N-Trivia

Body Mechanics
Atopic Dermatitis (Infantile Eczema)
Chemabrasions (Chemical Peels)

Posted: 14 Oct 2010 01:14 AM PDT

Body mechanics is a broad term used to denote an effort coordinated by the muscles, bones and nervous system. It can either be good or bad and can be directly related to the occurrence of back pains.

Jobs of health care team members require pushing, pulling, carrying and lifting during patient care activities. Prolonged performance of these actions and utilization of incorrect muscles in completing a task can cause severe musculoskeletal strains and fatigue thereby increasing the risk of injuring the patients as well. To avoid these problems, proper body mechanics should be consciously used in performing a physical activity.

Correct body mechanics is the utilization of proper body movement and a result of the coordination of musculoskeletal and nervous systems in maintaining balance, posture, body alignment during activity performance. The scope of body mechanics involves the knowledge on how certain muscles are utilized and explanations of its exploitation.

Purpose

Reasons on the utilization of body mechanics are mainly to prevent and avoid:

Musculoskeletal strain
Injuries to staff members
Injuries to clients
Extreme fatigue

Principles of body mechanics

Maintain a stable center of gravity – This posture evenly distributes the weight in the body.

Keep a low center of gravity.
A lower center of gravity means greater balance.
Flex the hips and knees while keeping the trunk erect as an alternative of bending on the waist.

A wide base of support is maintained – This provides lateral stability and helps in lowering the center of gravity.

Wider base of support means greater stability.
Spread the feet apart to a comfortable distance.
Flex the knees to move the center of gravity to the base of support.

Proper body alignment

Body alignment refers to the arrangement of joints, tendons, ligaments, and muscles while in a standing, sitting or lying positions.
A line of gravity passing through its base for support maintains equilibrium.
Equal activity balance in upper and lower body parts reduces risk of back injury.
A stronger muscle group means a greater amount of work can be safely executed with it.
Keep the back straight in performing any activity.

Body balance is achieved when these principles are implemented. Always remember, when the body is improperly balanced, the center of gravity is displaced, the base of support is narrowed and the body is not correctly aligned.

Pushing

Stand close to the object.
Place feet in a walking position (one is in front of the other)
With hands placed on the object, flex elbows and lean into the object.
Place the weight from the flexor to the extensor portions of the leg.
Apply pressure using leg muscles.
Alternate rest period is advisable to prevent fatigue.

Pulling

Stand close to the object.
Place feet in a walking position (one is in front of the other)
Hold object and flex elbows and lean away from the object.
Shift weight from the extensor to the flexor portions of the leg.
Avoid sudden, jerky movements.
Alternate rest period is advisable to prevent fatigue.

Lifting and Carrying

Assume a squat position facing the object or client.
Grasp the object and tighten the abdominal muscles.
Use the stronger leg muscles in lifting.
In carrying, hold the object at waist height and near the body.
Keep the upper trunk erect.
It is easier to pull, roll, push, turn, lever and pivot that it is to lift something.

Images from givingcare.org

Atopic Dermatitis (Infantile Eczema)

Posted: 14 Oct 2010 01:10 AM PDT

Atopic dermatitis or eczema is a common disease of infants, occurring as early as the second or six months of life. It is of unknown origin but speculations are noted that it may be related to food allergies and genetic factors. Heat and humidity (sweating), tight clothing, soap and other skin irritants may also trigger the onset of the illness.

Eczema is a chronic disease, possibly lasting until one (1) to two (2) years of age. It is neither a contagious nor an infectious disease but infection may occur as a complication due to prolonged scratching that allows the bacteria to get through the skin.

The word "atopic" denotes to a condition when an individual is highly sensitive to a particular thing (allergen) such as food, pollen, dust and molds. "Dermatitis" refers to skin inflammation.

Incidence

Prevalence appears to be high among:

Formula fed infants
Infants fed with solid food before 6 months
Family history with asthma and allergies

Signs and symptoms

With infantile eczema, an increase in capillary permeability occurs allowing more serous fluid to be extravasated out into the tissues. As a result, the baby will develop pink to red bumps or papules that may contain fluid (vesicles). The vesicular eruptions may rupture and releases sticky and yellowish secretions. As the exudates dry, they form crusts on the infant's skin.

Extreme pruritus is one major characteristic of the eruptions that causes the child to scratch the lesion, thereby, further irritating and tearing the skin. Infection may occur due to uncontrolled scratching that forms open lesions. The child may have a fever (first sign of infection) and swollen wound.

Aside from secondary infection, the child may exhibit irritability and may be overly noisy and restless. Generalized discomfort causes infant not to eat leading to poor nutritional intake.

As the papulovesicular lesions are healing, the child's skin may become shiny (lichenified), dry and flaky. The common eruption sites are the following:

Scalp and forehead
Cheeks
Neck
Behind the ears
Extensor surfaces of extremities (outer part of arms and skin)

In most infants, the fist location of lesions is the cheek area. The palms of the hands and soles of the feet are not affected by the eruptions.

Treatment

Conservative Management

Preventing allergen exposure, if allergens can be identified.

Studies reveal that the most allergenic foods to infants are milk, eggs, wheat, chocolate, fish, tomatoes, and peanuts.

One to two weeks (1-2) weeks interval when introducing solid foods is one way to determine the food that may cause eczema.

Reducing pruritus to prevent secondary infections.

Skin hydration is done by bathing the infant or applying wet dressing with tap water or Burrow's solution for 15-20 minutes.

Hydrating emollient application can be used like petroleum jelly (Vaseline) or vegetable shortening.

Select cotton fabrics for the infant's clothing. Tight clothing increases pruritus.

Preventing secondary infection

Keep the infant's fingernails short and clean. Use infant mittens.

Monitor for signs of infection (e.g. fever) to promote prompt treatment.

Medical Management

Antihistamines (reduces itching)
Topical steroids – 1% hydrocortisone cream to reduce inflammation and pruritus.
For dry lesions – use a corticosteroid ointment with an occlusive dressing overnight.
For moist lesions – use a lotion with an occlusive dressing overnight.
For infected lesions – hydrocortisone mixed with antibiotic (Neomycin)

image from pennmedicine.org

Chemabrasions (Chemical Peels)

Posted: 11 Oct 2010 01:39 AM PDT

Definition

Chemical peeling refers to the application of a cauterant to the skin for the purpose of causing a superficial destruction of the epidermis and upper layer of dermis. After healing, the treated area has a new epithelium and a somewhat more youthful appearance.
Several agents can be used toperform the chemical peel, including phenol and trichloroacetic acid and may be used in a combination formula, depending on the preference of the surgeon.

Discusssion

The cauterant acts in a way similar to surgical dermabrasions; it destroys the entire epidermis and upper portion of the dermis by chemical coagulation rather than by mechanical removal, with dermal regeneration occurring in 2 to 3 weeks postoperatively.
If corrective surgery on the eyelids and face is planned, the surgical procedure should be performed; at that time, only one area of the face should be treated by chemical application such as forehead and perioral region, with the remainder of the face and eyelids treated after an interval of atleast 8 to 12 weeks.
Chemical peeling is not a substitute for corrective surgery, but it is considered an excellent supplement for a finished look.
Contraindications for this procedure generally include:

Areas devoid or deficient of epithelial elements.
Dark skinned individuals.
Patients with poor nutritional status.
Diabetics

Positioning

Supine, with arms tucked in at the side.

Supplies/ Equipment

Chemosolution
Syringes
Impervious (waterproof) tape.

Procedure Overview

The face or selected area is painted with the chemosolution, which burns and erodes the area to which it is applied.
Small strips of impervious tape are precut and applied to the area, and allowed to dry.
A light dressing may be applied.

Perioperative Nursing Considerations

Heavy conscious intravenous sedation is usually used for the procedure, constant physiologic monitoring is required.
A P.C.A. pump may be used for postoperative pain management.
The surgeon will usually formulate the solution. A table containing the solutions and syringes should be created according to preferences.
The procedure may or may not require a sterile set-up depending on the surgeon's preference.
The skin preparation solution is only used to decrease the skin.
The circulator will cut the tape as directed by the surgeon; the tape usually stays on approximately 48 hours.
The patient should be cautioned to avoid any excessive talking, which could adversely affect the aesthetic results of the procedure.