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Answers to Your Nursing Career Questions

Recognizing and Treating Impetigo

January 8th, 2011 by – Sue Barton

  What does impetigo look like?  Do topical corticosteroids work for impetigo?

Impetigo is a bacterial infection of the skin and needs to be treated with antibiotics.  Topical steroids reduce inflammation, but do not have any antibiotic properties so they are not an appropriate treatment for impetigo.

Impetigo is most commonly seen in children, although it can occur in adults.  Wrestlers are prone to skin infections, among them impetigo, due to skin to skin contact and skin to mat contact.  Impetigo is caused by the staph and strep bacteria that are commonly found on the skin.  Often irritated skin ( for example on the face of a child who has a runny nose, or dry skin related to eczema, or in the diaper area) provides a portal of entry for these common bacteria to develop into an impetigo rash.  The rash may initially look like a few red pimples or pustules. These lesions quickly progress into the the classic impetigo rash, which has a red base topped by a honey colored crust.

Impetigo is notoriously contagious, so good hand washing and hygiene are important along with prompt treatment.  Over the counter antibiotic products have some value, but prescription mupirocin ointment or cream is specific to the bacteria involved.  More extensive areas of involvement may require a course of oral antibiotic , such as cephalexin.

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Troubleshooting Anemia

January 7th, 2011 by – Derek Brocklehurst

What are some nursing care plans for patients with anemia?

Anemia, or a decrease in hemoglobin and red blood cell count, can greatly affect a patient’s vital signs, organs, and breathing. It’s important to monitor hemoglobin, hematocrit, and red blood cell counts in various patient populations, including (but not limited to) immunocompromised patients, those with chronic conditions, patients receiving blood transfusions, sickle cell patients, anorexic patients, and elderly patients.

Red blood cells and iron are the sole means of transport for oxygen into all organs. If a patient is anemic, you would worry about a patient’s breathing and whether or not organ systems are getting an adequate amount of oxygen. Some early signs of anemia include overall pallor, squeezing the fingernails with a delayed capillary refill, and increased respiration rate.

Anemia is treatable and reversible when caught and diagnosed in time. Iron supplements might be required over a long-term period or, depending on the patient’s prognosis, for the rest of their life. A blood transfusion to get more red blood cells into the patient’s body might be required if the anemia is advanced. If you suspect laboratory values are deviated and you’re unsure of the reason, make sure to speak with the primary care provider for the patient and get them treated as soon as possible!

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Posted in Common Nursing Procedures, General

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Hand Washing 101 for Nurses

January 7th, 2011 by – Marijke Durning

Earlier this week, you read about washing your hands (Hand Washing Audits for Nurses) and while hand washing is a common, almost natural thing to do, it appears that many people – including nurses – aren’t properly washing their hands or are not washing them at all. Only half of the nurses in the study mentioned washed their hands. This finding improved after a six-week hygiene-training program, but not to 100 percent. When it comes to hand washing, nurses should score 100 percent. Always.

When to Wash Your Hands

Some of the times when you must wash your hands are patently obvious, but again, it’s disturbing to know how many people don’t do this very simple task. For best hygiene practices, you should wash your hands before:

– Eating or drinking yourself
– Giving medications
– Leaving your floor/unit
– Preparing a snack or meal tray, or a drink
– Touching a patient

You should always wash your hands after:

– Arriving home
– Coming in from outside the facility
– Dealing with any type of body fluid, a patient’s or yours,  including coughing into your hand
– Feeding a patient
– Handling animals including assistance animals
– Taking off your gloves (gloves are not 100 protective)
– Touching a patient
– Touching trash
– Using the toilet

How Do You Wash Your Hands?

Most nursing stations and many public sinks in hospitals have posters to remind people to wash their hands, but not everyone knows how to do this properly. If you have to explain hand washing to someone, here is an example you may use:

Soapless or alcohol hand cleansers are an excellent way to wash your hands if they are not visibly dirty. In fact, it’s been found that they do a better job of cleaning in these situations than soap and water. The motions of how to clean your hands with these cleansers are the same as with soap and water.

For the most effective hand washing:

1- Remove any rings and jewelry, including watches and bracelets
2- Use warm running water (not too hot) to wet your hands thoroughly
3- Apply the soap to your wet hands and lather them thoroughly over a period of  15 to 20 seconds
4- While you will instinctively rub your palms together and go over the tops of your hands, don’t forget to go in between the fingers, down to the web, particularly between the thumb and pointing finger. Remember to clean your fifth finger and your wrist. Finally, be sure to get under your nails.  This should take at least 30 to 60 seconds
5- Once you have finished washing your hands, gently pat them dry. Don’t rub them vigorously as this is irritating to your skin. If possible, use an individual paper towel. If you are at home, try having individual hand towels for each person in your household.

    If you are using a soapless cleanser,  you follow the same cleaning motions as with the soap and then allow your hands to dry naturally. Don’t rub them on your clothing to speed up the drying process.

    Hand washing, as basic as it is, is the foundation of good health care and health promotion. We should be vigilant about including it all the time.

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    Posted in Common Nursing Procedures

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    Eating Disorder Evaluation

    January 6th, 2011 by – Sue Barton

      What labs are important in the assessment of the patient with an eating disorder?

    Patients with an eating disorder may be anorexic, bulimic or may have a combination of these symptoms.   Restrictive eating patterns or binging and purging behaviors are symptomatic of the patient’s refusal to maintain a normal weight.  While  laboratory tests are typically done as part of the evaluation, in most cases the results are within a normal range and do not contribute substantially to the evaluation or treatment plan.

    Baseline lab testing should include a urinalysis, a complete metabolic profile, and a complete blood count with differential. The primary purpose of these tests is to rule out another cause for the weight loss, and to screen for complications. Bulimic individuals are most at risk of abnormal electrolyte values because of the vomiting nature of the disorder.  Bulimics may also have an elevated serum amylase level. It is also worthwhile to look for anemia secondary to iron deficiency. Bone density testing is often done at some point, since eating disorders can put patients at risk for osteoporosis.  Hormone levels may be ordered if there is amenorrhea, especially in the case of an adolescent who has not yet established regular menstrual cycles.

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    Pressure Ulcer Care

    January 5th, 2011 by – Derek Brocklehurst

    What is the proper nursing care for pressure ulcers?

    Pressure ulcers continue to be a problem in the hospital in-patient setting. Pressure ulcers are, for the most part, iatrogenic, meaning they begin in the hospital setting. They are preventable and avoidable if the proper nursing care is administered.

    Elderly patients, patients with mobility problems, bed-ridden patients, and immunocompromised patients are all at an increased risk for forming ulcers. To prevent pressure ulcers, you want to perform regular and comprehensive skin integrity assessments. Check for erythematous areas of the skin near the lower back, buttocks, back thighs, shoulder blades, heels of the feet, and any other noticeable pressure points on the body. Check to see that the patient is repositioning themselves often enough while in the bed.

    Once pressure ulcers have formed, prevent them from worsening. Change positioning of the patient every 4-6 hours. Be sure to use proper ergonomics as you do not want to injure your back in the process. Ask another nurse for help if needed. Debridements, cleansings of the wound, and antimicrobial therapies will also aid in the healing process. Make sure you consult a dietitian for optimizing the patient’s diet (high in protein) during times of wound healing and care.

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    Posted in Common Nursing Procedures

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    Hand Washing Audits for Nursing – Results Frightening

    January 5th, 2011 by – Marijke Durning

    Do you remember the first practical thing you were taught when you were a nursing student? Chances are, whether you were working to become a registered nurse, licensed practical nurse or even a certified nursing assistant (CNA) , you likely first learned how to wash your hands.

    How many of you groaned when you were told you’d be learning something so fundamental, so basic? How many of you were observed washing your hands and then were told by your nursing instructor that you were doing it improperly? After all, we’ve been washing our hands all our life, right? Unfortunately, no matter how long we’ve been washing our hands and  how we were taught to do it in nursing school, hand-washing audits still reveal there are nurses and other medical staff who aren’t washing their hands often enough and/or properly. Scary, isn’t it?

    A 2005 Journal of Advanced Nursing article published a study with sobering facts. The findings come from more than 150 staff members who were asked questions both pre- and post- a six-week hygiene program. About two-thirds of the staff members were nurses. According to the journal article:

    - Nurses washed their hands appropriately in 50 percent of cases before the program; this rose to 83 percent afterward
    Doctors hand washing was at 31 percent before education; this rose to 55 percent thereafter
    Hand washing of staff between visits to one patient and then another was  at 48 percent before education; this changed to 93 percent afterward
    Hand washing after touching bodily fluids was a low 42 percent before education; this rose to 75 percent thereafter

      The disturbing thing here is that everyone who trains in health care is taught the importance of proper hand washing. Without proper hand washing, nurses can easily (and do) spread infection from patient to patient, from staff to patient, and from patient to staff. In this day and age of stronger bacteria and more virulent viruses, this is a serious matter.

      Interestingly, the two groups of staff who had the best hand washing rates were physiotherapists and care assistants. One could argue that they may have more time to do so and that nurses are overloaded with patients, but that’s not a valid argument. Most facilities now have soapless cleansers available throughout wards and units precisely to allow for frequent hand cleaning.

      So what about you? Do you wash your hands as often as you should be? Have you ever been audited to see just how often you do this?

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      How to Use Topical Corticosteroids

      January 4th, 2011 by – Sue Barton

        How do I use topical corticosteroids?

      Topical corticosteroids are anti-inflammatory agents that are used in cream, ointment or lotion form by application to the skin.  They are best used on a short term basis to relieve inflammatory skin conditions caused by allergy or atopic disease.  Topical corticosteroids are available in a range of potency from low and intermediate to high and super-high.  One percent hydrocortisone is available without prescription; higher potency is available by prescription only.  Potency is also affected by the vehicle of use: ointments being more potent that creams.  Occlusive coverings or dressings also increase potency of the medication.  The lowest strength that is effective should be used.  Avoid using higher-strength products on the face, in body folds and with children.

      Topical corticosteroids may be applied two 0r three times daily depending on the preparation.  Usually only a small amount of the product is needed as it is rubbed into the skin.  Continuous use of topical corticosteroids, especially of higher potency products, can lead to skin atrophy as well as acne-like reactions, striae and changes in pigmentation.

      It’s important to maintain a good skin care regiment to minimize the need for corticosteroid use. However, wisely and appropriately used, these agents provide effective relief for a range of dermatological conditions.

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      Nursing Student Expelled for Placenta Photo on Facebook

      January 4th, 2011 by – Marijke Durning

      As nurses, we all know the importance of HIPAA, the Health Insurance Portability and Accountability Act, in health care today. In the past, too many people were accessing and sharing information about patients without their express permission, and HIPAA was created to prevent this. HIPAA seems particularly crucial in the age of social media since nurses and health care workers are privy to very private information about patients. But how far does HIPAA go and when is too far really too far?

      Student nurses and licensed nurses have been disciplined in various facilities for posting inappropriate comments or photos on social media websites like Facebook. Sometimes the posts are direct HIPAA violations, but other times they create questionable judgment calls. We like to think that we learn from mistakes, but there always seems to be another story of a nurse or a nursing student who ends up in trouble.

      Enter the newest member of that dubious club, a 22-year-old female student named Doyle Byrnes, who was in a registered nurse program in a community college in Kansas. According to a Wall Street Journal news article, Byrnes was dismissed from the program  for posting a picture of herself with a placenta on her Facebook page. She is now seeking a reversal of that court decision. She claims in a lawsuit that the photograph did not violate any of the school’s policies and that she had the alleged approval of the instructor, the WSJ article states.

      There could be discussion about the appropriateness of such a photo: some may find it distasteful while others do not.  To top it off, she wasn’t the only one taking photos; three others were as well, according to the WSJ. They were all kicked out of the program, but will be eligible to reapply in August of 2011, according to the piece.

      What do you think? Should Byrnes have been kicked out of the program? If she is allowed back in, do you think she’ll be treated fairly or will she have a mark on her back?

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      Posted in Nursing School

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      Nursing School for Labor/Delivery Nurses

      January 3rd, 2011 by – Derek Brocklehurst

      How long does it take to become a deliver/labor nurse?

      In order to become a registered nurse, RN,  in any specialty, it takes anywhere from 18 months to four years depending on previous education, degrees received and degree sought.

      If you are new to nursing and fresh out of high school, you can apply to community college or associate’s degree programs. These are also about two years in length. If you are working at a hospital you can apply to the diploma program and receive a diploma degree to practice as an RN. These programs are typically two years in length.

      If you want to learn more about nursing theory and are interested in nursing leadership or administration, you can apply to four-year-long bachelor’s degree programs. These focus more heavily on nursing theory and leadership courses, as well as including clinical rotations.

      If you already have a bachelor’s degree, you can apply to accelerated nursing school programs and become an RN in as few as 18 months. For most accelerated programs, you need some basic science classes, such as anatomy and physiology,  in order to apply.

      Make sure to check out Medi-smart’s nursing schools and programs directory for more information about different programs around the country!

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      Non-Latex Condoms

      January 1st, 2011 by – Derek Brocklehurst

      I’m still a virgin and I wanted to know what type of condom would be right for my first time because I am allergic to latex. Can you help me out please?

      This is a great question. The only way to prevent unwanted pregnancies and sexually-transmitted infections  called STIs, including HIV, is to abstain from sex until you are in a committed and monogamous relationship where both partners have been tested. That being said, condoms are the best protection if you choose to start having sex with someone. Condoms, when used properly, can prevent pregnancies and most STIs.

      While it is true that most condoms are latex, there are condoms available that are made of non-latex materials, including polyurethane, lambskin, sheepskin, and polyisoprene. Lifestyles brand condoms provide a new, clinically tested polyisoprene condom.

      If you begin having sex, make sure you have the education and knowledge you need to start having safe sex. Visit your primary care provider, school nurse, guidance counselor, or local public clinic to ensure your health and protection in this new and oftentimes nerve-wracking voyage.

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