dealing with stroke patient

Stroke is the primary cerebrovascular disorder in the world is the third leading cause of death in the United States. It refers to a functional abnormality of the central nervous system caused by a disrupted oxygen supply. Stroke can be divided into two major categories: ischemic and hemorrhagic.



To give a short background, Ischemic Stroke happens when there is an occlusion to any brain vessels that leads to depleted oxygen supply, hence, brain nerves dies. Hemorrhagic stroke in the other hand is a rupture of a brain nerve that leads to extravasation of blood into the brain. Although the two types have some differences in terms of its etiology, pathophysiology and medical or surgical management, the have almost the same clinical manifestation and nursing management.


One of the most debilitating complications of stroke is motor dysfunction manifested by weakness and paralysis of the face, arm, and leg on one or both side occurs. This makes the patient to be bed ridden. It is then the responsibility of the health care giver to improve the patient’s mobility and to prevent joint deformities.


NURSINGINTERVENTION


IMPROVIG MOBILITY AND PREVENTING JOINT DEFORMITIES


To deal with this, here is the list of interventions the caregiver might consider.

1. CORRECT POSITIONING. Correct positioning is important to prevent contractures. During each patient contact, position of the patient should always be evaluated. The most common positions that patients assume in bed are supine side-lying, and prone. The healthcare giver helps the patient assumes this position by using pillows and sometimes splints to prevent joint deformities.




2. PREVENT EXTERNAL ROTATION OF THE HIP. The patient who is confined to bed for longer period may develop external rotation deformity of the hip due to the tendency of the hip to rotate outward when the patient in supine position. Nurse or the caregiver must use trochanter roll to prevent this deformity. With correct placement, it serves as a mechanical wedge.


3. PREVENTING FOOTDROP. Footdrop is a deformity in which the ankle bends in the direction of the sole of the foot. Because of this, the patient will not be able to hold the foot in a normal position and will be able to walk only on his or her toes. To prevent this deformity, the patient’s feet should be kept in right angles relative to the legs by using padded splints. Precaution should be observed for positioning devices may cause unwanted pressure areas. The patient is assisted to perform ankle exercises several times each hour.


MAINTAINING MUSCLE STRENGHT AND JOINT MOBILITY


Optimal function depends on the strength of the muscles and joint motion. Range of motion exercises and specific therapeutic exercises must be included.


1. PERFORMING RANGE OF MOTION EXERCISES. Range of motion exercises may be active, assisted or passive. Unless prescribed, exercises must be made at least three times a day. The joint to be exercised is supported and the bones above the joint are stabilized. A joint should not be moved beyond its free range of motion and is only moved to the point of resistance and stopped at the point of pain.


2. PASSIVE RANGE OF MOTION. To perform passive or assisted range of motion, the patient must be in a comfortable position with the arms at the sides and the knees extended.


POSITION CHANGES


The patient’s position should be changed every 2 hours.

I HEAT YOU

We all experience environmental emergencies. These refer to urgent medical situation due to environment factors such as extreme environment temperature, drowning, anaphylactic reactions due to insect and animal bites. Of all, the most common is the heat stroke.

HEAT STROKE.

Heat stroke is an acute medical emergency caused by failure of our body’s heat regulating mechanism of the body. It usually occurs when extreme heat waves accompanied wit high humidity occurs. People prone to this are the elderly, very young, those who have underlying medical conditions and those who are taking certain medications.

CLINICAL MANIFESTATIONS.

Suspect heat stroke when you are experiencing any of these:  profound central nervous system dysfunction manifested by sudden impaired consciousness, confusion delirium, elevated body temperature (40⁰C or higher), hot, flushed and dry skin, absence of sweating, palpitations and difficulty of breathing. Go to the nearest hospital for prompt treatment or do any of the following home measures:

HOME TREATMENT.

1.       Remove all the patient’s clothing.

2.       Cool sheets and towels are provided to the patient. Continues rubbing of sponge wit cool water is advised.

3.       Ice wrapped to a cloth must be applied directly to the neck, groin, chest, and axillae of the patient. Precaution must be observed specially for patients with impaired sensory functions.

4.       Provide cooling blankets if available.

5.       Immerse the patient in a cold water bath with extreme precaution.

6.       Position an electric fan directly to the patient.

If after all of the above strategies fails to decrease the patient’s temperature, rush the patient to the nearest hospital.

On the other hand, below is the list of the different ways to prevent Heatstroke.

1.       Avoid exposure to immediate temperature and reduce activity in hot weather.

2.        Increase your fluid intake.

3.       Wear loose clothing.

4.       Plan outdoor activities and avoid the hottest part of the day usually between 10:00 am to 2:00pm.

Inflammed sinuses

Christmas is now just around the corner. All of us can now feel the cool breeze touching our skin early in the morning. And even though majority of us are now busy looking for the gift to buy or is busy putting home decorations, some of us, are unfortunately confined to bed. The cool and moist environment are bringing not just chills but also upper respiratory tract infections - the most common reason for hospital confinement during this season.

SINUSITIS -  an inflammation of the sinuses that is may be due to infection or allergies which commonly occur during cold season. The sinuses are cavities in the head lined with mucuos membranes. The functions of it includes humidification of the air inspired, lightening of the skull and absorption of shock to the face or skull.

SIGNS AND SYMPTOMS 

• In adult, the key symptom is pain in the cheekbones and upper teeth, in the forehead  over the eyebrows or around and behind the eye.
• In children, a chronic stuffy nose is a common symptom.
• If the sinuses are infected, fever may be present.
• sore throat or cough specially when post nasal drip occur.
• Sinus headaches may occur on rising and get worse in afternoon or when bending over

HOME TREATMENT 

• Drink extra fluids to keep mucus thin.
• Breathe moist air from a humidifier, hot shower, or a sink filled with hot water.
• Take oral decongestnt as prescribed. However, avoid products containing antihistamines.
• Take acetaminophen or ibuprofen for headache.
• Check the back of your throat for postnasal drip,  if the streaks of mucus appear, gargle with warm water to prevent sore throat
• Elevate your head at night
• Consult doctor if the condition worsens

foreign objects

Children are usually the victim of the foreign objects since they put almost anything inside their mouth, nose, ears and even in their eyes. Parents would not eventually notice it until the child complains of pain on the affected area. Below are the initial steps to consider when a foreign object was seen inside your child's body.

OBJECTS IN THE EAR

Small objects and insects are the common objects that get stucked in the ear. Before trying to remove them inside the ear, it is important that you know the anatomic picture of the ear.

the ear canal and the eardrum as seen in the picture above are sensitive part of the ear, hence, enough care must be taken not to damage this area.

HOME TREATMENT

• DON'T try to kill an insect in the ear. Instead, pull the ear up and back and with a gentle shake,  foreign objects or insects may roll or slide out of the ear. 
•  If the object is soft and can be easily seen, try CAREFULLY to remove it with tweezers.
• DON'T instill any mineral, olive oil or baby oil inside the ear for the object trapped inside, specially if it is a bea, may increase in size.
• If the object or the insects are too deep and you can't see it, bring the child to the nearest hospital.

OBJECTS IN THE EYE

Dirt and small objects in the eye will often wash out with your tears. However, if the objects is not removed, it may damage the cornea or the eye covering of the eye. see the picture below.

HOME TREATMENT

• DON'T rub theeye for it might scratch the cornea. Parents may have to restrain their chilldren's hand to avoid accidental eye rubbing.
• DON'T try to remove the object with using pointed objects nor your bare hand.
• If the objects is at the side of the eye or on the lower lid, moisten a ottown swab or the tip of a twisted piece of tissue and touch the end of the speck, the object should cling to the swab or tissue.
• Genty wash the eye with cool water. An eyedrop helps
• Keep your eye gently closed. Excessive blinking could cause more irritation and discomfort.
• If the object is on the pupil or is embedded  in the eye, if pain persisit and vision started to blur, bring the patient to the nearest hospital.

OBJECTS IN THE NOSE

Children also put objects inside their nose. This might get unnoticed not until a foul smelling yellowish or greenish discharge comes out from nostril. The nose may also be tender and swollen.

HOME TREATMENT

•  Spray a nasal decongestant in the affected nostril to reduce the swelling.
• Have the child pinch the other nostril closed and try to blow  the object out.
• If you can see the object, try to remove it with blunt-nosed tweezers. Hold the child's head sll and use care not to push the object further.
• If you are unable to remove the object after several tries and the patient complains of difficulty of breathing, bring the patient to the hospital.

eczema vs. you

We all want to have a healthy skin. It doesn't necessarily need to be young looking or as soft as the baby's skin but at least it must be a skin that is free from any rashes, redness, scales, and lumps. Unfortunately, getting a glowing skin is quite difficult to achieve since there are numerous skin problems that exist. Among the most common is the ECZEMA.

Eczema or medically known as atopic dermatitis is a CHRONIC SKIN DISORDER which means that once you have it, you will have it forever. It is common  in people with asthma, allergies and those with family history. The category of eczema usually relies on its clinical characterisics. However, the most common type is the ATOPIC ECZEMA.

The characteristic of a skin with eczema is moderate to severe itchiness, swelling, redness, dry and scaly. In children, Eczema appearsmost often on the face, scalp, buttocks, thighs and torso. In adults, it usualy affects the eck, inner arms, inside the elbows, and the back of the knee.

HOME TREATMENT:

1. Usually, severe itchiness is triggered by stress, infection, over infection and allergy. Hence, all these stimulants must be avoided.
2. Keep the skin moisturized.
3.Take a brief daily bath with lukewarm water.
4.Use hypoallergenic ang gentle soap.  Physicians, usually recommend the use of DOVE.
5. After bathing, pat skin dry , do not rub for it may contribute to swelling and redness. Apply lubricating cream  to keep the skin  from  drying out.
6. An oral histamine like Benadryl is prescribed  to relieve itchiness. However, antihistamines in cream form must be avoided for it may irritate the skin more.
8. Wash the clothes and the bed linens using a mild detergent, avoid fabric softener for it  is irritating.

WHEN TO CALL A DOCTOR

1.If crusting or sors with discharge appear, infection is present.
2. If a red patchy rash appears on the face accompanied by joint pain and fever
3. If itching can't make you sleep and it can now interfere with your daily responsibility.

combat the asthma now!

I know many people who are afflicted with asthma. Three of them are even my relative while the other one is my boyfriend. I've witnessed them grasping their breath as asthma episodically attacks them. They seem to be a helpless and defenseless victims, lying on their bed and attached to oxygen for survival.

Asthma is a respiratory condition where the air passageways narrows making the patient complains of difficulty of breathing. The narrowing of passageways may be due to several factors, with allergy being the most common. Allergens such as dust,pollen, mold and animal dander are the most common etiologic agent that triggers the attack of asthma. However, stress, infection, changes in weather may also contribute.

When asthma attacks, the airways became inflamed and constricted, muscles surrounding the air tubes go into spasm, the mucous lining swells and secretions build up. The victim would then experience difficulty of breathing accompanied with a whistling sound in inspiration. In severe cases, the patient may become bluish and might loss her or his consciousness.

Most of the attacks happen at home, hence, all of the family member must be knowledgeable and skillful enough to provide first aid treatment. Here is some of the important list, we must do when someone get's into attack

WHAT MUST BE REMEMBERED:

1. Loosen all constricted clothing and provide air ventilation by opening windows and use of electric fan.

2. Remove the patient from the reason of the attack i.e if the asthma was triggered with cigarette smoking.

3. Assist the patient in taking her or his inhaler. (Asthmatic patients usually carries with them their inhaler.)

4. If you have a nebulizer, have the patient nebulized.

If after all the above treatment and the condition worsen, it is strongly recommend to bring the patient to the nearest hospital.

attack the dengue

With the increasing reported cases of dengue virus for the past few months, no one can blame why most of the people are now freaking out. I, myself, even bought anti-mosquito bracelet, always apply and reapply repellent lotion and I was even thinking of using cloth detergents that claims to protect us from the attack of mosquitoes.

As the Department of Health states, the death toll of dengue fever in our country had already reached 500 with most of its victims belongs to the younger group of the population.

With these alarming facts, the best prevention is nothing but a good knowledge. As a registered nurse, having a good background with regard to this issue, let me then share what each of us ought to know.

1. The dengue virus is carried by a FEMALE ONLY mosquito.
2. These FEMALE ONLY mosquito are LOW-FLYING and attacks in the morning.
3. They breed in a CLEAN and STAGNANT water.
4. There is NO approve and tested vaccine for dengue virus.
5. The aim of treatment for dengue fever is avoidance of its complications.
6. There is really NO treatment regimen for DENGUE, only supportive and symptomatic treatment.
7. Dengue fever can be managed at home.

Many might ask how come a fatal disease like dengue fever can actually be managed at home. To be honest, there is really no definite treatment or drugs that can combat the dengue virus. Physician will only treat the arising complication and its symptoms. Paracetamol is given if the patient is febrile, antacids are prescribed for patients complaining of stomach pain. However, the center of the treatment is HYDRATION. If the patient is hospitalized, he or she is maintained on IVF. However, if the patient is treated at home, oresol solution is prescribed to take every 30 minutes.

Oresol Solution can be avail in the all leading drug stores, however, it would be good to know, how to make a home-made oresol solution. Just remember the formula of 1-8-1.

in a 1 liter of water, dissolve 8 teaspoon of white sugar and 1 tablespoon of salt. Make the patient drink at least two glasses of the solution every hour. The solution must be consumed in the span of 24 hours, nevertheless, it must be discarded.

I FAINT YOU!

Faintness is defined as a brief loss of consciousness. It is a general symptom rather than a specific illness. Usually faintness is precipitated with dizziness, light headedness, a spinning sensation, a tingling sound in the ear and sudden cool and clammy skin. Many medical cases are attributed with faintness. The most common of which is the sudden drop in blood pressure, an abnormally low level of blood sugar, decreased in red blood cell and some conditions like pregnancy and ear problems.

DROP IN BLOOD PRESSURE – if you experienced faintness after rising from a sitting or lying position then postural hypotension is most likely the cause of your faintness. This is due to the sudden pooling of the blood from the upper portion of your body to the lower portion of your body.
Home treatment: if you suffer from this type of faintness, make it a habit of changing position slowly. Give your time at least five minutes in every position change. When coming from a lying position, sit first and dangle your feet before standing up. If above treatment doesn’t help, lie down and raised your leg. Put pillow under your legs, it should be higher than your head.

LOW BLOOD SUGAR – if you are diabetic or it had been a long time since your last meal, the cause of your faintness may be due to low level of sugar in your blood. Accompanied with faintness is trembling, blurring of vision, slurred speech and headache.
Home treatment – If you are a diagnosed diabetic patient, you should wear diabetic wristband which could aid rescuers to diagnose the cause of your loss of consciousness. Along with this, you should always carry glucose tablets, sugar or candy and soft drinks which you can eat to prevent the attack.


DECRESED IN RED BLOOD CELL – Red blood cell carries and delivers oxygen to the different parts of the body including the major organs such as brain. A decreased in the number of red blood cell is then synonymous with a lack of oxygen in the body. If your body particularly your brain lacks oxygen, it won’t work properly, you might then feel dizzy and faint.
Home treatment – Normally, your physician will request a complete blood count. This diagnostic test would then confirm whether you lack RBC. Once diagnosed, you will be prescribed with iron vitamins. Along with this, you should eat foods high in iron content. Examples of these are the green leafy vegetables and organ meats.


General treatment – to help someone who suddenly fainted, check first is the patient is breathing normally. Lay the person on his or her back and raised her or his legs as high as possible. Loosen any tight clothing, open the windows to allow air ventilation or when you are outside, and remove the patient from direct sunlight. Once the person regain consciousness have her or him to remain on the lying position for at least 15-30 minutes and remind that he or she should slowly change his or her position very slowly.

Insomia - why can't you sleep

Has it been hard for you to fall asleep when you go to bed at night? Do you often wake up during the night or very early in the morning and finding it to go to sleep again? If your answer is yes then you might be suffering from insomnia, a medical condition which refers to difficulty in sleeping.
Many conditions may affect one’s sleep pattern. A diet high in caffeine, for example, may make you feel more energetic thus you will find it hard to sleep. Stress also has something to do with our sleepless nights. Studies shows that people who had been feeling tense during the day feel unrested the following morning even after an eight our of uninterrupted sleep. A full stomach late in the evening is also not conducive to sleeping for it cause your body works overtime. On the other hand, sleeplessness is quite normal if you are pregnant. The condition of a pregnant woman make it hard for her to get a comfortable position to sleep into Also, the movement of the baby may keep her awake the whole night. Furthermore, pregnant women normally urinate more frequent thus, a need to get up from bed every night and then.
It is recommended to observe your usual sleep pattern. List down when did you experienced difficulty in sleeping, what have you eaten or what did you do the entire day prior to sleeping. This information will be helpful for your doctor once you seek medical help. On the other hand, below are list of some tips that might help you to avoid sleeplessness yet a visit to your doctor is still advised.
1. Take a warm bath. A warm bath instead of a shower helps to relax your mind and body.
2. Read recreational books that are not associated with your work or study. This helps your mind to divert your attention and thinking from your work to a more calm ideas.
3. Try to find new activities to during your extra waking hours. Strenuous exercises made your body work harder that it will get tired and will require you to have it rested by getting a good sleep at night.
Every people has different regimen to help them rest at night. Some drink warm milk, some listen to a relaxing music, while some watched relaxing movies. Try to discover your own regimen, however if after every effort and still you feel restless at night, consulting your physician is highly recommended.