Electrolyte imbalances

Electrolyte imbalances:

1. Hyperkalemia
2. Hypocalcemia
3. Hypoalbuminemia
4. Increase serum creatinine
5. Hyponatremia
6. Hypoproteinemia

Clinical measurements
Three simple clinical measurements that we can initiate without a physician order are daily weights, vital signs, and fluid intake and output.

1. Daily weights
Daily weight measurements can provide a relatively accurate assessment of patient fluid status. Each kilogram (2.2 lb) of weight gained or lost of equivalent to one liter of fluid gained or lost. To obtain accurate weight measurements the nursing responsibility is the nurse should balance the scale before use and weigh the client:
a. At the same time each day, (eq, before breakfast and after the first void)
b. Wearing the same or similar clothing
c. And on the same scale.
The type of scale (i.e. standing, bed, chair) documented.

2. Vital signs
Monitor vital signs regularly, because changes in the vital signs may indicate fluid, electrolyte, and acid base balances or compensating mechanisms for maintaining balance:
 Checked temperature regularly, because elevation in body temperatures may be a result of dehydration or a cause of fluid balance problems.
 Checked pulse rate regularly, because tachycardia is one of the first signs of hypovolemia, irregular pulse rates may occur with potassium imbalances.
 Checked respiration regularly, because changes in respiration rates and depth may cause respiratory acid base balances or act as a compensatory mechanism in metabolic acidosis.

3. Fluid intake and output chart
Intake
 Convert household measures such as a glass, cup, or soup bowl to metric units.
 Records intake each time.

Output
Wear gloves and measure the following fluids:
 Record the amount of urine from catheter and bilateral percutaneous nephrostomy at the end of the shift and records the 24 hours total on the clients graphic sheet.
 Compares the total 24 hours fluid output measurement with the total fluid intake measurement to determine whether the fluid out put is proportional to fluid intake.

Physical Examination
Skin turgor
Skin turgor is an indication of interstitial fluid volume and skin elasticity. Edema is associated with fluid volume excess or decrease oncotic pressure due to loss of albumin.
 Check for pitting edema.
 Check for decrease or increase skin turgor.

Neuromuscular irritability
Because imbalance of calcium, the nurse assess the client for increased or decreased neuromuscular irritability.
 Assess Chvostek’s sign, the nurse percusses ( taps) the facial nerve about 2 cm anterior to the earlobe. A positive response that is unilateral twitching of the facial muscles, including the eyelids and lips, indicate hypocalcemia.
 Assess Trousseau’s sign, places a blood pressure cuff on the area and inflates the cuff above the systolic for 2-3 mmhg, if develop carpal spasm or tetany indicate or possible hypocalcemia.

Stress out of communication

Review dari artikel referensi, ada dua jenis gaya komunikasi dan efeknya
terhadap pasen, pertama perawat dan health care provider memakai gaya
komunikasi biomedikal atau tradisional dengan pendekatan close ended
komunikasi dan pertanyaan tertutup yang berfokus hanya merespon keluhan
pasen tanpa dan sedikit melibatkan partisipasi pasen, dan berkomunikasi
tatkala ada prosedur dan tindakan yang kadang tidak manusiaw., Yang
kedua memakai pendekatan gaya komunikasi biopsikososial yang melibatkan
pasen aktif dalam komunikasi, memutuskan sesuatu yang berhubungan dengan
perawatan pasen. Menurut hasil riset, gaya komunikasi kedua memiliki
beberapa nilai positif diantaranya meningkatkan kepuasan pasen dalam
pelayanan kesehatan, meningkatkan ketaatan dan kepatuhan pasen dalam
pengobatan dan meningkatkan kesembuhan sakit pasen. Pengalaman
dilapangan sebagian besar gaya komunikasi kita mengarah ke gaya pertama
disebabkan karena beberapa faktor; language barrier contohnya, bahasa
arab dan bahasa inggris menjadi kendala kita untuk menerangkan dan
menjelaskan lebih detail dengan bahasa kesehatan kepada pasen yang
berbeda bahasa ibu dan bahasa nasionalnya dengan kita. Selanjutnya, kita
tidak mau diambil pusing sama pasen, dengan banyaknya menerangkan dan
berkomunikasi membikin pasen banyak bertanya dan merintah yang kdang
bukan garapan atau job description kita, contoh gaya orang Mesir, tidak
cukup diterangkan satu kali, mereka akan bertanya berkali-kali dengan
pertanyaan yang sama, yang akhirnya waktu kita juga terbuang padahal
pekerjaan lain menanti, padahal kalau ditelaah salah satu yang
ditanyakan sama mereka adalah pertanyaan garapan profesi lain yang
karena kurangnya komunikasi kepada pasen akhirnya pasen kebingungan dan
bertanya kepada kita, misalnya pasen diadmit di rumah sakit hari ini
untuk jadwal operasi besok, tapi tidak mempunyai pengetahuan dan tidak
di kasih tahu tentang jenis operasi, anesthesia, siapa dokter yang mau
mengoperasi dia, resiko, lamanya tinggal setelah operasi, dll, sampai
informed consent yang harusnya kita sebagai witness akhirnya mengerjakan
tugas limpahan dari mereka karena kondisi, yang sebagian besar waktu
kita terfokus dan mengerjakan tugas limpahan, apakah kondisi ini dapat
diterima secara professional? sehingga secara otomatis kita terjebak
kepada komunikasi gaya pertama.
Wassalam

MENTAL ILLNESS COMMON IN RETURNING SOLDIERS

NEW YORK: High rates of mental health disorders are being diagnosed among US military personnel soon after being released from duty in Iraq and Afghanistan, according to investigators in San Francisco. They estimate that out of 103,788 returning veterans, 25 percent had a mental health diagnosis, and more than half of these patients had two pr more distinct conditions.
     Those most at risk were the youngest soldiers and those with the most combat exposure, Dr. Karen H. Seal at the Veterans Administration Medical Center and Associates report in the Archives of Internal Medicine.
     Seal’s group based their findings on records of US veterans deployed in Iraq and Afghanistan who were seen at VA health care facilities between September 2005.
In addition to the high rate of mental health disorders, about one in three (31 percent) were affected by at least one psychosocial diagnosis.
The most frequent diagnosis was post traumatic stress disorder. Other diagnoses included anxiety disorder, depression, substance use disorder, or other behavioral or psychosocial problem.
     The researchers observed very little difference between men and women, racial and ethnic subgroups, and those on active duty and National Guard or Reserves.
     “the youngest group of active duty veterans (age,18 to 24 years) had significantly higher risk of receiving one or more mental health diagnoses and post traumatic stress disorder compared with active duty veterans 40 years or older.” Seal and her colleagues write. The research team maintains that enhanced prevention, detection, and treatment of mental health problems “should be targeted at the youngest…veterans, ”especially those who were on active duty. Reuters

    

QUICK WALK COULD HELP SMOKER QUIT

London: As little as five minutes of exercise could help smokers quit, says new study. Research published in the international medical journal Addiction showed that moderate exercise, such as walking, significantly reduced the intensity of smoker’s nicotine withdrawal symptoms. “ If we found the same effects in a drug, it would immediately be sold as an aid to help people quit smoking, “Said Dr Adrian Taylor, this study’s lead author and Professor exercise and health psychology at the university of Exeter.




Taylor and colleagues received 12 papers looking at the connection between exercise and nicotine deprivation. They focused on exercises that could be done outside a gym, such as walking and isometrics, or the flexing and tensing of muscles. According to they research, just five minutes of exercise was often enough to help smokers overcome their immediate need for nicotine fix. After various types of moderate physical exercised reported reduced a desire.

Minor burns management

Thanks to my friend for asking the article about burns and muscle injury in the previous post, at this moment i would like to present to you about burns management.According so many types of burns which is frequently complicated by presence of fire, an explosion, electricity, smoke, toxic fumes, or other hazards, and because burns can be very distressing, and both you and the casualty may be upset by the smell of singed hair and burned flesh, so i am going to specify to manage minor burns and scalds.

Assessing a Burn

Before treating a burn, it is important to consider the extent and the depth of the burn, its cause, and wether the airways is affected.
Once you are able to establish the cause of the burn, you can decide on the treatment. If the airway has been injured, the casualty may experience breathing difficulties, which will require urgent attention.

Minor Burns and Scalds

Small, superficial burns are often caused by domestic accidents. Most can be treated by a First Aider and will heal naturally. If you are in any doubt as to the severity of the injury, seek medical advice.

Treatment

your aims are:

> To stop the burning.
> To relieve pain and swelling.
> to minimise the risk of infection.

1. Flood the injured part with cold water for at least ten minutes to stop the burning and relieve the pain. If water is not available, any cold, harmless liquid, such as milk or canned drinks, will do.

2. Gently remove any jewellery, watches, belts, or constricting clothing from the injured area before it begins to swell.

3. In some country MEBO (moist exposure burn ointment) is available in the pharmacy, so we can apply gently before covering by steril gouze, or it can be exposed if minor burn only occur.

4. Cover the area with a sterile dressing, or any clean, non fluffy material, and bandage loosely in place. A plastic bag or some kitchen film makes a good temporary.

5. If you identify as Severe burns, immediately to gather relevant information for emergency services and arrange to removal to hospital.

Caution:

DO NOT break blisters or otherwise interfere with injured area.
DO NOT apply adhesive dressing or adhesive tape to the skin; the burn may be more extensive than it first appears.

BLISTERS:
Thin "bubbles", known as blisters, form on skin that has been damages by heat or friction. they are caused by tissue fluid (serum) leaking into the burned area below the skin's surface. During healing, new skin forms at the base of the blister; the serum is re-absorbed and the outer layer of dead skin will eventually peel off.

Good luck, so you can be a doctor at home or workplace to give first aid.

First aid; Effect of extreme cold

The body reacts to cold by shutting down blood vessles in the skin to stop "core heat" escaping. When deprived of warm blood, extremities such as finger or toes may freeze in severe conditions, causing frostbite. If the body's core temperature becomes dangerously low, bodily functions slow down (hypothermia) and may cease altogether.

Frosbite
This condition usually occurs in freezing and often dry and windy conditions. Those who cannot move are particularly vulnerable. The tissues of the extremities freeze-in severe cases this can lead to permanent loss of sensation and, eventually, gangrene.
Frostbite is often accompanied by hypothermia, which should be treated accordingly.
Recognition
There may be:
> At first, "pins and needles".
> A hardening and stiffening of the skin.
> A colour change to the skin of the affected area: first white; then mottled and blue; and eventually black;on recovery,red,hot,painful, and blistered.

Treatment
your aims are:
> To warm the affected area slowly, to prevent further tissue damage.
> To obtain medical aid if necessary.

1. Very gently remove gloves, rings, and any other constructions, such as boots. Warm the affected part with your hands, in your lap, or in the casualty's armpit. Avoid rubbing because it can damage skin and tissues.

2. Move the casualty into warmth before you thaw the affected part; carry her if possible when the feet are affected.
3. Place the affected part in warm water. Dry carefully, and apply a light dressing of fluffed-up, dry gauze bandage.
4. Raise and support the limb to reduce swelling. An adult casualty may take two paracetamol tablets for intense pain. Take or send her to hospital, if necesarry.

Leptin: The Weight-Loss Hormone

Despite day-to-day variations in food intake and physical activity, a healthy individual maintains a constant body weight and energy reserves of fat over long periods. Clearly, long-term negative feedback mechanisms are at work, but until recently scientists did not understand them. With the discovery of the hormone Leptin ( from the Greek word leptos, meaning thin), researchers have been able to piece together one long adypocytes, the cells in adipose tissue. Fat storage that occurs when food intake exceeds the body's demands stimulates adipocytes to release more leptin into the bloodstream. Centers in the hypotalamus respond to the increased leptin by decreasing food intake and increasing food intake and increasing energy expenditure, which result in weight loss. If this feedback mechanism is disrupted, obesity wil result. For example, mice with a genetic mutation that prevents them from making leptin are obese. Injecting the mice with leptin causes them to lose weight.
After discovering leptin and demonstrating that it could reverse obesity in genetically obese mice, researchers hoped that leptin cold be used to treat obesity in humans. It is now known that unlike genetically obese mice, the vast majority of obese humans are able to make leptib. Human obesity appears to be caused by an inability of the hypotalamus to respond to leptin, rather than our inability to make the hormone.