Archive | February 2024

Peri-anesthesia Nurse Awareness in February!

Feb17

The nation’s 60,000 perianesthesia nurses will highlight and celebrate their work during PeriAnesthesia Nurse Awareness Week (PANAW), which is observed throughout the United States the first full week of February.

Perianesthesia Nurses care for patients before and after procedures requiring anesthesia, sedation, and analgesia. Approximately 40 million surgical procedures take place in the U.S. each year.

What Does a Perianesthesia Nurse Do? The main responsibility of a perianesthesia nurse is to monitor patients who are recovering from anesthesia and medical procedures. To do this, they will regularly monitor and record patients’ vital signs, including heart rate, blood pressure, temperature, and respiration rate.
The core ideology of the American Society of PeriAnesthesia Nurses (ASPAN) is to serve nurses “practicing in all phases of preanesthesia and postanesthesia care, ambulatory surgery, and pain management.  The National Association of PeriAnesthesia Nurses of Canada (NAPAN©) promotes leadership to PeriAnesthesia nurses (from the PreAdmission/PreOperative Phase through to the Anesthesia Phase and all of the PostAnesthesia phases) in education, research and adapting to evolving practices in client and health services needs within the Canadian health care system.
This type of nursing usually includes at lease a associate degree or in certain hospitals a BSN degree in Nursing plus certifications for this area that has to be renewed q 2 years.  The certifications start with getting certified in Basic Care Life Support (BCLS) and Advanced Care Life Support (ACLS).  In the United States, RNs can receive specialty certification through the American Society of PeriAnesthesia Nurses (ASPAN) as either Certified PostAnesthesia Nurses (CPAN) or Certified Ambulatory PeriAnesthesia Nurses (CAPA).
n Canada, the Canadian Nurses Association has recently added peri- or post-anesthesia nursing as a certified specialty with the first Certification qualification examination currently being offered (registration fall, 2013 with exam date April 5, 2014). The Canadian certification is PeriAnesthesia Nurse Certified (Canada), or PANC(C).

The work environments these nurses work in consists of  a few areas that are critical:

1. Pre-operative  –  Nurses are responsible for a large amount of the assessment done in pre-operative clinics, where patients (pts or pt)are evaluated for the ability to tolerate anesthetic and screened for factors which may affect the course of the anesthetic experience.  The nurses set up up from IV’s started, vital signs, assessment of the pt from head to toe, making sure the pt did not eat for the amount of hours prior to going into surgery.  It is doing whatever is necessary prior to a patient having surgery is done from physically and that all paperwork is done in the chart from consents to even labs done within 24 hours or a few days depending on the type of surgery being done if its in a ambulatory day clinic but as a hospital pt labs are usually done that morning 2a or 6a if not further than the day before depending on the reason the pt is in the hospital.
2. Post – operative – Nurses provide extensive care to patients in the early stages of emergence from anesthetic and in the immediate post-operative period until they are deemed stable enough to safely transfer to other areas; which vary from returning back to the room on the unit they are on in the hospital or to the ambulatory room they came from in the hospital where in the end the pt leaves from their and goes home or in some cases leave from straight from the recovery room to home.  Nurses in the post – op or recovery room are assessing pts around the clock till cleared stable and cleared by the MD to go home, usually with a driver with them or back to their room.
3. Ambulatory – There is a large number of procedures that are performed on an outpatient basis where the patient is not expected to require hospitalization after the procedure. Examples include dental, gynecological, back surgery where a MD inserts steroid injections in a pt, and diagnostic imaging clinics.  Ambulatory surgery usually is micro surgeries.
4 – Pain Management – Pain management nurses are sometimes considered to be perianesthesia nurses, given the collaborative nature of their work with anesthetists and the fact that a large proportion of acute pain issues are surgery related. However, distinct pain management certifications exist through the American Society for Pain Management Nurses.
Peri-anesthesia nursing encompasses several sub-specialty practice areas and represents a diverse number of practice environments and skill sets.  Thank you to all the nurses in America and in other countries for your service in caring for patients in this specialty area.

QUOTE FOR FRIDAY:

Feb16

“Millions of people in the United States are living with a visual impairment. A visual impairment can make it hard to do everyday activities, like getting around, reading, or cooking. And it can’t be fixed with glasses, contacts, or other standard treatments, like medicine or surgery.

The good news is that vision rehabilitation services can help people with a visual impairment make the most of the vision they have — and keep doing the things they love. Take some time this Low Vision Awareness Month to learn about vision rehabilitation.”

NIH – National Eye Institute (https://www.nei.nih.gov/learn-about-eye-health/outreach-resources/vision-rehabilitation-resources/low-vision-awareness-month)

QUOTE FOR THURSDAY:

Feb15

“Darier’s disease is a dominantly inherited condition affecting skin, nails and mucosae.   Prevalence is estimated at 1 in 36 000 (in North-East England). Skin signs generally develop between 6 and 20 years of age, although lesions may be overlooked until aggravated by heat, sweating or sunlight.

Clinically, the distinctive lesion is a warty plaque formed by coalescing firm, greasy, skin-coloured papules. The seborrhoeic areas of the trunk and face are predominantly affected. Pruritus is common, occurring in 80% of patients, and may be intractable; pain is unusual. When flexures are involved, the lesions may be hypertrophic, fissured and malodorous.”

National Library of Medicine (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539598/)

 

What is Darier’s Disease?

Feb15

 

Darier disease, previously known as keratosis follicularis, is a rare autosomal dominant genodermatosis characterized by keratotic papules and longitudinal eyrthronychia; it is caused by mutations in the ATP2A2 gene, encoding a calcium pump within the endoplasmic reticulum.

Darier disease, also known as Darier-White disease, keratosis follicularis, or dyskeratosis follicularis (MIM #124200), again know it is a rare autosomal dominant genodermatosis characterized by a persistent eruption of red-brown, keratotic papules scattered to confluent in a seborrheic distribution, nail abnormalities, pitting of palms and soles, and mucosal changes [1]. The disease usually starts around puberty and runs a chronic course with exacerbations induced by sun exposure, heat, friction, or infections.

Darier disease is exacerbated by sunlight, heat, infections, and friction. This activity reviews the clinical presentation encompassing multiple red or brown papules with hyperkeratosis, nail anomalies including longitudinal erythronychia, and mucosal changes typically surfacing around puberty and persisting throughout life. By exploring evaluation techniques and treatment modalities, this session empowers healthcare professionals to adopt a holistic approach, focusing on interdisciplinary collaboration to manage this dermatological disorder effectively. The interprofessional team’s role in assessing, diagnosing, and coordinating care for Darier disease patients is underscored, recognizing the impact of external exposures and emphasizing tailored therapeutic strategies to improve patient outcomes and quality of life.  Avoid going to the dermatologist which is the worst move you could do since it will only get worse to the spread of the disease to completely over the body over  years due to what exacerbates it (take the sun just alone).

This disease can be characterized by multiple dark scaly patches of itchy skin most commonly affecting the chest, back, ears, forehead, scalp, neck, and groin areas. These wart-like lesions can be foul smelling and disfiguring and has been known to affect nails and mucous membranes of the individual.

The occurrence of Darier disease is rare with the age of onset usually in the first or second decade of life. It is frequently worse in the summer with heat and humidity as major precipitating factors and can be exacerbated by sun exposure, trauma, or bacterial infections.

Review of the cause of this disease is oftentimes due to a mutation in a specific gene known as ATP2A2 which can alter the function and development of the skin. The affected parent with this gene has at least a fifty percent chance of passing it down to their children. Patients with this disease may be associated with behavioral disorders and rarely with decreased intelligence. Most patients with Darier disease have a family history of either one or both parents being affected. However, it can also present itself without any family history as well. Even though the severity fluctuates over time, Remember, Darier disease is a chronic condition that persists throughout life and is not associated with any skin cancers.

Darier disease is a rare disorder that affects all ethnic groups. The estimated prevalence ranges from 1 to 4 per 100,000 people [2-5]. In a Singaporean study, the incidence was 0.3 per 1 million people per year.

What helps diagnosing this disease     :

1 A dermatology consult for the MD just to look at the skin as the first approach is the best MD to go to, the expert on skin disease diagnosing.

2. Depending on the area affected, patients with Darier disease often presents with multiple crusty and itchy patches of skin. When the scaly crusts are removed, a slit-like opening becomes visible. In areas such as nails, they are described as a sandwich of red and white bands running along the length of the nail that is thin with its characteristic V-shaped scalloping. Mucous membranes may present as white, cobblestone appearing lesions of the cheeks, palate, and gums. With the discovery of the ATP2A2 gene, skin biopsy is helpful in diagnosis through gene sequencing when suspected. SKIN BIOPSY is always helpful with diagnosing skin disease which includes tumors on the skin.

Treatments for Darier’s Disease:

This disease depends on the severity of the presented clinical symptoms.

1. For most minor cases , the disorder can be managed by using sunscreen, moisturizing lotions, avoidance of non-breathable clothing, and excessive perspiration.

2, For more severe cases of Darier’s disease, hospitalisation may be required to heal affected individuals who display frequent relapse and remit patterns. In less severe cases, signs and symptoms may clear up completely through hygienic interventions. Most patients with Darier’s disease live normal, healthy lives. Rapid resolution of rash symptoms can be complicated due to the increased vulnerability of affected skin surfaces by secondary bacterial or viral infections.

****In cases of Epidermal Staphylococcus aureus, human papillomavirus (HPV) and herpes simplex virus (HSV) infections have been reported. In these cases, topical and/or oral antibiotic/antiviral medications may need to be prescribed.****

Typical recommendations are the application of antiseptics, soaking in astringents, antibiotics, benzoyl peroxide, and topical diclofenac sodium.

If Darier’s is more localized, common treatments include:

  • Topical retinoids: used to help in the reduction of hyperkeratosis, retinoids work by causing the skin cells in the top layers to die and be shed off. The common retinoids used for this disorder are:
    • Adapalene
    • Tazarotene gel
    • Tretinoin
  • Dermal abrasion
    • Removal of the top layer of skin to help smooth and stimulate new growth of the skin.[21]
  • Electrosurgery
    • Used to help stop bleeding and remove abnormal skin growths.
  • Topical corticosteroids

 

 

QUOTE FOR WEDNESDAY:

Feb14

“Every year in the US, approximately 19 million people are infected with an STD (), and 50,000 people are infected with HIV (). The risk of STD and HIV infection can be greatly reduced with correct and consistent condom use (), yet condom use remains low, even among individuals who are engaging in sexual behaviors that put them at risk for STDs and HIV (, ).”

NIH-National Library of Medicine (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4108502/)

QUOTE FOR TUESDAY:

Feb13

“Heart and blood vessel disease, also called heart disease, includes numerous problems, many of which are related to atherosclerosis.

Atherosclerosis is a condition that develops when a substance called plaque builds up in the walls of the arteries. This buildup narrows the arteries, making it harder for blood to flow through. If a blood clot forms, it can block the blood flow. This can cause a heart attack or stroke.”

American Heart Association AHA (https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease)

QUOTE FOR MONDAY:

Feb12

“The primary causes of injury due to burns are fire-flame, scalds, contact with hot objects, electrical and chemical. Today, 96.8% of those who suffer burn injuries survive. Significant research and medical advances have dramatically improved burn care and treatment. Aftercare support for the physical and emotional effects of burns plays a key role in the successful reintegration back into the community for survivors. Many survivors still unfortunately sustain serious scarring, life-long physical disabilities and adjustment difficulties.”

Illinois.gov (https://www.illinois.gov/news/press-release.21115.html)

BURN TYPES – How to treat them, prevent them and the basic first aid in how to treat them!

Feb11

National Burn Awareness Week – Burn Prevention and Treatment for Children

Burn Prevention and Burn Treatment for Kids

Many people have, or know someone who has, a story about learning the concept of ‘hot’ as a child through getting burned. 300 children ages 0-19 are treated in emergency rooms every day for injuries related to burns. Increased public awareness about burns has helped to lower the number of injuries and fatalities caused by burns, scalding, and fires – which is the intent and the importance of Burn Awareness Week. This week, we want to bring awareness to some of the most common ways that children get burned, and how parents and caregivers can aid in burn prevention.

TYPES OF BURNING WITH HOW TO PREVENT THEM:

 

SCALDING

A scald is a burn sustained from a hot liquid or steam. Younger children are most likely to be burned in this way, though anyone can be scalded. To prevent scalding, follow these tips:

  • Set your hot water heater to 120℉ or lower. These temperatures should prevent tap water from getting hot enough to burn.
  • Always check the temperature of bathwater before placing your child in the bathtub, and never leave your child unattended in the bathroom. Unattended children may accidentally turn on the hot water or increase the temperature, increasing the risk of scalding.
  • Set a child-free zone around stoves or hot items in the kitchen until children are old enough to understand the dangers of cooking. Depending on your space and children, this may mean making the kitchen off-limits while cooking, or placing tape on the floor to create a visual barrier for children.
  • Turn pot handles toward the back of the stove to prevent them being grabbed, knocked, or pulled off the stovetop.
  • Avoid the use of tablecloths with younger children, to prevent them being pulled off the table and bringing hot liquids or cookware with them. Never leave a container (cup, bowl, etc.) with hot liquid at the edge of a table or countertop, in reach of a child.

 

BURNS FROM COOKING

Cooking is the top cause of fires and burns in homes and should be a focus for burn prevention. Older children are more likely to receive burns from flame or hot objects than scalds. When cooking, make sure to follow these tips to prevent burns in children and adults:

  • Never leave the stove on and unattended. This seems logical, but is a common occurrence.
  • When using a microwave, make sure to stir foods and always test the temperature. Microwaves do not heat food evenly, leaving some portions hotter than others. Never heat formula or milk in a microwave, for this same reason.
  • Do not hold children while cooking, removing food from the stove or microwave, or carrying hot food or liquids.
  • When using a grill, smoker, or barbeque, make sure that children play away from the grill and understand that it is hot and will remain that way for many hours.
  • Teach older children how to cook safely, providing them age-appropriate cooking tasks.
  • Keep children a safe distance from hot oil and frying foods, and utilize a pot lid or splash guard to prevent burns from grease splatter.

 

OTHER BURN PREVENTION

While the most common, cooking is not the only way people experience burns. There are many items in the home that can cause burns – some more obvious than others. Here are some additional tips to help prevent burns in other parts of the house:

  • Check electrical cords and outlets frequently for wear, fraying, or other damage that could result in heat or fire. Damage to cords can impair their heat retention, causing them to become hot enough to burn or catch nearby materials on fire.
  • Make sure you are not overloading electrical outlets or power strips. Too much electricity running through cords or outlets can cause them to become hot, causing burns, melting plastic, or fires. If outlets or power strips are hot to the touch, plugs need to be moved to different outlets to prevent overloading.
  • Check heating devices, like space heaters, to ensure they are working properly and make sure to keep them out of reach of children.
  • If your home has a fireplace, make sure it is cleaned before you use it and don’t allow children to play on or around it.
  • Teach children about heat, fires, and fire safety, including not to play with lighters, matches, or fireworks. One way to teach preschool-aged children about objects that might be hot is to create a sorting game where children sort images of items that might be hot or are not hot.
  • Keep a fire extinguisher at home, and make sure it’s in working order. Ensure everyone in the family knows where it is, and that those who are old enough know how to use it.

 

BASIC FIRST AID FOR BURNS:

If someone in your family does sustain a burn, it is important to know how to treat it.

  1. Make sure the person is out of harm’s way and everyone is safe from the cause of the burn.
  2. Remove any clothing, jewelry, belts, or other items that are near or possibly restricting the burned area. Do this quickly, before the burn swells.
  3. For minor burns (under 3 inches), run the burn under cool (not cold!) water to help cool the area, or apply a cool, wet compress. Do not immerse a large burn in water.
  4. For major burns (burns that are deep, have caused a dry and leathery area on skin, or are charred, or burns larger than 3 inches), seek immediate medical care.
  5. Bandage or cover the burn with a loose, clean cloth to protect the area and keep air off it. Make sure the bandage is not putting pressure on the burn.
  6. Provide an age-appropriate dose of a pain reducer, as needed, in order to help with the pain of the burn.

QUOTE FOR THE WEEKEND:

Feb10

“National Burn Awareness Week is a window of opportunity for organizations to mobilize burn, fire, and life safety educators to unite in sharing a common burn awareness and prevention message in our communities. On July 13, the House Appropriations Committee approved its Fiscal Year (FY) 2022 defense appropriations bill, which provides $10 million in continued annual funding for the Military Burn Research Program. The American Burn Association (ABA), by joint recommendation of the Committees on Burn Prevention and Government Affairs, developed statements to educate the public on the importance of preventing burn injuries and deaths resulting in various ways from military to home oxygen and medical services (oxygen to medical fluids).”

American Burn Association (https://ameriburn.org/advocacy-and-prevention/advocacy/)

Burn Awareness Week.

Feb10

 

 

 

 

This week is National Burn Awareness Week (NBAW) – which is an excellent opportunity to increase burn awareness and prevent fires from occurring! During NBAW, want to bring attention to fire safety and prevention to help lower the number of burn injuries.

Burn Injuries

Approximately every minute, someone in the United States endures a burn injury severe enough to require treatment. Lionel Crowther is one of the many firefighters who was injured while on duty. Crowther responded to what seemed to be a routine garage fire, but within minutes, a flashover occurred. When the fire was cleared, two fire captains had been killed, and Crowther was among four severely injured firefighters.

There are three types of burns:

  • First-degree burns are considered mild compared to other burns. …
  • Second-degree burns (partial thickness burns) affect the epidermis and the dermis (lower layer of skin). …
  • Third-degree burns (full thickness burns) go through the dermis and affect deeper tissues.
  • Fourth-degree burns involves injury to deeper tissues, such as muscle, tendons, or bone.   This is the deepest and most severe of burns. They’re potentially life-threatening. These burns destroy all layers of your skin, as well as your bones, muscles, and tendons.

Treatments:

As with first-degree burns, avoid cotton balls and questionable home remedies. Treatments for a mild second-degree burn generally include:

  • running the skin under cool water for 15 minutes or longer
  • taking over-the-counter pain medication (acetaminophen or ibuprofen)
  • applying antibiotic cream to blisters

First-degree burns are usually treated with home care. Healing time may be quicker the sooner you treat the burn. Treatments for a first-degree burn include:

  • soaking the wound in cool water for five minutes or longer
  • taking acetaminophen or ibuprofen for pain relief
  • applying lidocaine (an anesthetic) with aloe vera gel or cream to soothe the skin
  • using an antibiotic ointment and loose gauze to protect the affected area

Second-degree burns are more serious because the damage extends beyond the top layer of skin. This type burn causes the skin to blister and become extremely red and sore.

Some blisters pop open, giving the burn a wet or weeping appearance. Over time, thick, soft, scab-like tissue called fibrinous exudate may develop over the wound.

Due to the delicate nature of these wounds, keeping the area clean and bandaging it properly is required to prevent infection. This also helps the burn heal quicker.

Some second-degree burns take longer than three weeks to heal, but most heal within two to three weeks without scarring, but often with pigment changes to the skin.

The worse the blisters are, the longer the burn will take to heal. In some severe cases, skin grafting is required to fix the damage. Skin grafting takes healthy skin from another area of the body and moves it to the site of the burned skin.

Treatment for third-degree burns may include the following:
  1. Early cleaning and debriding (removing dead skin and tissue from the burned area). …
  2. Intravenous (IV) fluids containing electrolytes.
  3. Intravenous (IV) or oral antibiotics if your child develops an infection.
  4. Antibiotic ointments or creams.
Treating fourth-degree burns
  1. Raising the injured body part above the heart, if possible.The burn is often black and frequently leads to loss of the burned part. Burns are generally preventable.
  2. Covering the affected area with a loose bandage or cloth.
  3. Placing a light sheet or blanket over them, especially if they appear cold from reduced blood pressure.
  4. Flushing the area with water (for chemical burns only)

Prevention

Unfortunately, Crowther’s story is not uncommon, but with an increased awareness of fire safety and prevention, we can lower the number of fire-related injuries and deaths together. NBAW is the perfect time to learn more about fire prevention and what you can do to prevent and prepare for a home fire.

  • Smoke Alarms: Did you know that three of every five fire deaths resulted from fires in homes with no working smoke alarms? Smoke alarms that are properly installed and maintained play a key role in reducing fire deaths and injuries. They should be installed on every floor and in every sleeping room. Be sure to test them once a month and replace the batteries at least once a year.
  • Fire Extinguishers: It is also important to have at least one fire extinguisher on every level, especially in the kitchen. In many cases, fire extinguishers are the first line of defense and often contain or extinguish a fire.
  • Escape Routes: Ensure that every room has at least two escape routes in case of a home fire. You may need to purchase escape ladders, especially for second story rooms. Escape ladders are not required by law, but they could be beneficial in case of a house fire. Once you establish escape routes, practice at least twice a year.
  • Teach: It is essential to teach the whole family about fire safety and what to do in case of an emergency. This includes making an emergency communications plan, knowing where to meet up outside, and making sure everyone knows how to call 9-1-1.