N-Trivia

Aspergillus Fumigates
Complete Blood Count (CBC) Normal Values and Nursing Considerations
Ethical Principles

Posted: 10 Jan 2011 09:26 PM PST

Aspergillus fumigates is one of the many fungus belonging in the family of Aspergillus species. These species are ubiquitous saprobes and occurs worldwide. Aspergillus fumigates is one of the most common pathogen causing a disease. Colonies of this species produce small conidia that are easily aerosolized. Once inhaled, it causes severe allergic reactions especially in immunocompromised patients.

In normal healthy individuals, upon inhalation of the conidia, the alveolar macrophages are able to engulf the conidia thus destroying it. However, in immunocompromised individuals the macrophages have weakened ability to trap the inoculum. If this happens, conidia in the lung start to swell and germinate to produce hyphae that have the probability to invade preexisting cavities or blood vessels.

Aspergillus fumigates can bring about different clinical findings. Among which includes the following: Allergic bronchopulmonary aspergillosis, Aspergilloma and Invasive aspergillosis.

In allergic bronchopulmonary aspergillosis, there is the presence of asthma, recurrent chest infiltrates, eosiniphilia and both type 1 and type 3 skin test hypersensitivity to Aspergillus antigen. Individuals experiencing allergic bronchopulmonary aspergillosis, often have difficulty in breathing and may develop lung scarring.

Aspergilloma occurs when inhaled conidium enters an existing cavity, germinates and produces abundant hyphae in the abnormal pulmonary space. Patients with previous history of sarcoidosis, tuberculosis and emphysema are at risk to such infection. This disease is characterized by cough, dyspnea, hemoptysis, and fatigue and weight loss.

Invasive aspergillosis follows after an inhalation and germination of conidia. Patients at risk in acquiring this disease are the immunocompromised. Symptoms include cough, dyspnea,hemoptysis and fever. From the lungs, the infection may spread to nearby organs such as the GI tract, kidneys and liver.

Allergic bronchopulmonary aspergillosis is treated with corticosteroids or disodium chromoglycate. Itraconazole or amphotericin B is usually used in treating fungal infections caused by Aspergillus fumigates and is best used in cases of Aspergilloma. In treating Invasive aspergillosis, rapid administration of native or liquid formulation of amphotericin B or voriconazole is used.

Nursing Consideration

Since aspergillus fumigates only infect those individuals who are immunucompromised, it is best if these individuals are placed in a reverse isolation and their visitors should be kept to minimum. Their room should be always kept clean, free from molds and fungus or other materials where aspergillus fumigates will thrive. Fresh flowers and fresh fruits should not be given to these patients as gifts for these may harbor the fungi. As ordered by the doctor, patients at risk for acquiring invasive aspergillosis are given prophylactic low dose amphotericin B.

Complete Blood Count (CBC) Normal Values and Nursing Considerations

Posted: 10 Jan 2011 08:37 PM PST

Complete Blood Count (CBC)

It is a basic screening test and is one of the most frequently ordered laboratory procedures.
The findings in the CBC give valuable diagnostic information about the hematologic and other body systems, prognosis, response to treatment, and recovery.
The CBC consists of a series of tests that determine the number, variety, percentage, concentration and quality of blood cells.

Tests

White blood cell count (WBC): presence of infection
Differential white blood cell count: specific patterns of WBC
Red blood cell count (RBC): carries oxygen and carbon dioxide from lungs to tissue and vice versa
Hematocrit (Hct): measures RBC mass
Hemoglobin (Hgb): main component of RBC
Red blood cell indices: calculated values of size and Hgb content of RBCs, important in anemia evaluation
Platelet count: necessary for clotting and control of bleeding
Red blood cell distribution width (RDW): indicates degree variability and abnormal cell size
Mean platelet volume (MPV): index of platelet production

Normal Values in Adults

WBC: 5.0 – 10.0 x 10³/mm³

RBC: 4.0 – 5.5 x 10⁶/mm³

Hgb: 12.0 – 17.4 g/dL

Hct: 36 – 52%

Platelet: 140 – 400 x 10³/mm³

RDW: 11.5 – 14.5%

MPV: 7.4 – 10.4 fL

Nursing Considerations

Explain test procedure. Explain that slight discomfort may be felt when the skin is punctured.
Encourage to avoid stress if possible because altered physiologic status influences and changes normal hematologic values.
Explain that fasting is not necessary. However, fatty meals may alter some test results as a result of lipidemia.
Apply manual pressure and dressings over puncture site on removal of dinner.
Monitor the puncture site for oozing or hematoma formation.
Instruct to resume normal activities and diet.

Ethical Principles

Posted: 10 Jan 2011 07:01 PM PST

Ethical Principles

The ethical principles provide a foundation for nursing practice. Ethical principles are defined as basis for nurse's decisions on consideration of consequences and of universal moral principles when making clinical judgments. The most fundamental of these principles is the respect for persons.

The primary and basic ethical principles are the following:

Respect for autonomy
Nonmaleficence
Beneficience
Justice

The secondary ethical principles that can be incorporated with the primary principles when interpreting ethical issues and making clinical decisions are the following:

Veracity
Confidentiality
Fidelity

RESPECT FOR PERSONS

According to the American Nurses Association (ANA), the most fundamental principle of professional behavior is the respect for persons. This principle not only applies to the clinical settings but to all life's situations. This principle emphasizes that all people should treat others as a worthy individual. In nursing practice this principle should be simplified. Thus, respect for persons generally means respecting a client's autonomy.

RESPECT FOR AUTONOMY

Respecting a client's rights, values and choices is synonymous to respecting a person's autonomy. Informed consent is a method that promotes and respects a person's autonomy. For a client to make an autonomous decision and action, he or she must be offered enough information and options to make up his or her mind free of coercion or external and internal influences. In clinical settings, this is promoted by proving informed consent to the client.

NONMALEFICENCE

Nonmaleficence means duty to do no harm. This is promoted by doing the following nursing interventions:

Avoiding deliberate harm, risk of harm that occurs during the performance of nursing actions.
Considering the degree of risk permissible.
Determining whether the use of technological advances provides benefits that outweigh risks.

BENEFICENCE

Beneficence is doing or active promotion of good. This is done by:

Providing health benefits to the clients.
Balancing the benefits and risks of harm.
Considering how a client can be best helped.

JUSTICE

Justice is the promotion of equity or fairness in every situation a nurse encounters. The following nursing implications promote justice:

Ensuring fair allocation of resources. (example: appropriate staffing or mix of staff to all clients)
Determining the order in which clients should be treated. (example: priority treatments for the clients in pain)

SECONDARY PRINCIPLES OF ETHICAL CONDUCT

Veracity – duty to tell the truth

Confidentiality – duty to respect privileged information

Fidelity – duty to keep promises