adults, the doctor will examine the ear canal for signs of infection, a foreign object, or damage to the ear drum. A primary care doctor can test each ear separately with a tuning fork to check for conductive hearing loss, but the patient may be referred to an audiologist for more detailed
measurement of the type and extent of hearing loss.

Nursing Care Plan Treatment
Treatment for hearing loss depends on the cause. Infections of the outer and middle ear can be treated with medicated ear drops or oral antibiotics. Earwax and foreign bodies in the ear are removed by suction, forceps, or flushing the ear canal with water. If the earwax has hardened, the doctor may use special drops to soften it and have the patient return a few days later to have it removed. Hearing loss caused by medications is treated by discontinuing the medication. A tumor of the auditory nerve will usually be removed by a neurosurgeon or an otolaryngologist (a doctor who specializes in ear, nose, and throat disorders). Patients with sensorineural hearing loss are also usually referred to ear, nose, and throat specialists for evaluation and treatment. Patients whose hearing loss is caused by exposure to high levels of noise in their workplace will be advised to wear earplugs or other protective equipment. Well-fitted ear plugs can reduce noise level by about 25 dB. In extreme cases, the patient may be advised to switch jobs.

Conductive hearing loss can be treated by hearing aids, which are electronic devices that fit in or behind the ear and amplify sounds. A recent variation on traditional hearing aids is the bone-implanted hearing aid or BAHA. A BAHA is implanted in the patient’s skull by a neurosurgeon. It consists of a titanium post that allows a sound processor to be attached outside the skull. The processor transmits sound waves to the titanium implant, which transfers the sound vibrations to the skull and inner ear. BAHAs are recommended for patients who cannot wear hearing aids inside the ear or for those with one-sided hearing loss.

Another newer treatment for severe sensorineural hearing loss is the cochlear implant. A cochlear implant is an electronic device that is inserted in the inner ear by a surgeon and connected to a device worn outside the ear. Unlike a traditional hearing aid, a cochlear implant does not make sounds louder or clearer. Instead it works by stimulating the auditory nerve directly and bypassing damaged hair cells in the cochlea. Cochlear implants can be used only in adults or children over the age of twelve.

Nursing Care Plan Prognosis
The prognosis of hearing loss depends on the cause and type. CHL is often reversible; typically, patients who suffer conductive hearing loss as a result of a plug of earwax or a foreign body in the ear, an infection of the outer or middle ear, or a ruptured eardrum will find that their hearing returns to normal after treatment. Hearing loss caused by a medication may or may not improve after the drug is stopped. There is no proven treatment that can restore hearing other than discontinuing the drug. Hearing loss caused by meningitis, tumors of the auditory nerve, and aging is usually permanent.

Nursing Care Plan Prevention
Hereditary hearing loss cannot be prevented, but there are ways that other people can lower their risk of hearing loss as they get older:
• Avoid using several noisy machines at the same time.
• Learn to enjoy music, television, or radio programs at a moderate sound level.
• Avoid going to loud rock concerts on a frequent basis. Listening to rock music is a common cause of sensorineural hearing loss in teenagers and young adults.
• Wear earplugs when operating noisy equipment or when exposed to loud background noise for long periods of time. Earplugs can mean the difference between a safe and a dangerous level of noise.
• If work or commuting involves exposure to high noise levels, choose quiet activities for recreation or leisure time.
• See a doctor if hearing is lost suddenly or if there is pain, dizziness, or ringing in the ears.

The Future
Hearing loss is a growing concern to public health doctors because there is evidence that it is a growing problem in the United States, particularly among younger adults. One study completed in 2008 estimated that as many as 29 million Americans have at least partial hearing loss.

Nursing Care Plan | NCP Headache

A headache is a disorder in which a person feels pain or discomfort somewhere in the face, neck, or scalp. The brain and the skull are not the sources of headache pain because they do not contain pain-sensitive nerve endings. The sources of headache pain are nerve endings in the scalp, face, throat, the muscles of the head, and blood vessels at the base of the brain. When any of these nerve endings are triggered by stress, tension in the muscles, inflammation, or dilation of the blood vessels in the head, the person may experience pain.

Doctors have described over 130 different types of headaches. They can be classified into primary and secondary headaches. Primary headaches are those in which the headache is not caused by an injury, infection, or other disorder, but rather by some type of disturbance in the brain’s relationship to the body. They include migraine headaches, tension headaches, cluster headaches, and so-called ordinary headaches. Secondary headaches are caused by an injury or some other illness. There are at least 300 known causes of secondary headaches. The major types of secondary headaches are post-traumatic headaches, sinus headaches, reactive headaches, and rebound headaches. It is possible for a person to suffer from more than one type of headache.
Nursing Care Plan | NCP Headache
Headache pain can vary in location, severity, duration, and quality (dull, piercing, throbbing, etc.) depending on the cause or type of the headache. The main characteristics of the major types of headaches are described below.
Primary headaches:
• Migraine headaches: Migraine headaches are caused by disturbances in the central nervous system leading to swelling of the blood vessels in the brain and severe pain. The pain affects only one side of the head in 60 percent of cases, and is often accompanied by nausea, vomiting, and extreme sensitivity to light. There are two basic types of migraine: migraine with aura (visual disturbances preceding the pain of the headache) and migraine without aura. The person may be sick for one to two full days.
• Tension headaches: These are characterized by a sensation of tightness or pressure in the head and are often accompanied by muscle tension in the neck. Tension headaches may occur on a daily basis or only at random. They usually last for several hours.
• Cluster headaches: Cluster headaches are sharp and extremely painful headaches that tend to occur several times per day for months and then go away for long periods of time. They are the rarest type of primary headache.
• Ordinary headaches: Some doctors think that ordinary headaches are actually a mild form of migraine. These headaches usually occur at random, are not associated with a head injury or other illness, and usually go away with rest and mild pain relievers.

Secondary headaches:
• Post-traumatic headaches: Post-traumatic headaches occur in as many as 88 percent of people with a closed head injury and 60 percent of people with a whiplash injury. This type of headache is accompanied by pain in the neck and shoulders, dizziness, mood or personality changes, and sleep disturbances.
• Sinus headaches: These are associated with post-nasal drip, sore throat, and a discharge from the nose. The pain of a sinus headache is usually experienced in the front of the face and head, and is usually worse in the morning than later in the day.
• Reactive headaches: Reactive headaches are triggered by an irritant
in the environment or another illness. There are hundreds of possible triggers, ranging from the weather, pollen, dust, and other allergens, to colds, flu, eyestrain, and stomach upsets.
• Rebound headaches: Rebound headaches are a reaction to overuse of over-the-counter medications for pain relief, decongestants, or muscle relaxants. They can also be caused by withdrawal from caffeine or alcohol.

Headaches are a very common problem in the general population. Almost everyone gets an occasional headache, particularly when they are short on sleep, emotionally stressed, have skipped a meal, or are suffering from flu or a cold. Children can get headaches as well as adults; by age six, 31 percent of children have had at least one headache; by the time a child is fifteen, the number has risen to 70 percent. Between 60 and 80 million Americans suffer from frequent headaches but only 30 percent of these people consult a doctor for treatment.

According to the National Institutes of Health (NIH), children in the United States miss 1 million days of school each year because of headaches while adults miss 160 million days of work. Headaches cost the economy an estimated $30 billion each year in medical expenses. Headaches affect people of all races equally; however, the gender ratio varies depending on the type of headache. Women are three times as likely as men to suffer from migraine headaches, but men are ten times as likely as women to get cluster headaches.

Nursing Care Plan Signs and Symptoms
The basic causes of headaches include disturbances in the central nervous system leading to irritation of the blood vessels in the head; tension in the muscles of the head and neck; infections; allergens and other environmental triggers; overuse of or withdrawal from drugs; lack of sleep; clenching or grinding the teeth; menstruation; depression or anxiety; certain foods; and head injuries.

Less common but dangerous causes of headaches include:
• Brain tumors
• Stroke
• An infection of the brain (encephalitis or meningitis)
• Bursting of a blood vessel in the brain

In addition to the pain of a headache, people may experience nausea, vomiting, diarrhea and other digestive symptoms; dizziness, loss of balance, and visual disturbances; mood and personality changes; extreme tiredness; muscle cramps in the neck and shoulders; inability to concentrate; and extreme sensitivity to light or noise.

Nursing Care Plan Diagnosis
Diagnosing headaches can be complicated because there are so many potential causes and because some people have more than one type of headache. In addition to examining the patient’s head, neck, mouth, and throat in the office, most doctors will ask the patient to keep a headache diary, noting the time when a headache occurs, how long it lasts, other symptoms that accompany the headache, the quality and location of the pain, possible triggers, and other illnesses that the patient had at the time. In some cases the doctor will order a computed tomography (CT) scan or a magnetic resonance imaging (MRI) of the patient’s head. If encephalitis or meningitis are suspected, the doctor may order a spinal tap.

Nursing Care Plan Treatment
Treatment depends on the type of headache. Secondary headaches are treated by removing or avoiding the underlying cause, whether a head or whiplash injury, environmental trigger, food allergy, overuse of alcohol or medications, sinus infection, eyestrain, or other problem.

Primary headaches are usually treated by appropriate medications:
• Migraine headaches can be treated either by medications taken before an attack to stop it or reduce its severity, or by medications taken to relieve the headache after it begins. Preventive medications include a group of drugs called triptans; certain antidepressants; and antiepileptic drugs. After the headache starts, the patient may be treated with over-the-counter pain relievers like acetaminophen, naproxen, or ibuprofen, or prescription medications like ergotamine. Most patients with migraine are helped by resting in a quiet darkened room.
• Tension headaches: Usually respond well to over-the-counter pain relievers or to prescription pain relievers containing codeine. Hot showers and rest are also recommended for self-care at home. Some patients are also helped by biofeedback, relaxation training, yoga, or massage therapy. In some cases the doctor may recommend psychotherapy if the patient’s headaches are related to emotional stress.
• Cluster headaches: The triptans are effective in treating cluster headaches in many patients, as is oxygen inhalation. Because cluster headaches often come on very quickly, the triptans are usually given by injection rather than by mouth.
• Ordinary headaches: Usually treated in the same way as tension headaches.

Nursing Care Plan Prognosis
The prognosis for a headache depends on whether it is primary or secondary and its underlying cause or causes. Most ordinary headaches can be treated at home with few long-term side effects or complications. Cluster headaches, recurrent tension headaches, and migraines require long-term follow-up with a doctor. Cluster headaches are more difficult to treat successfully than either migraines or recurrent tension headaches.

Prevention
People can lower their risk of headaches in several ways:
• Getting enough rest, eating a healthful diet without skipping meals, and exercising regularly.
• Taking occasional work or study breaks, particularly if working at a computer or reading for long periods of time.
• Having the eyes checked regularly, particularly if the person wears prescription eyeglasses or contacts.
• Avoiding overuse of over-the-counter pain relievers, decongestants, caffeine, or alcohol.
• Quitting smoking.
• Practicing relaxation techniques, yoga, meditation, or other approaches to stress management.
• Avoiding allergens, foods, or other factors known to trigger headaches whenever possible.

The Future
Headaches are likely to be an ongoing health problem in the general population, if only because they have so many possible causes and environmental triggers. Research into the causes of migraine headaches has yielded new insights since the late 1990s. Clinical trials include research into the causes of cluster headaches, which are still not well understood; evaluations of newer triptan drugs in treating migraine and cluster headaches; studies of the factors that affect the prognosis for recovery from headaches; studies comparing different types of treatment for rebound headaches; and studies of yoga, acupuncture, massage therapy, and other alternative treatments.