N-Trivia

Chlamydia Psittaci
Mycobacterium: Mycobacterium Leprae
Mycobacterium: Mycobacterium Tuberculosis
OR Nursing Personnel

Posted: 06 Jan 2011 07:03 PM PST

Chlamydia Psittaci is acquired from contact with infected birds and other domestic fowls. Contact with infected birds includes its handling and inhaling its dried excreta. The infection can also be transmitted through bite wounds done by the infected bird. The infection enters the body through the skin and the nose and then resides in the lungs of an individual. Its incubation period usually lasts in 10 days. The infection is common to those who are pigeon breeders, farmers, and employees of poultry processing plants and flock owners.

C. Psittaci causes Psittacosis, which is an acute generalized infectious disease usually characterized by headache, fever, non productive cough, pus in the sputum, severe anorexia, constipation, slow pulse rate , and lethargy. Psittacosis causes a patchy inflammation in the lungs. There are presences of lesions which are found only in pneumonitis. Enlargement and congestion of the liver, spleen, heart and the kidneys are often the possible complication of the disease.

Laboratory diagnosis of this infection includes the culture of the infection. The detection of the organism using the immunoassays is preferred. Immunity in human beings is incomplete. Infected humans after recovering from the disease can become carrier for 10 years. The infection could still persist in the sputum of the carrier.

There is no specific treatment indicated for such viral infection but only the treatment of the symptoms experienced by the client. There are those who use azithromycin, clarithromycin and erythromycin clears most of the C. Psittaci infections but not completely all. There is an apparent improvement among those who took these drugs as compared to those who did not. As a form of prophylaxis, tetracylines are given to domestic birds and poultries.

Nursing Consideration

Since theclient is taking in antibiotics such as Azithromycin, the nurse should make sure that the client observes compliance to the drug therapy and the ten rights of drug administration is observed when giving the drug to the client. Basing from the symptoms manifested by the client, strict bed rest should be observed and chest formentation should be given in mornings and evenings. The bird owners and those owning poultry farms should submit their flocks for prophlaxis treatment of tetracyclines.

Photo credits: www.abcpestcontrol.co.uk

Mycobacterium: Mycobacterium Leprae

Posted: 06 Jan 2011 06:59 PM PST

Mycobacterium leprae is first described by Hansen in 1873, thus the name of the disease, Hansen's disease or more commonly known as leprosy. Leprosy is a chronic highly contagious disease affecting the colder parts of the human body such as the face, ears and elbows. It is characterized by pale, anesthetic macular lesions that have been enlarged and multiplied. This is accompanied by loss of sensation and eventually paralysis, muscle wasting, and development of deformities which will lead to mutilation.

It is classified into two types:

a. Paucibacillary

It is further subdivided into two: the indeterminate type and the tuberculoid type. In indeterminate, there is a painless flat and whitish discoloration of the skin. In tuberculoid type, the course of the disease is benign and non progressive. It has macular lesions with sever nerve involvement and the affected skin in the site no longer sweats. In tuberculoid leprosy, cell mediated immunity is intact and the skin is infiltrated with helper T cells.

b. Multibacillary

It is subdivided into two: the borderline type and the lepromatous type. In borderline type, there are many raised patches having different shapes and sizes with well deformed nerve endings. In lepromatous type, the course of the disease is progressive and malignant. It has nodular skin lesions, with slow symmetric nerve involvement. These lesions often appear in the face. The cheeks and eyebrows are swelling irregularly thus giving a deformed appearance of the face.

Incubation period of the disease usually ranges from 2 – 5 years. It is transmitted slowly via direct contact of skin to skin. Signs and symptoms to observe in patients with leprosy includes: skin changes which includes changes in skin color, growth of ne lesions in the skin and thickening of the skin. There are reports also of loss of skin sensation on the site where lesions have grown. Loss of sweating and hair growth is present where the lesion has developed. There is also weakness of the limbs that is experienced by the patient. Although not present in all, some may experienced such signs and symptoms indicative of the disease and these are: painless ulcers on limbs which do not heal and unexplained eye redness which is incurable by ordinary drugs. Late signs and symptoms often manifested are as follows: madarosis, inability to close eyelids, claw hands, wrist and foot drop, sinking of the nose bridge, blindness, hoarseness of voice, dysphagia, and loss of taste and smell.

Lepromin test is used to classify the types of Leprosy. The test is positive in tuberculoid type of leprosy and negative to those having a lepromatous type of leprosy.

Dapsone and rifampicin are usually used to suppress the growth of bacilli and signs and symptoms of leprosy if given for many months. Clofazimine is an oral drug used to inhibit mycobacterium growth. The disease has no proven racial immunity so everyone are at risk for acquiring one.

Nursing Consideration

As a nurse, it is important for you to educate the masses on the course of the disease and how it can be prevented. Stress the importance of personal hygiene at home. Do not let other people at home use the belongings of a patient with leprosy to avoid transmission of the disease. The dressings used to clean the lesions and the tissues used in cleaning the nose should be burned or buried to prevent the spread of disease. They should also stress the importance of compliance to drug therapy to prevent the possibility of drug resistance. The nurse should also make sure that all the children under her care in the barangay setting, have received and completed their BCG boosters. For suspected cases in the barangay of the disease it best to refer it to higher health authorities to contain the infection.

Photo credits: www.netgene.it

Mycobacterium: Mycobacterium Tuberculosis

Posted: 06 Jan 2011 06:57 PM PST

Mycobacterium tuberculosis came from the Mycobacterium genus, an acid fast bacilli. It is resistant to air and drying. The TB bacilli are able to survive for months in dried sputum. It is transmitted through inhalation of droplet infection like in sneezing and coughing. It can be also transmitted through ingestion of contaminated substance or direct contact of formites having the secretions of this infection.

Mycobacterium tuberculosis is responsible for the disease called tuberculosis. Tuberculosis is a highly contagious disease involving the lungs as manifested by the formation of tubercles in the tissue which undergo caseation, necrosis or fibrosis and calcifications. M. tuberculosis does not only infect the lungs but other parts of the body including the skin which later on causes lupus vulgaris; neck glands which leads to scrofula; the spine which results to pott's disease and the nerves in which can lead to neurological damage causing spondylitis.

Common tuberculosis is on the lungs, known as pulmonary tuberculosis and it is usually characterized by:

Chest pain
Hemoptysis
Prolonged productive cough
Fever at night
Night chills and sweats
Loss of appetite
Weight loss
Insomnia

Tuberculosis in children is termed as primary complex and often has these signs and symptoms:

Cough for more than 2 weeks
Fever with no cause for more than 2 weeks
Weight loss
Anorexia
Unable to respond to antibiotic therapy

Pulmonary tuberculosis is characterized into:

Category 0 – there is no history of PTB exposure.

Category 1- there is positive PTB exposure, negative PPD interpretation and there are no signs and symptoms of the disease.

Category 2 – there is positive PTB exposure, positive PPD interpretation and there are no signs and symptoms of the disease; if interpreted this people have been exposed to the PTB infection.

Category 3 – there is positive PTB exposure, positive PPD interpretation with presence of signs and symptoms of the disease; if interpreted this people have an active PTB infection.

Category 4 – there is positive PTB exposure, positive PPD and is recovering from PTB infection; the client is on multi drug therapy.

Category 5 – there is positive PTB exposure, negative PPD interpretation but with presence of PTB signs and symptoms; the client is suspected to have PTB infection.

In the diagnosis of an active infection, PPD or Mantoux test is usually done. A pure protein derivative (PPD) is injected intradermally in the skin which results to a bleb. The skin test is read after 48- 72 hours. It is expected to be positive if the bleb has reddened, become edematous and with induration. 10mm or more is the expected induration once the patient is positive for PTB.

Pulmonary tuberculosis is treated with multi drug therapy. First line anti TB drugs is rifampin+ isoniazid + streptomycin+ ethambutol which usually lasts for 6 months. Second line drugs include the pyrazinamide, cycloserine viomycin and p-aminosalicylic acid which lasts for 1-2 years of therapy.

Nursing Consideration

Nurses should emphasize to patients and folks the importance of drug compliance so as to prevent the incidence of multi-drug resistance. The drugs used for PTB chemotherapy often have dangerous side effects like for example Rifampin drugs are hepatotoxic; Isoniazid inhibits the absorption of Vitamin B6; Pyrazinamide leads to hyperuricemia; Ethambutol causes optic neuritis that is why ophthalmologic checkups are very important; and Streptomycin causes ototoxicity. To prevent the spread of infection to young children, it a must that the child has received and completed his booster of BCG. The patient with an active infection should be isolated from other members of the family. Inside the hospital room, it is better to let the patient wear the mask instead of his caregivers because he is the one harboring the infection.

Photo credits: www.health.allrefer.com

OR Nursing Personnel

Posted: 06 Jan 2011 05:47 PM PST

ADVANCED NURSE PRACTITIONER

Advance Nurse Practitioners are nurses who hold the title of team leader, resource clinical nurse, nurse clinician, clinical nurse specialist or nurse practitioner. These personnel are capable of organizing and providing complex care while using their initiative and independent judgment.

Requirements of an Advanced Nurse Practitioner:

Has acquired a degree in nursing (BSN)
Must pass the licensure examination (RN)
Graduate of master's program in nursing (MN or MAN)
Expert in a clinical specialty

Functions of an advanced nurse practitioner:

Coordinates plan of care for each patient surgical patient with the surgeon, other professional nurses and other allied health care staff who will assist in the performance of the functions that are related to the plan of care.
Decides what needs to be done in an operating room set-up with the coordination of the surgeon and other OR personnel. The decision is related to the direct and indirect nursing care of the patient in the operating room set-up by utilizing his or her specialized judgments and skill acquired.
Coordinates nursing and supportive services.
Directs and determines the nursing implementations that will be done by others.
They may fulfill the circulating nurse duties in one operating room or serve as a consultant coordinator for several rooms in which patients are being operated by a surgeon within a given surgical specialty.
Evaluates the quality of nursing care postoperatively through direct [patient interaction.

REGISTERED NURSE OR STAFF NURSE

The entry into the operating room personnel is as a staff nurse with license or registered nurse. Before exposed and allowed to work in an actual operation, a structured orientation program is done to develop basic competencies in both scrub and circulating duties of a nurse.

Functions of a registered nurse or staff nurse:

Should have the ability to perform either the scrub or circulating nurse duties. In most cases, the more experienced nurse (RN) functions as the circulator and oversees the activities in the OR and the OR team. The nurse functions as patient's advocate.
Works in collaboration with the surgeon and the anesthesiologist in identifying the needs of the patient during the operation or surgical procedure.
Assumes responsible for patient care during surgical operation.
Document and evaluate the effectiveness of nursing interventions performed.
Visits patients before the operation to assess their individualized needs and plan nursing care that will be carried out during the surgical procedure.
Conducts postoperative follow-up directly with patients. The rationale for doing this is to provide opportunities to evaluate the outcomes of the nursing care planned and implemented.