N-Trivia

Preventing Needlestick Injuries
Hepatitis E
Unna’s Boot Dressing Procedure

Posted: 18 Dec 2010 10:32 PM PST

Working as a health professional means exposure to various work-related injuries ranging from back pain to needle stick injuries. Nurses especially are always at the front liners since their responsibility is to administer medications intravenously after proper physician's order.

There are numerous researches and surveys done in order to know the extent of this dilemma and th rough the results of the study steps were made in order to prevent incidences of needle stick injuries.

Needle stick injuries are small injuries or holes on the skin as a result of incidental contact of sharp pointed objects on the skin. The most common pricking object is a needle. Such injuries is not only limited on the tip of the fingers but as well as on the arms, foot, or any part of the body.

Needle stick injuries should not be taken for granted since used needles could have been used to inject people with blood-borne diseases such as hepatitis or HIV infection.

Since health workers are one of the people at risk of such injury, here are suggested simple steps in preventing needle stick injuries.

Always observe universal standard precautions in handling sharps such as needles. Gloving or double gloving could be essential when withdrawing blood or other substances that may be suspected as pathogenic.
Utilize a needle burner or needle cutter if it is available in the area.
Perform recapping only when as needle burner or needle cutter is not available. Use the "scoop technique" in recapping the syringes. Scoop technique could be by using the needle to lift the safety cap from the flat surface and recapping it single handed way without any contact on the safety cap nor on the tip of the needle.
Use a puncture resistant container in disposing needles and syringes. The container should have a solution formulated to disinfect all the needles and syringes to be disposed.
Provide a separate container for each kind of shraps such as one for needles, scalpels and other sharps objects used in the hospital.

There are instances when such injury is unavoidable. The best way to contain the wounded area is to wash the wounded area thoroughly with antibacterial soap and running water. After this first aid, it would be better to rush to the nearest hospital in order to have the wound evaluated and proper actions can done after that.

Treatment could range from antibiotics, over-the-counter pain medications up to antiviral medications depending on the root cause of the injury.

Photo credits: www.ivteam.com

Hepatitis E

Posted: 18 Dec 2010 06:57 PM PST

Hepatitis E Hepatitis E

It was in 1980 that hepatitis E was discovered to be distinct from other types of hepatitis. This type of hepatitis is caused by Hepatitis E virus.

The Hepatitis E virus is described to be a non-enveloped, single-stranded RNA virus. The natural reservoir of this virus is primarily humans but primates could also carry such virus.

The mode of transmission of this virus is through fecal-oral route. Water contaminated by feces are the major source of outbreaks in the communities. This case is rampant to communities with poor sanitation.

Hepatitis E incidence is common in areas of Central and South-East Asia, North and West Africa as well as in Mexico.

The virus' incubation period may last between 3 to 8 weeks.

Signs and Symptoms:

Jaundice (yellow discoloration of the skin and sclera of the eyes dark urine and pale stools)
Anorexia (loss of appetite)
An enlarged, tender liver (hepatomegaly)
Abdominal pain and tenderness
Nausea and vomiting
Fever

Diagnostic Evaluation:

Blood tests are obtained in order to detect elevation of antibody levels of specific antibodies
Areas are of suspected Hepatitis E incidence when Hepatitis A was ruled out. If laboratory tests are not available, epidemiologic investigation is the source of the diagnosis.

Medical Management:

The goal of management is to prevent the spread through fecal-oral route.
Always observe good hygiene.
Proper and regular water analysis must be made for public water supplies.
HEV infections is limiting and hospitalization is not done. Vaccines are not yet developed so focus in management is more on preventive measures.

Nursing Management:

Proper surveillance of the community and the source of water should be emphasized to the community leaders.
Teach the children as well as the adults of proper hand washing and good hygiene.
Evaluate the source of water supply in the community and refer to the leaders of the community if the source of drinking water is at danger of making the transmission of Hepatits E possible.
Emphasize to the leaders of the community the political will to provide hygienic sanitation to each of the houses in the community.

Photo credits: http://www.712designs.com/illustrations.htm

Unna’s Boot Dressing Procedure

Posted: 18 Dec 2010 06:29 PM PST

Definition

Is a commercially prepared, medicated gauze compression dressing that wraps around the foot and leg.
It can be sued to treat uninfected, non-necrotic leg and foot ulcers caused by venous insufficiency and stasis dermatitis.
Unna's paste such as gelatin, zinc oxide, calamine lotion, and glycerin may be applied to the ulcer and covered with lightweight gauze.
Effectiveness results from compression (bandage) and moisture (paste).

Contraindications

Allergy to any ingredient
Arterial ulcer
Weeping eczema
Cellulites

Equipment

Scrub sponge with ordered cleaning agent
Normal saline solution
Commercially prepared gauze bandage saturated with Unna's paste
Bandage scissors
Gloves
Elastic bandage to cover Unna's boot
Extra gauze for excessive drainage

Procedure

Verify the patient's identity using two patient identifiers, such as the patient's name and identification number.
Reinforce the explanation of the procedure and provide privacy
Wash your hands and put on gloves
Monitor the ulcer's size, drainage, and appearance and the surrounding skin.
Clean the affected area with the sponge and cleaning agent to retard bacterial growth and remove dirt and wound debris.
If commercially prepared gauze bandage isn't ordered, spread Unna's paste evenly on the leg and foot; cover with the light weight gauze
Apply three to four layers of paste interspersed with layers of gauze.
Apply gauze or the prepared bandage in a spiral motion, form just above the toes to the knee.
Cover the heel, the wrap should be snug not tight.
Continue wrapping the patient's leg up to the knee, using firm and even pressure.
Stop the dressing 1" below the popliteal fossa to prevent irritation when the knee bent.
Mold the boot with your free hand as you apply the bandage to make it smooth and even.
Cover the foot with an elastic bandage to provide compression.
Instruct the patient to remain in bed with his leg outstretched and elevated on a pillow until the paste dries for about 30 minutes.
Leave the boot on for 5 to 7 days or as ordered.
Change the boot weekly or as ordered to monitor the underlying skin and ulcer healing.
Remove the boot by unwrapping the bandage from the knee back to the foot.

Nursing Interventions

If the boot is applied over a swollen leg, it must be changed as the edema subsides-if necessary, more frequently than every 5 days.
Don't make reverse turns while wrapping the bandage. This can create excessive pressure areas that may cause discomfort as the bandage hardens.
Reinforce the explanation of the procedure to the patient.
Remind the patient to walk on and handle the wrap carefully to avoid damaging it.
Remind the patient that the boot will stiffen but won't be as hard as a cast.
Remind the patient that before bathing, he should cover the boot with a plastic kitchen trash bag sealed at the knee with an elastic bandage too avoid getting the boot wet.
Reinforce that he should take a sponge bath if his safety is concern

Complications