Thursday, March 31, 2011

Loud Urogenital Symptoms

Here's another entry from a nurse who emailed us at ernurseyblog @ gmail and won gift certificate for a free set of scrubs.

20 year old male and his female companion come to the er. They are c/o of urogenital symptoms. (Translation: had unprotected, dirty sex and are now paying the price)

They get their workup and appropriate antibiotics are prescribed. However, they will not leave without pain medication!

It is explained to them multiple times by multiple staff that they are not getting their requested lortabs for an STD. Take tylenol, motrin, antibiotic as directed. (A bar of soap was also provided :>) Increase your fluids, bath, use a condom and you'll be fine.

Male is getting agitated (did I mention his UDS was positive also?) and is now standing in the middle of the ER corridor screaming "You don't understand...I have a really small pee hole and it hurts to urinate!"

The elderly gentleman in the next room started cracking did staff! We replied (as we called security)
the size of your penis is a personal problem that cannot be resolved in the ER, please leave now!

Nursing Care Plan for Measles

Measles Campak Morbili Rubella


Measles is a highly contagious viral disease, which affects mostly children. It is transmitted via droplets from the nose, mouth or throat of infected persons. Initial symptoms, which usually appear 8–12 days after infection, include high fever, runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards.

There is no specific treatment for measles and most people recover within 2–3 weeks. However, particularly in malnourished children and people with reduced immunity, measles can cause serious complications, including blindness, encephalitis, severe diarrhoea, ear infection and pneumonia. Measles can be prevented by immunization.
Source :

Nursing Care Plan for Measles

Physical Examination

Physical examination is to measure vital signs and other measurements and examination of all parts of the body using the techniques of inspection, palpation, percussion, and auscultation. (Potter, 2005: 159)

Physical Assessment of Measles :
  1. Typically in 3 days with malaise and high fever.
  2. Cough, runny nose, and conjunctivitis occurs in 24 hours. These symptoms gradually increased, reaching a peak with the appearance of rash on day four.
  3. About two days before the rash, spots appear on the mucous membranes in the mouth. Spots increased in number at 3 days and spread to all mucous membranes. It emerged at the end of the second day after the rash.
  4. Rash appears first on the hair area and then spread from head to foot about 3 days. During this phase, high fever, lymphadenopathy, and pharyngitis, occurred in a typical. Left rash began to decrease more than 5 to 6 days. Fever persists for 3 days in the time of rash that is usually because of complications.

Nursing Diagnosis for Measles and Nursing Interventions for Measles
  1. High risk of infection related to the host and infectious agents.

    Expected results :
    • Children who are vulnerable do not have the disease.
    • Infection does not spread
    • Children do not show evidence of complications such as infection and dehydration.

    Nursing Intervention :
    • Identify high-risk children
      Rational: to ensure children avoid exposure
    • Make a referral to a community health nurse if necessary.
      Rational: to ensure proper procedures at home.
    • Monitor temperature
      Rational: increased body temperature is not expected to indicate an infection.
    • Maintain good body hygiene.
      Rational: to reduce the risk of secondary infection from the lesions.
    • Give a little water absorption, but often a child or a favorite drink and fine food.

  2. Pain related to skin lesions, malaise

    Expected results :
    • The skin and mucous membranes clean and free from irritation.
    • Children show evidence of a minimum of discomfort.

    Nursing Intervention :
    • Use a cool mist vaporiser, mouthwash, and tablets suck.
      Rational: to keep mucous membranes moist.
    • Clean the eye with physiological saline solution
      Rational: to remove secretions or leprosy
    • Keep your child cool.
      Rational: because the air is too hot can increase itching.
    • Give a cold water bath and give a lotion such as calamine
      Rational: to reduce itching.
    • Give analgesic, antipyretic, and antipruritus according to the needs and requirements.
      Rational: to reduce pain, lower body temperature, and reduce the itching.

Nursing Specialties Expand as Health Care is Reformed

By: The American Institute of Health Care Professionals, Inc.
By: The American Institute of Health Care Professionals, Inc. June 2010. With the recent passage of health care reform, professional nurses are fast seeking transformation of their own practices. Health care reform will provide the platform for new models of care delivery as well as new nursing roles, such as highly trained case managers, legal consultants and health care promotion and disease prevention specialists.

Health Care reform will demand a more central focus on patient care through the continuum of care. Nurses will play the most pivotal roles in case managing patients not just through one episode of care, but through long-term issues of care and rehabilitation. There will be more emphasis on disease management which will also focus heavily on high quality patient education and program development for health promotion and wellness strategies. The American Academy of Case Management, a professional division of the American Institute of Health Care Professionals, Inc., provides nurses a real opportunity to study and acquire advance knowledge and skills in this practice specialty. The organization offers a case management fellowship upon completion of its rigorous program.

Another major area of practice specialty that will see growth and demand for nurses is that of legal consulting. Nurses are now acquiring advanced knowledge and skills in health care law, malpractice law and defensive practice strategies. The American College of Legal Nurse Consulting, another professional division of the American Institute of Health Care Professionals, Inc., provides a full, distance education program for registered nurses seeking entry in this practice specialty. Nurses complete an entire, extensive education and training program and are prepared to practice as consultants related to health care malpractice issues, risk management, life care planning and defensive practice. These nurses market themselves to attorneys, risk management and insurance companies, health care organizations, and other related agencies. Most legal nurse consultants develop their own practices. Others obtain positions with law firms, insurance companies, and health care organizations.

Understanding the face of changing health care delivery, the AIHCP, Inc. also offers various other programs that are open to nurses seeking education and certification in a practice specialty. These include; Grief Counseling, Meditation Instruction, Stress Management, Crisis Intervention Consulting, Spiritual Counseling, Child and Adolescent Grief and Holistic/Integrative health care and nursing practice. Other programs include Pastoral Thanatology, Clinical Hypnotherapy and Health Life Coaching.

All of the programs provide a full curriculum of continuing education courses that are provided in online classroom, and provide for one-to-one mentoring by highly qualified faculty. Nurses entering these programs have a two-year time period in which to complete all of the courses in a defined curriculum. Once all of the education standards are successfully met, the nurse then applies for and receives professional certification by the AIHCP, Inc. Each specialty certification is overseen by professional advisory board members who are highly qualified with ample experiences in the practice specialty. Most all of the advisory board members are also certified in their practice specialty. There are also full programs of “re-certification” for certified professionals. Re-Certification is achieved over time by the certified member meeting additional, ongoing continuing education in the specialty practice, as well as achieving a set standard of actual practice in their certified specialty.

Health care reform promises to bring major changes, challenges and transformations to the delivery of care in this country. Professional nurses will be at the forefront of these transformations by having prepared themselves for advance roles in various specialty practices. These advanced roles will allow nurses to maintain a significant and crucial position on the health care team, as care delivery is focused on higher quality, better patient outcomes and cost effectiveness. The AIHCP, Inc., remains dedicated to researching knowledge and skill needs for health care professionals, and developing high quality programs of continuing education and certification, to meet the markets needs, both professionally and from a patient-centered care perspective.

The American Institute of Health Care Professionals, Inc. 2400 Niles-Cortland Rd. SE Suite

Article Source: Article Directory -

Alzheimer's Treatment For More Happy, Normal, And Vibrant Years

There are Alzheimer's treatments that can help you turn your life around and give you many more years of healthy, normal, and vibrant life.

Alzheimer's disease (AD) is a frightening and debilitating disease with no known medical cure at this stage, but that doesn't mean there is nothing you can do. There are a whole range of steps you can take right now to give yourself the best chance of all your years being quality years. You will need to put in some effort to get the best results, and while there are no guarantees in this life, many other people have already made major differences, even some like Louis Blank who are now symptom free!

So let's get started. Just make sure that you discuss any Alzheimer's treatment, even natural ones, with your doctor.

Early Diagnosis For a Better Chance

You need an early diagnosis. The earlier Alzheimer's treatment is started the more effective both medical and natural treatments are. No-one wants to be told they have Alzheimer's, but it's far better to know now and fight now than procrastinate and give this terrible disease a chance to beat you.

Medical Treatments For Alzheimer's

There is no medical cure for Alzheimer's but there are drugs approved by the FDA that can slow the rate of cognitive and functional decline.

There are four drugs that work by raising the levels of acetylcholine in the brain. Acetylcholine is a neurotransmitter, or in other words a chemical that carries messages from one neuron to another in the brain. Alzheimer's sufferers have lower levels of acetylcholine than normal.

The drugs are Cognex (no longer prescribed) Aricept, Exelon, and Reminyl, and they are only effective for sufferers with mild to moderate AD. Side effects include nausea, vomiting and diarrhea.

Memantine is the first of a new class of drugs for Alzheimer's treatment, and it's approved for moderate to severe sufferers. It protects the brains neurons against the toxic effects of high levels of glutamate which is released by cells damaged by Alzheimer's disease.


Supplements can help us mentally and physically.

One of the best nutritional supplements for AD is vitamin E, used with vitamin C. Studies have shown that they can slow the progression from moderate to severe Alzheimer's by an average of eight months. It's thought that vitamin E and C work because they are antioxidants and help reduce oxidative stress and injury in the central nervous system.

The B vitamins are important for a healthy brain, and it's thought that folic acid, B12 and riboflavin together are especially beneficial.

Ginkgo Biloba is another supplement that can be used as an Alzheimer's treatment. It's been used for thousands of years in Chinese medicine, and for decades in Europe. It improves memory and improves cognitive function in dementia patients. A review of studies of ginkgo biloba has shown that it gave improvements with attention and short-term memory similar to patients using the drug donepezil (Aricept).


Diet as an Alzheimer's treatment? It's no secret that diet has a major affect on physical health, so it should be no surprise that it affects mental health as well.

Researchers have found that people with healthy diets are less likely to get dementia. Plenty of fruits, vegetable, grains, and dairy products keeps your brain in top condition, and at the same time it decreases your risk of heart attacks. That's not a bad bonus!


Exercise helps with memory and problem solving skills, and it improves mood, which is great because there's a strong correlation between AD and depression. And for prevention, doing resistive and endurance exercise for 30 minutes or more a day at least three times a week can reduce your chances of getting AD by up to 50 percent.

Mental Exercise

Stimulate those neurons! Mental exercise is powerful as a preventative, and powerful as an Alzheimer's treatment. It can actually increase the number of neurons in the brain. And it is never too late to start.

Mental exercise for Alzheimer's can be as simple as reading, learning poetry (some poetry is very good indeed), and playing cards. Even jigsaw puzzles and origami help. You could also do a course in something that interests you, or if you're still working do some professional continuing education.

Other Alzheimer's Treatments.

Here are a few more ideas that have been proven to help.

Get enough sleep, lower your stress levels, socialize, and be more active. Volunteer, or keep working. More active people suffer less from AD.

Just Do It!

You may be thinking, "What if I try and I fail? What if I do my best and still get Alzheimer's?"

I have a different question for you. What if you succeed? What if you keep Alzheimer's at bay for the rest of your life? What a difference that would make to you, your family and your friends.

Don't give up!

By: Warren Newson

A Buddie Good Idea

THE city of Green Bay, Wisconsin and the town of Paisley, Renfrewshire each has a population of approximately 100,000. Each is home to a professional sports team - the American Football Green Bay Packers and the real football St Mirren.

That apart, besides the fact each was once managed by the arguably ultimate manager in their particular sport: Vince Lombardi of the Packers and Alex Ferguson of St Mirren - there's not much the two places have in common and the disparity is particularly obvious when you compare the two sports clubs. The Packers are one of the major teams in the multi-billion dollar NFL, Saints are apparently permanently rooted in the basement of the far from loaded SPL.

But, if on-going discussions come to fruition, the Packers and the Buddies might soon have another thing in common, both will be owned by their local communities. I don't know how it works, but unlike all the other NFL franchises, Green Bay is a community club, owned by the city and citizens of Green Bay. Now St Mirren is apparently about to become the property of a Community Trust of Paisley citizens, who are well down the road to purchasing the controlling interest in the club, put up for sale by the existing board.

This is a leap into the unknown for Scottish football, but, if it works it might be the blueprint for a successful and continuing future for Scottish football.

Of course most of the current buy-out interest is being generated just a few miles from Paisley, with Craig Whyte apparently moving closer to buying Rangers. However, if he succeeds, Rangers will simply change from being one rich businessman's plaything to being another's. Saints' sale will take us into comparatively uncharted waters.

Of course there are other community clubs in Scotland, over 150 of them if you look at the clubs in membership of the SJFA. Auchinleck Talbot, Linlithgow Rose, Bo'ness United, Tayport, Banks o' Dee, Pollok and the rest are almost all owned by their fans. Certainly there are cases of one or two well-to-do local businessmen if not owning the club outright, under-writing their continued existence, but, to all intents and purposes, these are community clubs.

I would like to think Saints could come up with a new template for how to run a Scottish club and that they succeed and their template is picked up elsewhere. For I believe community clubs are the long-term answer to the Old Firm hegemony which has lasted this past century and more.

If a community club is run properly there is the potential for every kid within the club 's catchment area to be ddirected towards that club - to want to pull on the first team strip. But only if the club really fuses with that community.

They ought to have community development officers, and first team players getting out into their community, organising the leagues, ensuring the local cup finals are played on the big pitch in New St Mirren Park. They should be getting into the schools, coaching, selling St Mirren and again, making certain all the schools cup finals are played at Greenhill Road; putting the Paisley Schools representative team into black and white stripes and so forth.

I do not think for a moment all the Old Firm fans in Paisley, of which there are many, will immediately burn their hoops and sashes and start learning to sing: "When the Saints Go Marching In", but, given time the outflow of Old Firm fans to the Glasgow Giants can be staunched.

It will take time, money and massive effort, but I wish the Community Trust well in their efforts to revive St Mirren and weave a Paisley pattern which can be picked up and exported.

Top Biomedical Science Schools

Following are the top leading schools for biomedical sciences:

University of Texas Graduate School of Biomedical Sciences (GSBS)
- The doctoral programs in The University of Texas Graduate School of Biomedical Sciences (GSBS) at Houston is ranked among the best in the nation by the National Research Council (2010). The Interdisciplinary Biomedical Sciences Program was ranked highly (range of 7

Wednesday, March 30, 2011

Cash Gifting Programs

Cash Gifting Programs is a wonderful way to help others and encourage progress in your own life. Giving gifts has become a concept embraced by humanity since the first. Religious orders throughout the world all surround the concept of providing sincere. Giving is good. Giving gifts to others are also 100% legal in the United States and Canada and several countries. There are many legitimate programs that are available for selection. How do you know which one is right for you? Here is a list of helpful considerations:

1 If you intend to get involved in Cash Gifting Programs online, you need to ensure that these programs allow online promotion.

2 You need to ensure that the program you are considering is one of the programs that maintain integrity. Applications must be an administrator and software programs are all activities within the plan. Must have a proven track record.

3 Before starting a program, you need to consider how much money you want and / or gifts. Typically, programs are based on the amount of $ 500, $ 1500 and $ 3500. Of course, the bigger advantage when it is your turn to receive if the initial prize is higher.

4. Keep your prejudices if you have a suspicion, be a good suspicion. Because if you have been prejudiced, then you lose a tremendous potential opportunity.

When you give cash prizes when someone in need, make you feel welcome. A warm feeling generated in you knowing you've helped someone less fortunate than you. These programs are member benefits for thousands of people each year help to get out of debt, buy homes, send their children to college and start their own business.

If you want to know more about this opportunity, please visit the Cash Gifting Programs.

Help yourself a favor by using Mortgage Brokers Ft. Worth

When you want to buy a house, what do you need? You do not have the cash and looking for funding agencies to finance the ownership of your home, what do you need? When your credit score is not high and the next, also what do you need?

Yes, Help yourself a favor by using Mortgage Brokers Ft. Worth.

A long time, you need to search for information by telephone, analyzing the rate of interest and expenses that you need, they can save if you help yourself by using Mortgage Brokers Ft. Worth.

The benefits of using Mortgage Brokers Ft. Worth, in addition to saving your time, your money, you will also have a variety of alternative rates of interest to you.

Mortgage Brokers Ft. Worth, an independent institution that is not aligned to the bank, but are specialized to help you find your financial institution for interest rates very low.

So do not wait any longer, have a house, with a broken financial ones, surely you can. Because, you help yourself by using Mortgage Brokers Ft. Worth.

Shelf Exams. Done.

If I passed. First day was horrible and I knew it. Second day went better. Today felt like I knew every answer. Please please PLEASE PlEaSe let it be good enough for me to pass 2nd year. Say prayers for me folks. I need it right now.

Invitation to an awesome oral history project!

I received a heads up about this really cool endeavor from Laurel at Full Spectrum Doula Network. Read on to learn more about an oral history of queer and gender non-conforming birth workers. Spread the word!
Jeramie @ SQUAT

My name is Ryan Pryor.  I am working on a study/oral history collection project- carrying out spoken and written interviews with queer and gender non-conforming birth workers.

My primary goal for the project is to bring together some of the perspectives and experiences of queer and(/or) gender non-conforming birth workers; to better understand the knowledge and perspectives we bring to our varied work and to create a forum to share our perspectives and experiences. I hope that accomplishing this goal might allow our perspectives to be increasingly represented within the fields of birth work and health care more broadly, including in education and in client care. Birth work in my mind includes working as a full spectrum doula, a midwife, or any other formal or informal role. The study is open to anyone who identifies as a birth worker in any way. I use queer in this letter as an umbrella term that references sexual orientation without specifying gender. Participants might self identify as queer, gay, lesbian, bisexual, same gender loving, being a man who has sex with men, a woman who has sex with women, or any other personal identities.

The project was initially structured to fulfill part of my 3-year midwifery education program at Maternidad La Luz, a midwifery school I attended in El Paso, TX. Over the past year, the project has evolved somewhat. I have been incredibly inspired by the perspectives and insights of the birth workers who I have interviewed. My desire is to present the integrity of everyone's voices in a collective. While the project will likely take several years to complete, my goal and hope is to complete the majority of interviews this spring. The end result may be a formally structured qualitative study. But more likely it will be an artistic presentation.  I have been speaking with my partner, who's a filmmaker, and another close friend, about developing a free-form documentary over the next couple of years. This documentary could include a wide range of contributions such as art, in person interviews, etc.

The interviews would be open ended and focus on whatever you choose to share. With interviews so far, I have asked guiding questions on topics including personal identity, experience working in health care and with pregnant and birthing people, your experience during your birth related education, your philosophy about birth, etc. That said, I am open to any way any person would like to structure a conversation. This study is broadly aimed at queer and gender non-conforming birth workers, however it is based in the idea that no part of our identities are isolated from the others; race, class, ethnicity, nationality, language, geography, ability, experiences of trauma and survival, raising children, occupation, work and education experience all make up who we are and what we bring to our work in well person, pregnancy, birth and postpartum care. Additionally, each participant can choose the level of participation and confidentiality that they prefer.

A little more about me:  I am queer and transgender, genderqueer identified midwife (CPM) and aspiring family health nurse practitioner. I was raised primarily in Great Falls, VA, a suburban town near Washington D.C., and I have lived the majority of my adult life in the New York City area. I am white and I have Polish, Ukrainian, Romanian, British, German and Welsh heritage. I was raised very wealthy and Catholic in a politically-conservative family (mom, dad, 2 younger brothers) who I have a complicated and loving relationship with. English is my primary and only fluent language; as an adult I have learned to speak and write Spanish moderately well. I attended a small liberal arts college in New York and have spent my adult life working for non-profit organizations (primarily with queer and transgender youth in New York City), cooking at a summer camp in Vermont, and studying and then working as a midwife in El Paso, TX. I currently live in Austin, TX where I am taking pre-nursing classes and working in a small, non profit hospice that serves people with HIV/AIDS. I am moving to Philadelphia in a couple of months to begin a graduate RN/NP family nurse practitioner program.

It is possible to participate through an interview on the phone or in person. The  will be scheduled at your convenience in April or May, 2011. If you are not available at this time, please let me know when you would ideally like to be interviewed. Participation in any form is welcomed - for example, letters, art work, or I can provide a written set of questions. Please feel free to pass this letter freely.

You can reach Ryan at ryanpryor4 at gmail dot com

Postcard Fusion : Marketing Your Products and Services Direct to Your Customer

In Direct Mail marketing, an advertising method is very effective, either alone or as part of an overall marketing strategy. Although effective, this method is costly but very expensive, if not planned and thoroughly research the target market very carefully.

Here are some tips that can be done before you do direct marketing:

- Learn how the same methods to bring the results of advertising in the past, before you apply them in your business.
- The more specific your target market means that the more you can leverage your promotional costs. Not a wasted costs movable in vain.
- Create marketing materials based on the perspective of potential viewers. Visit Postcard Fusion to help you make the ads much more effective in this regard.
- Ask for opinions from people near you, how they respond to your campaign goes.
- Value-added of the business or service you offer along with the sensational and the time limit will make your customers immediately take action to buy your product.
- Use paper with the best products. Give your product and service awards with an elegant promotional material, so the position that your product is a classy product.
- Make use of internet, email and telephone to follow up your campaign.
- Choose the right printer for the job. Take advantage of the knowledge and insight, a good printer to offer some valuable ideas, strategies or cost saving measures.
- Integrate your direct marketing with your other marketing strategies.
-Test and measurement of a smaller scale. If the results look good, go with the promotion of greater cost.

Learn more about Postcard Fusion and Direct Mail so you will get a significant increase in business turnover.

Nordstrom scholarship

Please go to their website for the most  up to date information.
Nordstrom Scholarship  Click here
They are giving 10,000 to 80 students around the country where Nordstrom has a store.

From their website, here are their qualifications
To be considered for a scholarship, you must meet the following criteria:

•Be a high school junior

•Maintain a cumulative unweighted GPA of at least 2.7 (on a 4.0 scale) throughout your high school career

•Have participated in community/volunteer activities

•Live and attend school in one of the participating states designated by Nordstrom

•Be planning to apply for financial assistance to attend college

•Attend an accredited four-year college or university during all years for which the scholarship is awarded

•Be eligible to attend a four-year college or university in the United States

•Live and attend school in one of the participating geographic areas designated by Nordstrom

•Not have a conviction for any crime

Tuesday, March 29, 2011

Risk for Deficient Fluid Volume | Nursing Care Plan for Bariatric Surgery

Risk factors may include
Excessive gastric losses—nasogastric suction, diarrhea
Reduced intake

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Maintain adequate fluid volume with balanced intake and output (I&O) and be free of signs reflecting dehydration.

Nursing intervention with rationale:
1. Assess vital signs, noting changes in blood pressure (BP), such as orthostatic hypotension, tachycardia, and fever. Assess skin turgor, capillary refill, and moisture of mucous membranes.
Rationale: Indicators of dehydration and hypovolemia and adequacy of current fluid replacement. Note: Adequately-sized cuff must be used to ensure factual measurement of BP. If cuff is too small, reading will be falsely elevated.

2. Monitor I&O, measuring nasogastric (NG) suction losses.
Rationale: Changes in gastric capacity and intestinal motility and nausea greatly influence intake and fluid needs, increasing risk of dehydration.

3. Evaluate muscle strength and tone. Observe for muscle tremors.
Rationale: Large gastric losses may result in decreased magnesium and calcium, leading to neuromuscular weakness and tetany.

4. Establish individual needs and replacement schedule.
Rationale: Determined by amount of measured losses and estimated insensible losses and dependent on gastric capacity.

5. Encourage increased oral intake when able.
Rationale: Permits discontinuation of invasive fluid support measures and contributes to return of normal bowel functioning.

6. Administer IV fluids, as indicated.
Rationale: Replaces fluid losses and restores fluid balance in immediate postoperative phase until client is able to take sufficient oral fluids.

7. Monitor electrolyte levels and replace, as indicated.
Rationale: Use of NG tube, vomiting, or onset of diarrhea can deplete electrolytes, affecting organ function.

Risk for Ineffective Tissue Perfusion | Nursing Care Plan for Bariatric Surgery

Risk factors may include
Diminished blood flow, hypovolemia
Decreased hemoglobin concentration in the blood
Impaired oxygen transport
Interruption of venous blood flow (thrombosis)

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Circulation Status
Maintain perfusion as individually appropriate—skin warm and dry, peripheral pulses present and strong, and vital signs within acceptable range.
Risk Control
Identify causative or risk factors.
Demonstrate behaviors to improve or maintain circulation.

Nursing intervention with rationale:
1. Monitor vital signs, palpate peripheral pulses routinely, and evaluate capillary refill and changes in mentation. Note 24-hour fluid balance.
Rationale: Indicators of circulatory adequacy.

2. Encourage frequent range-of-motion (ROM) exercises for legs and ankles. Maintain schedule of sequential compression devices (SCD) on lower extremities when used.
Rationale: Stimulates circulation in the lower extremities, reduces highrisk complications associated with venous stasis, such as DVT and pulmonary embolus (PE).

3. Assess for redness, edema, and discomfort in calf.
Rationale: Indicators of thrombus formation, but warning signs may not always be present in obese individuals.

4. Encourage early ambulation; discourage sitting and dangling legs at the bedside.
Rationale: Sitting constricts venous flow, whereas walking encourages venous return.

5. Provide adequate and appropriate equipment, including trapeze for turning, transfer device, walker, and wheelchair, and sufficient staff for handling client.
Rationale: Helpful in dealing with obese client for moving and ambulating. Reduces risk of traumatic injury to both client and caregivers.

6. Evaluate for complications, such as rigid abdomen, nonincisional abdominal pain, fever, tachycardia, and low blood pressure.
Rationale: Although rare, client can develop abdominal complications, such as abdominal compartment syndrome, sepsis or septic shock secondary to anastomotic leak or wound infection, requiring intensive interventions or return to surgery.

7. Administer heparin therapy, as indicated.
Rationale: May be used prophylactically to reduce risk of thrombus formation or to treat thromboemboli.

8. Monitor hemoglobin (Hgb), hematocrit (Hct), and coagulation studies, such as prothrombin time (PT) and International Normalized Ratio (INR).
Rationale: Provides information about circulatory volume and alterations in coagulation and indicates therapy needs and effectiveness.

Nursing Care Plan | NCP Bariatric Surgery

Nursing diagnosis: ineffective Breathing Pattern related to Decreased lung expansion, Pain, anxiety, Decreased energy, fatigue, Tracheobronchial obstruction

Possibly evidenced by
Shortness of breath, dyspnea
Tachypnea, respiratory depth changes, reduced vital capacity
Wheezes, rhonchi
Abnormal arterial blood gases (ABGs)

Desired Outcomes/Evaluation Criteria—Client Will
Respiratory Status: Ventilation
Maintain adequate ventilation.
Experience no cyanosis or other signs of hypoxia, with ABGs within acceptable range.

Nursing intervention with rationale:
1. Monitor respiratory rate and depth. Auscultate breath sounds. Investigate presence of pallor and cyanosis, increased restlessness, or confusion.
Rationale: Respirations may be shallow because of incisional pain, analgesia, immobility, and obesity itself, causing hypoventilation and potentiating risk of atelectasis and hypoxia. Note: Many anesthetic agents are fat soluble, so the postoperative “resedation” and the potential for respiratory complications are increased.

2. Elevate head of bed 30 to 45 degrees.
Rationale: Encourages optimal diaphragmatic excursion and lung expansion and minimizes pressure of abdominal contents on the thoracic cavity. Note: When kept recumbent, obese clients
re at high risk for severe hypoventilation postoperatively.

3. Encourage deep-breathing exercises. Assist with coughing and splint incision.
Rationale: Promotes maximal lung expansion and aids in clearing airways, thus reducing risk of atelectasis and pneumonia. Note: Use of abdominal binder—properly fitted and placed at least 2 inches below the xiphoid process—can encourage deep breathing.

4. Turn periodically and ambulate as early as possible.
Rationale: Promotes aeration of all segments of the lung, mobilizing and aiding movement of secretions. Note: If client was a good candidate for bariatric surgery, she or he was probably relatively healthy before operation and is usually able to turn self, walk, and transfer to chair within 8 hours of surgery.

5. Pad side rails and teach client to use them as armrests.
Rationale: Using the side rail as an armrest allows for greater chest expansion.

6. Use small pillow under head, when indicated.
Rationale: Many obese clients have large, thick necks, and use of large, fluffy pillows may obstruct the airway.

7. Administer supplemental oxygen.
Rationale: Maximizes available O2 for exchange and reduces work of breathing.

8. Assist in use of blow bottle or incentive spirometer.
Rationale: Enhances lung expansion; reduces potential for atelectasis.

9. Monitor ABGs or pulse oximetry, as indicated.
Rationale: Reflects ventilation, oxygenation, and acid-base status. Used as a basis for evaluating need for and effectiveness of respiratory therapies.

10. Monitor patient-controlled analgesia (PCA) and administer analgesics, as appropriate.
Rationale: Maintenance of comfort level enhances participation in respiratory therapy and promotes increased lung expansion. Note: For the first 48 hours after the procedure, intravenous (IV) PCA is the method of choice. Oral medications are usually the next level of pain management.

Nurses promoting safety

“Safety is NO Accident: Live Injury-Free” is the theme for National Public Health Week April 4-10. The American Public Health Association is encouraging all Americans to think about how, by making just one positive change a day, you can prevent injuries and start living a safer life.

“Villanova Nursing faculty and students will use this week as a reminder of the important role nurses play in keeping individuals and communities safe,” says Prof. Kim Connolly, director of the College of Nursing’s Center for Global and Public Health. From discussing safety messages with patients in clinical settings—such as preventing falls at home or encouraging safe environments for children-- to providing education in elementary school settings, Villanova nurses will highlight the importance of thinking about and implementing safety measures at school, work, home, and in the community.

Why is patient safety an integral part of nursing care and teaching? Thirty million people are hurt seriously enough each year to go to the emergency room and injuries are the most common cause of premature death before the age of 65.

Here’s what you can do TODAY:
1. Buckle up
2. Stop driving while distracted or under the influence
3. Move cleaning supplies and medicines to higher ground, out of reach of children
4. Program emergency numbers, such as the Poison Control Hotline (1-800-222-1222), into your phone
5. Use car seats for children as directed
6. Have children use the bike helmet EVERY time
7. Check your smoke and CO detectors
8. Fix any risky areas in the house that can cause a fall
9. Ask your children about bullying in school or online
10. Find out who your children are talking to online

For more statistics and safety tips, visit

A New Direction for Midwife Connection

by Cassie Moore, ACNM Writer and Editor We hope you’ve seen our fabulous new Web site—and hope you love it as much as we do! We’re also taking this blog to the next level, and we need your help. First, we’re moving the blog from Blogger to the new Web site. To find it from, go to “News and Events,” then select “ACNM Blog.”Content Hand-Picked for You Previously, Midwife Connection was

spring in the hood

I saw 5 eagles soaring together round and round over the mississippi river today. I am going to take that as a good omen and signal that winter really is coming to an end.

Meanwhile back to the hood, where the hood rats are out in full force shooting at each other. Its like a rite of spring. Four shootings in the last couple of days. Two ended up in our ER, one died. Somebodys child, perhaps somebodys parent. Somehow the one who didn't die, but was shot, managed to drive the two of them in by car from about 6 blocks away. We lock down the ER in this situation, not knowing its gangbangers or if they are coming to the hospital for revenge. I have the feeling its gonna be a long summer

Various essays samples provided free to you

Discover the various essay samples, free for you in the format of MLA and APA formats. This essay is intended to help you write the essay itself or ensure quality of service from professional services here. These samples can be downloaded for free at essay samples.

Please note that these samples come from customers who have used the essay samples, and they have given permission for distribution.

Do not sacrifice your career by copying or imitating other people's essays is not wise. If you are a busy person and do not want to fail in your education, you can take advantage of services such as the manufacture of essays in this essay samples.

Do not worries, the essay that you receive there will be no duplicating. Because there will be no one is going to post the essay online or sell it.

A variety of sample essays are provided such as:
- Essay for College
- Essay for Graduate School
- Themed Essay Samples terrorism
- Themed Essay Samples of food and nutrition world
- Sample Essays on American History
- Essays on Art Samples
- Business Essay Samples
- Sample Essays on Computers & Technology
- Sample Essays on Economics
- Sample Essays on Education
- Sample Essays on History
- Law Essay Sample
- Essays on Literature Sample
- Sample Marketing Essays
- Sample Essays on Management
- Sample Essays on Medicine & Health
- And many more.

You have difficulty making the essay, now you helped with the essay samples.

Cash Gifting Program as an extra income for you

In economic times, many people are strapped for cash. Many people are looking for all ways to get money to make ends meet. Finding a second job. The people choose to bring lunch to lunch, even better when used for work. Everyone is tightening their financial belts. So what can we do to solve our financial problems?

Some people do not have a second job. Some people may realize that the cost used to perform a second job is worth the extra money that comes from that second job. Therefore, many people trying to make money online. Without having to do the activity a second job. To make money online, you do not require travel expenses. A popular way to make money online is to give cash. Cash gifting program, is a solution to the problem of money today? Do you have to use the prize money if you need extra money?

Cash gifting program is a revolutionary program residual income. Residual income is what we need in these economic times. Residual income is income that is made over and over again without doing any work. A cash reward program focuses on helping people to people. With a cash gifting program, a person can change his life immediately and financial situation.

It is very difficult to make a lot of cash gifting program to the program. This system is also an effective automated system. That's because a computer software system that manages personal follow up and placement of all members of the program structure gift box.

All you have to do is get people to join the program. However, you may receive the gift at first did not even get people to join the program. Cash gifting program of course ways to get money easily, the perfect way to make extra money, or even replace the income during these economic times.

Cash gifting program is the system that is perfect for people who are trying to make a living. This is not a sales or demand. Nothing like selling eBooks, or spend hours of time to freelance writing. This is not a get rich quick scheme, and does not require advanced technical knowledge to succeed in this program. Then, you feel a little short of money in the present? A cash gifting program can be for you.

Compare auto insurance rates are easily

Various types of auto insurance offered by insurance companies to you. The various advantages offered. But you see there are various advantages and disadvantages of various insurance companies that come to you.

The need for you to compare from one insurer to another. So you really are in the right position, because it has the right to choose the best auto insurance to protect your vehicle.

Looking for information one by one sometimes troublesome. Moreover, manually. But the existence of the Internet easier for you to do that.

Simply enter your zip code to compare rates from various insurance vehicles.

1. Enter your zip to compare providers and compare rates;
2. Get the top companies for your local area and confirm your bid selection;
3. Fill out a simple form for each company or service to get instant rates;
4. You will begin to compare instant online car insurance quote and rates;

Do not wait anymore, please protect your car with car insurance and how quickly is that you can compare auto insurance online.

How to Choose Good Research Paper Topics

A good research paper begins by choosing a good research paper topic. Try to choose your own topic you want, especially that you know well or you are interested in the discussion of the topic.

But, if you're having trouble, you can find topics from a variety of service professionals.

As in good research paper topics, you will find a variety of topics for the research paper topics.

- How mobile phones change your life?
- Do you think it is illegal to use animals for sports and entertainment?
- And many more.

Some of the following can be used as a guide for choosing your topic research papers, namely:

1. Write a list of topic that you know well, or you are interested to it.
2. Specify the title associated with the topic, as detailed as possible.
3. Customize the topic you choose for the purpose of making paper.

How to Make A Good Research Paper Format

A research paper aims to test the hypothesis, prediction and many other things that have been acquired during long-term research, which further proves that a hypothesis generated quite valid.

The composition of document research papers, can reflect a deep relationship between theory and fact.

Develop a good paper with the format begins with the selection of an appropriate topic, the topic you know well or topic you are interested in it.

The composition of the research paper in a simple format consisting of :


- Background
Contains the reason the election theme in the manufacture of paper.

- Objectives
Contains about goals to be achieved by making paper / paper.

- Scope of Material
Contains about science or theory relating to the themes that were taken in the paper / paper.

Contains both the discussion and research on the science or theory that has been discussed by experts associated with the theme of paper / paper selected. The material discussed theoretically associated with the practical application of theory / science in everyday life reality.

To write a theory drawn from the experts do not forget to include your name, year or ever book containing the theory. So that the source / speaker is clear and no doubt the source. If making a quotation please quote the same page where the quote was taken.

Contains the data obtained in the field / reality and is associated with a science or an existing theory. If there is compliance discussed further and may also include a personal opinion which is closely related to the theme / proposals / suggestions / ideas / ideas.

If it found a discrepancy between the theory or science that already exist with the reality on the ground, it also needs to be discussed to see why this can happen. Can also be included personal opinion is closely related to the theme / proposals / suggestions / ideas / ideas that between reality with science, whether that has to do or not, can be articulated and detailed.

Contains the final conclusion of the discussion that has been made. Writing a short conclusion and clear, no such long discussions.

The proposal and Suggestions
It can also be included proposals and suggestions from authors who have emerged in the discussion.

Contains all the sources used in the manufacture of paper / paper. Bibliography of books, newspapers, magazines, Internet sites and information from others. The writing is complete and follow the rules of Indonesian writing is good and right.

It contains the whole image / photo or graphic or also data that support the creation

If you want to know more deeply, you can find in the research paper format.

Part Time MBA Rankings 2012

Northwestern University (Kellogg Graduate School of Management) and University of Chicago (Booth School of Business) are tied for the 1st place in the US News part time MBA rankings (2012 edition). The ranking was based on a Fall 2010 peer assessment survey of business school deans and MBA program directors.

The Shidler College of Business at the University of Hawai‘i at Mānoa is ranked 105th

Watching The Big Picture

WE have apparently stopped making things in Scotland. The best ships are no longer "Clyde-built"; the sun has surely stopped rising over Albion Motors; North British Loco lang syne ran out of puff.

Scotland, as was all-too-evident at The Emirates on Sunday, has also stopped producing top-flight footballers. We are in a raw state and what is happening? Well the Labour Party, for so long the inheritors of Sir William Wallace's late post as Guardian(s) of Scotland decided to embark on guarding us by trying its best to give everyone a government job, either as a civil servant, local authority employee or turning us into something memorably conjoured-up in an old Francie and Josie sketch: "sort of nobility - ra government peys us an allowance so as we don't hiv fur tae soil oor hauns wi toil" i.e. a statistic.

Our football clubs have gladly latched onto this social largesse, paying poor-quality players, quite a few of them non-Scots, a good living to demonstrate on a weekly basis: that while they can do brilliant headless chicken impressions, and they meet the first requirement for gaining a contract with an SPL side - that their second touch is a slide tackle in a desperate attempt to regain the possession they gave away with their first; they cannot trap a bag of cement; their spatial awareness is generally lacking; they can shoot, but not always hit even the goal frame; they cannot legally tackle anything more mobile than a fish supper.

We're in a mess. Arguably the two worst Old Firm squads ever have turned the SPL into a two-horse race. There is no money in the game (not that money is a panacea for all football's ills); the SFA commissions a Review, then, once its findings are published, because turkeys don't vote for Christmas, its findings are conveniently buried.

The great body of the football kirk, which has contributed nothing to the game for years does nothing in public, but is working feverishly behind the scenes to preserve their sole right - to exist.

And what, this spring of 2011, are the two main points of debate - that somebody threw a piece of fruit at a Brazilian and that some nasty Rangers fans sang some nasty songs, which were heard on TV and upset perhaps the most-influential religious body on earth.
Michty me, as Ma Broon might say.
Anent the banana: this one has me stumped. Throwing a banana just doesn't stack up with the usual behaviour of the Tartan Army. The fact it came from a section of the crowd which was almost 100% Brazilian also makes this a funny (peculiar rather than ha ha) one. Protests have been made on behalf of the good name of the TA, best leave it at that maybe.

Now, anent that sectarian singing, and I realise here I'm getting into perilous waters. Basically, in this year of the lord two thousand and eleven, why is there still a religious element invovled in Old Firm football? And what has guarding Derry's Walls or standing in the Fields of Athenry got to do with SCOTTISH Football anyway?

It beats me. I have seen no evidence of Rangers being formed as a "Protestant" club and while Celtic was certainly born in the Catholic faith and much of its early work involved lightening the lot of the (mainly Catholic) down-trodden of the East End of Glasgow, in its player recruitment policy it has always been non-denominational.

Rangers would I suggest need a very good advocate representing them to escape charges of, for much of its history, tacitly encouraging the support of those with an anti-Catholic agenda - but, since Sir David Murray took over, they have worked hard albeit still unsuccessfully, to eradicate any perceived anti-Catholic agenda within the club.

But, Rangers's pandering to Orangeism has I would suggest been more than matched by Celtic's historical playing of the "Oirish" card. If anything, I feel this has maybe grown somewhat in recent years.

When you see this, neutrals might think those singing that: "The Famine Is Over" might have a point (badly put though their point is).

Then there is the feeling, which I have heard voiced in some pubs in the admittedly "staunchly Protestant" former mining area where I live, that there is a cosey wee link-up between the Catholic Church, the Labour Party and Celtic. That when the Catholic Church makes noises about the Rangers' fans's sectarian singing, they are doing so on behalf of Celtic.

Given some of the scandals involving RC priests in recent years, it has been said, maybe that church should sort its own sinners out before turning on sinners from another faith.

Like wise, Celtic is now being increasingly seen as the opposition to the SFA. The SFA is by no means perfect, anything but in fact. But, Celtic has been a member of that body for over 120 years. The club has provided several important and influential administrators since 1888, so it is maybe a wee bit late in becoming a force for reform.

I know some sections of the Celtic "family" see themselves as the outsiders in Scottish football. Get real, you're some 70-odd trophies too late to play the "victim" card.

Both sides of the Old Firm need to be ever-more-vigilant in rooting-out the continuing cancerous element within their supporters. The battle will be a long one, but it can be won.

Celtic, certainly should be encouraged in their efforts to sort-out the failings of the SFA. But I suggest this mission would better be accomplished: "in the tent pishing oot, rather than oot o' the tent pishing in".

But, as Sunday at The Emirates showed - Scottish football has got bigger problems to overcome than sectarian singing from a fringe group of neanderthals - no matter how large.

Monday, March 28, 2011

Important documents in conducting Medical Tourism

What should I take to complete the journey medical tourism? Do I need special documents? For people who have never traveled far, the action across the state border, to make medical tourism raises additional questions about the documents that must be prepared. Then what documents should be prepared before making the medical tourism?

Statistics of patients who do travel for medical tourism activity is increasing every day. Many of those new first time traveling abroad. Travel for medical tourism is not constrained, the need for good preparation. The first thing suggested is to create a list of documents that must be taken.

Lists of documents required are:

    * Valid passport
    * Visa to the country of destination
    * Immunization records (if necessary)
    * Prescription medicines and your doctor's letter
    * Photocopy of passport and other documents.
    * Travel insurance policy and other insurance as deemed necessary
    * Cash to taste.

Passports are Still Valid: All travel to foreign countries require the use of a passport, so make sure you review or do this procedure for the first and sometimes the process can take longer than expected. Depending on your country, your passport can be valid for 5 to 10 years, but most require entrants to have a passport valid for at least 6 months.

Visa to the country of destination: Depending on your nationality and country of destination you may need to adjust the travel visa. This can be a complicated process, with the long form to fill out and send lots of documents. It may even be necessary for you to send documents by mail to the city where the consulate of the country of destination or even if you stop in another country where a visa is also required.

Vaccination Cards: Some countries require this vaccination card for certain infectious diseases before entering the country. For this, you usually get the vaccine at a public clinic and asked for a yellow book that explains what you have. This process also had to do with time.

Prescription drugs and a letter from your doctor. This is only necessary if you have a medical condition that requires you to take your medications at the time on board the aircraft. Letter doctor is required only if you have physical problems that can cause doubt to the immigration authorities of your health, so doctors must certify that you are able to travel.

Photocopies of documents. We recommend you carry at least two photocopies of any important documents and store them in different parts of the original. This will help you if you have an emergency with the loss or theft of documents (It is better you prepare your confusion rather than later!)

Travel insurance, health insurance and others: If you purchase travel insurance, bring a copy of the policy to you to make a claim if you need it.

Cash: It is required to bring cash to pay a little trouble on the road. Cash can function at the time of giving tips, buying something with cash, and should be applicable to the type of money in the State of destination.

You already know the list of documents you should prepare. Everything takes time, be wise if you take care of it well in advance before making your medical tourism.

post certificate diploma in oncology nursing

Tata Memorial Hospital Mumbai invited application for post
certificate diploma in oncology nursing
Tata memorial center (Tata memorial hospital) invites application for
11 months including one month internship)
post certificate diploma in oncology nursing for qualified nurses

The course is recognized by Maharashtra Nursing council and Indian
Nursing council. It iwll commence from 20-06-2011

Further details log on

oh no you can't order that CT

Well it seems that if docs cannot regulate their use of such things as CT scans, the government is going to do it for them. For example, CMS (Center for Medicaid and Medicare Services) has decided that CTs ordered for nontraumatic headaches will not be paid, and in the future MDs may be financially penalized for ordering what they deem as unnecessary.

Another sign of the coming crash and burn of the healthcare system. There are three players in the coming meltdown:

1) Government and insurance payers who are starting to refuse to pay for what they deem as unnecessary tests.
2) Doctors who say they have to order such tests in order to avoid potential liability.
3) Patients who expect expensive tests to be done.

Radical change is coming, no doubt about it. Without it, the government will go bankrupt with healthcare costs and insurance premiums will become unaffordable. Malpractice awards will have to be limited or doctors are just going to have to deal with assuming more risks. Patients expectations will have to be drastically lowered.

In the end, government and insurers will drive change because, bottom line, they pay the bills. Its time for doctors to accept the changes coming to their practice. The fact of the matter is the days of docs ordering any test they want are gone. Their autonomy is decreasing. Its reality. You can accept it, work with it, be part of it or not. Research based medicine is the future.

Now don't even get me started on all the ridiculous MRIs being ordered in the ER...

Always Look On The Bright Side Of Life

I'VE HAD my rose-tinted specs on constantly since watching yesterday's friendly between Brazil and Scotland from the Emirates. And, by the way, STV's coverage was nothing like as poor as I feared it might be. However, even with these glasses on, I cannot be a positive spin on a match in which the final score was 2-0 going on 6-0.

Thankfully, this time around we didn't have a bit daft Angus "loon" like David Narey in our team and ready to score against them, thereby angering the Brazilians into really skelping oor bahookies.

We got off lightly, on which point, well-done Howard Webb. I've long believed you to be a crap referee; at least in confirming this impression you did us a favour by not awarding the Brazilians a stonewall penalty for that late hand-ball by Gary Caldwell.

But how demoralising is it to realise we - Scotland - the nation which invented team work, which pioneered close short passing, support play, pass and run, can no longer get close to the nation which best picked-up on what the Victorian English termed "the Scotch passing game".

Time and again they cut through us, like a knife through butter. In every aspect of the game, we were a poor second. Even Charlie Adam, the man onto whose shoulders the cape of Baxter and Co has fallen, couldn't adequately match-up with his opponents.

Charlie has made his reputation this season from his "World Cup passes", the 50 or 60 yard cross-field passes to free-running team mates. Sadly, on Sunday, he either over or under-hit his trade mark balls, although it must be said, it seemed to me his team mates didn't always read Charlie's passes properly.

Aye, it wis a sair fecht, and sadly I don't see it getting any better soon. We might still be good enough to finish second behind Spain in the Euro 2012 qualifiers, but Sunday only emphasised that, the first time we have to get past a decent team, we're doomed, doomed ah tell ye.

ENOUGH doom and gloom. At least we are aware of our failings and limitations. I had a good laugh at our southern neighbours' take on what was apparently a stroll in the park in beating Wales on Saturday.

England were, apparently, in cruise control. LIke Brazil against us, they won 2-0, but whereas Brazil rattled our goal fram a few times, missed at least three chances which I never expected to see a Brazilian player miss, and were of course denied that one stonewall penalty, and a possible other.

The English scored two and never looked like getting a third. But, so dire were Wales, they were never in danger.

Pardon me but, if England are as good as the English like to tell us they are, how come they could only score two goals in a cake walk? A top-class team, playing markedly inferior opponents, should score at least four or five.

I feel the English are still shite - but that fact hasn't yet hit home.

THE Spanish referee who sent him off, apparently has "form" when it comes to exiling managers to the grandstand. However, is there nobody within "the Celtic Family" able to tell Neil Lennon: "Screw the nut wee man".

Getting sent to the stand in a meaningless friendly will do him no favours with the SFA, who are truly out to get him any way they can.

At this rate Paul McBride QC will be easily the highest-paid man within Parkhead this season. Wonder if he can play in central defence, since they need a good defender.

MIND you, Celtic don't need a good QC as much as Rangers now the institutionalised power of the Catholic church is on their case. Their intervention after the sectarian singing at the League Cup Final is just about the last thing Rangers need and maybe now, at long last, the club will seriously have to do something about those of their fans who are hell-bent on pushing their right to free speech to the absolute extreme.

It can be done, but Rangers will need to be serious and consistent in their efforts to finally silence the bigots.

It's all very well going on about "their" bampot tendancy getting a fairly free ride. But as the old adages say: "People in glass houses etc" and "Let he who is without sin cast the first stone". But if you don't muck your own byre out regularly, you can hardly complain about a lingering pong.

Top Universities in Florida

Barry University is ranked highly in granting degrees to Hispanic students in the United States, according to Hispanic Outlook in Higher Education. It is also included in Hispanic Outlook’s “Top 100 List of U.S. Colleges and Universities Graduating Hispanics”.

University of Florida is ranked 15th in the U.S. News "Top Public Universities" (2010). It is consistently ranked among the top 10

Sunday, March 27, 2011

Nursing Diagnosis and Nursing Interventions for Alzheimer's Disease

Nursing Diagnosis for Alzheimer's Disease
  1. The risk of changes in nutritional patterns : less / more needs relate to:
    • Sensory changes
    • Damage assessment and coordination
    • Agitation
    • Easy to forget, setbacks hobby and concealment

  2. Changes in the pattern of elimination of constipation / incontinence related to :
    • Loss of neurological function / muscle tonus
    • The inability to determine the location of the bathroom / identify needs
    • Changes in diet or food intake.

Nursing Interventions for Alzheimer's Disease
  1. The risk of changes in nutritional patterns : less / more needs relate to:
    • Sensory changes
    • Damage assessment and coordination
    • Agitation
    • Easy to forget, setbacks hobby and concealment

    Nursing Intervention :
    • Determine the number of exercises / steps that patients do
    • Try to provide a snack each about an hour as needed
    • Who freely give time to eat
    • Collaboration
      • Refer to consult with a nutritionist: Identify the need to help formulate individual education plan
      • Nutrient inputs may be necessary to meet the needs of a close touch with individual calorie adequacy
      • Large amounts of food may be too much for the patient which resulted in difficulty in swallowing. Snacks can increase the input accordingly. Restricted amount of food they attempted only once when giving patients will decrease confusion about which foods selected.
      • The relaxed approach helps digestion of food and reduce the possibility that sparked angry crowd
        Assistance may be needed to develop a balance diet individually to find the needs of patients / preferred food

  2. Changes in the pattern of elimination of constipation / incontinence related to :
    • Loss of neurological function / muscle tonus
    • The inability to determine the location of the bathroom / identify needs
    • Changes in diet or food intake.

    Nursing Intervention:
    • Review the previous pattern and compare it with the current
    • Put a bed with a bathroom if possible make a certain sign of a special coded door.
    • Give a certain enough light at night
    • Create a training program defecation / bladder. Increase the participation of patients according to their ability level
    • Encourage adequate menu during the early morning, high-fiber diet of fruit juice. Limit drinking at dusk and bedtime
    • Collaboration
      • Give a moisturizer drug stool, metamacil, glycerin suppositories as indicated Provides information about changes that may require further assessment / intervention
      • Improve orientation / discovery bathroom. Incontinence may be accompanied by an inability to find a place to urinate
        Stimulating awareness of patients, improve body function regulation and help avoid accidents
      • Reduce the risk of constipation / dehydration. Restrictions on the evening drinking in the evening to reduce frequent urination / urinary incontinence at night
      • May be required to facilitate / stimulate the detection of regular.

Nursing Care Plans for Alzheimer's Disease

Alzheimer's Disease - Nursing Care Plans for Alzheimer's Disease

Alzheimer's disease

Alzheimer's disease (AD) is the most common form of dementia among older people. Dementia is a brain disorder that seriously affects a person's ability to carry out daily activities.

AD begins slowly. It first involves the parts of the brain that control thought, memory and language. People with AD may have trouble remembering things that happened recently or names of people they know. Over time, symptoms get worse. People may not recognize family members or have trouble speaking, reading or writing. They may forget how to brush their teeth or comb their hair. Later on, they may become anxious or aggressive, or wander away from home. Eventually, they need total care. This can cause great stress for family members who must care for them.

AD usually begins after age 60. The risk goes up as you get older. Your risk is also higher if a family member has had the disease.

No treatment can stop the disease. However, some drugs may help keep symptoms from getting worse for a limited time.

NIH: National Institute on Aging

Nursing Care Plans for Alzheimer's Disease

Nursing Assessment
  1. Activity / rest
    Symptoms: feeling melting / tired
    Signs: anxiety, helplessness, disruption
    Lethargy sleep patterns and impaired motor skills

  2. Circulation
    Symptoms: History of cerebral vascular disease / systemic, hypertension, embolic episodes

  3. Ego integrity
    Symptoms: suspicious or afraid of the situation / person fantasies, misperceptions of the environment, loss of multiple.
    Signs: hide incompetence, sit and watch the other, the first activity may accumulate objects are not moving and emotionally stable

  4. Elimination
    Symptoms: The urge to urinate
    Signs: Incontinence of urine / feaces

  5. Food / fluid
    Symptoms: Historical episodes of hypoglycemia, changes in taste, appetite, weight loss.
    Signs: loss of ability to chew, avoiding / refusing to eat and looked increasingly thin.

  6. Hygiene
    Symptoms: Need help, depending on other people
    Signs: a lack of personal habits, forget to go to the bathroom and less interested in eating time

  7. Neuro Sensory
    Symptoms: Improvement of existing symptoms, especially cognitive changes,
    a history of cerebral vascular disease / systemic as well as seizure activity

  8. Comfort
    Symptoms: A history of serious head trauma, accident trauma
    Signs: ekimosis laceration and a sense of hostile / attack others

  9. Social Integrity
    Symptoms: Feeling lost power
    Signs: Loss of social control, inappropriate behavior.

Impaired Social Interaction | Nursing Care Plan Obesity

Nursing diagnosis: impaired Social Interaction related to Verbalized or observed discomfort in social situations, Self-concept disturbance

Possibly evidenced by
Reluctance to participate in social gatherings
Verbalization of a sense of discomfort with others

Desired Outcomes/Evaluation Criteria—Client Will
Social Involvement
Verbalize awareness of feelings that lead to poor social interactions.
Become involved in achieving positive changes in social behaviors and interpersonal relationships.

Nursing intervention with rationale:
1. Review family patterns of relating and social behaviors.
Rationale: Social interaction is primarily learned within the family of origin. When inadequate patterns are identified, actions for change can be instituted.

2. Encourage client to express feelings and perceptions of problems.
Rationale: Helps identify and clarify reasons for difficulties in interacting with others, such as feeling unloved or unlovable and insecure about sexuality.

3. Assess client’s use of coping skills and defense mechanisms.
Rationale: May have coping skills that will be useful in the process of weight loss. Defense mechanisms used to protect the individual may contribute to feelings of aloneness or isolation.

4. Have client list behaviors that cause discomfort.
Rationale: Identifies specific concerns and suggests actions that can be taken to effect change.

5. Involve in role playing new ways to deal with identified behaviors or situations.
Rationale: Practicing these new behaviors enables the individual to become comfortable with them in a safe situation.

6. Discuss negative self-concepts and self-talk, such as, “No one wants to be with a fat person,” “Who would be interested in talking to me?”
Rationale: May be impeding positive social interactions.

7. Encourage use of positive self-talk such as telling oneself “I am OK,” or “I can enjoy social activities and do not need to be controlled by what others think or say.”
Rationale: Positive strategies enhance feelings of comfort and support efforts for change.

8. Refer for ongoing family or individual therapy, as indicated.
Rationale: Client benefits from involvement of SO to provide support and encouragement.

Disturbed Body Image/chronic low Self-Esteem | NCP Obesity

Nursing diagnosis: disturbed Body Image/chronic low Self-Esteem related to Biophysical factors—changes in health status, Psychosocial factors—client’s view of self; changes in body image, personal identity, Family or subculture encouragement of overeating—slimness is valued in this society, and mixed messages are received when thinness is stressed, Perceived failure at ability to control weight, Control, sex, and love issues

Possibly evidenced by
Verbalization of negative feelings about body—mental image often does not match physical reality
Fear of rejection or reaction by others
Feelings of hopelessness, powerlessness
Preoccupation with change—attempts to lose weight
Lack of follow-through with diet plan
Verbalization of powerlessness to change eating habits

Desired Outcomes/Evaluation Criteria—Client Will
Body Image
Verbalize a more realistic self-image.
Demonstrate some acceptance of self as is rather than an idealized image.
Seek information and actively pursue appropriate weight loss.
Acknowledge self as an individual who has responsibility for self.

Nursing intervention with rationale:
1. Determine client’s view of being fat and what it does for the individual.
Rationale: Mental image includes our ideal and is usually not up-to-date. Fat and compulsive eating behaviors may have deep-rooted psychological implications, such as compensation for lack of love and nurturing or a defense against intimacy. In addition, chronically obese client may report long-term discrimination in family, social, and professional settings. She or he may experience mixed feelings of fear and shame or compensate for psychological trauma by developing a strong or “big” personality.

2. Promote open communication, avoiding criticism or judgment about client’s behavior.
Rationale: Supports client’s own responsibility for weight loss, enhances sense of control, and promotes willingness to discuss difficulties and setbacks and to problem-solve. Note: Distrust and accusations of “cheating” on caloric intake are not helpful.

3. Outline and clearly state responsibilities of client and nurse.
Rationale: It is helpful for each individual to understand area of own responsibility in the program so that misunderstandings do not arise.

4. Graph weight on a weekly basis.
Rationale: Provides ongoing visual evidence of weight changes, reinforcing reality.

5. Ensure availability of properly sized equipment, including gowns; blood pressure cuff; wider and strong wheelchair, bed, commode, and transfer devices, when providing inpatient care.
Rationale: Healthcare providers have a moral and legal obligation to meet the client’s needs for comfort and safety.

6. Encourage client to use imagery to visualize self at desired weight and to practice handling of new behaviors.
Rationale: Mental rehearsal is very useful in helping the client plan for and deal with anticipated change in self-image or occasions that may arise, such as family gatherings or special dinners, where constant decisions about eating many foods will occur.

7. Provide information about the use of makeup, hairstyles, and ways of dressing to maximize figure assets.
Rationale: Enhances feelings of self-esteem and promotes improved body image.

8. Encourage buying clothes instead of food treats as a reward for weight loss and life successes.
Rationale: Properly fitting clothes enhance the body image as small losses are made and the individual feels more positive. Waiting until the desired weight loss is reached can become discouraging.

9. Suggest the client dispose of “fat clothes” as weight loss occurs.
Rationale: Removes the “safety valve” of having clothes available “in case” the weight is regained. Retaining fat clothes can convey the message that the weight loss will not occur or be maintained.

10. Be alert to myths the client and SO may have about weight and weight loss.
Rationale: Beliefs about what an ideal body looks like or unconscious motivations can sabotage efforts to lose weight. Some of these include the feminine thought of “If I become thin, men will view me as a sexual object”; the masculine counterpart, “I don’t trust myself to stay in control of my sexual feelings”; as well as issues of strength, power, or the “good cook” image.

wasting away in frequent flyerville

A small town hospital in my state decided to do something about the bane of every ER nurses life: frequent flyers. The ones that come up to the triage desk and you tell them to have a seat in the lobby, you don't need their name because it is etched in your brain.

Anyway, this hospital decided to hire a social worker whose job it became to identify these people and work with them to decrease their visits. She started with 24 people and reduced their visits from 294 to 178 in a years time. Saved almost 300,000 dollars. Many of the people had untreated mental illness or stress related problems, were unemployed or homeless. She hooked them up with psychiatrists or social workers, etc.

Why doesn't every ER do this? Sometimes I think that the hospital doesn't want them to stop coming. Medicaid money is better than no money I guess

You are what you love....

Not what loves you. I just keep telling myself that. Is there anything worse than loving someone who doesn't love you back? I doubt it. I've been in this cycle for 6 months now. It's maddening. I want to forget about him SO badly. Sigh. Too bad he lives near me and that doesn't make it easy to forget about him. Especially not when he is so effing charming and adorable. Sigh again.

US News Entrepreneurship Ranking 2012

Babson College's MBA program is ranked No. 1 in entrepreneurship in U.S. News & World Report's 2012 edition of “Best Graduate Schools”, followed by Stanford University (2nd) and MIT Sloan (3rd).

The University of Virginia Darden School of Business entrepreneurship program, part of Batten’s Center for Entrepreneurial Leadership, is placed in a tie for 14th in the category. Last September, the

Saturday, March 26, 2011

Nursing Diagnosis for Risk for Imbalanced Body Temperature

NANDA Definition: At risk for failure to maintain body temperature within a normal range

Risks for altered body temperature exist for all persons, but some situations and individual physical capacities place greater risk on certain individuals. Neonates and elderly patients are physically incapable of compensating for environmental exposures and are at greater risk in life-threatening events. Healthy persons, such as the athlete who is performing under extremely hot conditions, are also at risk. Prevention is accomplished by providing education specific to individual needs. For the hospitalized patient, the nurse must recognize potential risks related to the diagnosis and the treatment a patient is receiving.

NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Risk Control
* Risk Detection
* Immune Status

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Temperature Regulation

Nursing Diagnosis for Anxiety

NANDA Definition: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response (the source often nonspecific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. It is an alerting signal that warns of impending danger and enables the individual to take measures to deal with the threat.

Anxiety is probably present at some level in every individual’s life, but the degree and the frequency with which it manifests differs broadly. Each individual’s response to anxiety is different. Some people are able to use the emotional edge that anxiety provokes to stimulate creativity or problem-solving abilities; others can become immobilized to a pathological degree. The feeling is generally categorized into four levels for treatment purposes: mild, moderate, severe, and panic. The nurse can encounter the anxious patient anywhere in the hospital or community. The presence of the nurse may lend support to the anxious patient and provide some strategies for traversing anxious moments or panic attacks.

NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Anxiety Control
* Coping

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Anxiety Reduction
* Presence
* Calming Technique
* Emotional Support

* Defining Characteristics: Physiological:
o Increase in blood pressure, pulse, and respirations
o Dizziness, light-headedness
o Perspiration
o Frequent urination
o Flushing
o Dyspnea
o Palpitations
o Dry mouth
o Headaches
o Nausea and/or diarrhea
o Restlessness
o Pacing
o Pupil dilation
o Insomnia, nightmares
o Trembling
o Feelings of helplessness and discomfort
* Behavioral:
o Expressions of helplessness
o Feelings of inadequacy
o Crying
o Difficulty concentrating
o Rumination
o Inability to problem-solve
o Preoccupation

* Related Factors: Threat or perceived threat to physical and emotional integrity
* Changes in role function
* Intrusive diagnostic and surgical tests and procedures
* Changes in environment and routines
* Threat or perceived threat to self-concept
* Threat to (or change in) socioeconomic status
* Situational and maturational crises
* Interpersonal conflicts

* Expected Outcomes Patient is able to recognize signs of anxiety.
* Patient demonstrates positive coping mechanisms.
* Patient may describe a reduction in the level of anxiety experienced.