N-Trivia

10,000 Nurses Needed for DOH’s "RN Heals" Project
Salbutamol Drug Study
Paramyxoviruses: German Measles
Paramyxoviruses: Mumps
Leptospira Icterohaemorrhagiae

10,000 Nurses Needed for DOH’s "RN Heals" Project

Posted: 13 Jan 2011 01:42 AM PST

Last Wednesday, the Department of Health (DOH) announced that they are looking for 10,000 registered nurses to be trained and deployed to poor rural communities in the Philippines.

RN HEALS, an acronym for Registered Nurses for Health Enhancement And Local Service, is expected to address the shortage of skilled and experienced nurses in 1,221 rural and unserved or underserved communities for one year.

The nurses will undergo learning and development in accordance with the roles and functions required by the project. A certificate of competency and employment will be given by the DOH, DSWD, and the Professional Regulation Commission to those who have satisfactorily completed their requirements.

Qualified nurses will be given an allowance of P8,000 per month, plus a minimum of P2,000 from the local government unit (LGU) they are serving.

Registered nurses who are physically and mentally fit, and willing to serve in their municipalities may apply online at the DOLE website (www.dole.gov.ph) from January 17 to February 4 this year. Preference will be given to residents of the municipalities covered by the Health Facilities Enhancement Program of DOH and Pantawid Pamilyang Pilipino Program or the Conditional Cash Transfer of the DSWD.

The list of successful applicants with their area of assignments shall be posted online at the DOLE website from February 7-10. An orientation shall be held on February 11-12 in their provincial centers of assignment by the regional DOH, DSWD, Professional Regulation Commission – Board of Nursing and the Philippine Nurses Association prior to deployment.

Source: DOH

Salbutamol Drug Study

Posted: 12 Jan 2011 10:19 PM PST

Generic Name: Albuterol

Brand Name: Salbutamol, Proventil, Ventolin, Accuneb, airet, Novo-Salbutamol, Proventil HFA, Gen-salbutamol, Ventodisk, Ventolin HFA, Volmax, VoSpira ER

Classification: Bronchodilator (therapeutic); adrenergics (pharmacologic)

Indications

To control and prevent reversible airway obstruction caused by asthma or chronic obstructive pulmonary disorder (COPD)
Quick relief for bronchospasm
For the prevention of exercise-induced bronchospasm
Long-term control agent for patients with chronic or persistent bronchospasm

Mechanism of Action

It relieves nasal congestion and reversible bronchospasm by relaxing the smooth muscles of the bronchioles. The relief from nasal congestion and bronchospasm is made possible by the following mechanism that takes place when Salbutamol is administered.

First, it binds to the beta2-adrenergic receptors in the airway of the smooth muscle which then leads to the activation of the adenyl cyclase and increased levels of cyclic- 3'5'-adenosine monophosphate (cAMP).
When cAMP increases, kinases are activated.
Kinases inhibit the phosphorylation of myosin and decrease intracellular calcium.
Decreased in intracellular calcium will result to the relaxation of the smooth muscle airways.

Contraindications

Hypersensitivity to adrenergic amines
Hypersensitivity to fluorocarbons

Precaution

Cardiac disease including coronary insufficiency, a history of stroke, coronary artery disease and cardiac arrhythmias
Hypertension
Hyperthyroidism
Diabetes
Glaucoma
Geriatric patients – older individuals are at higher risk for adverse reactions and may require lower dosage
Pregnancy especially near term
Lactation
Children less than 2 years of age because safety of its use has not been established
Excess inhaler use which may lead to tolerance and paradoxical bronchospasm

Side Effects and Adverse Reactions

Nervousness
Restlessness
Tremor
Headache
Insomnia
Chest pain
Palpitations
Angina
Arrhythmias
Hypertension
Nausea and vomiting
Hyperglycemia
Hypokalemia

Route and Dosage

PO (Adults and Children more than 12 years): 2-4 mg 3-4 times a day or 4-8 mg of extended dose tablets twice a day.

PO (Geriatric Patients): initial dose should not exceed 2 mg 3-4 times a day and may be increased carefully up to 32 mg/day

PO (Children 6-12 years old): 2 mg 3-4 times a day or 4 mg as extended-release tablets twice a day; may be carefully increased as needed but not to exceed 24 mg/day

PO (Children 2-6 years old): 0.1 mg/kg 3 times a day

Inhalation (Adults and children more than 4 years of age): 2 inhalations every 4-6 hours

Inhalation (Children 2-12 years old): 0.1-0.15 mg/kg/dose 3-4 times a day

Nursing Interventions

Assess lung sounds, PR and BP before drug administration and during peak of medication.
Observe fore paradoxical spasm and withhold medication and notify physician if condition occurs.
Administer PO medications with meals to minimize gastric irritation.
Extended-release tablet should be swallowed-whole. It should not be crushed or chewed.
If administering medication through inhalation, allow at least 1 minute between inhalation of aerosol medication.
Advise the patient to rinse mouth with water after each inhalation to minimize dry mouth.
Inform the patient that Albuterol may cause an unusual or bad taste.

Paramyxoviruses: German Measles

Posted: 12 Jan 2011 09:42 PM PST

German Measles is also known as Rubella or 3-day measles and is brought about by Rubella virus. Rubella virus, although classified as in the family of Togaviridae because of its physical and chemical properties, it can be considered with the paramyxoviruses on epidemiological bases. Incubation of this virus is from 7 to 21 days and it is transmitted through droplet infection in which it enters the upper respiratory tract.

German measles is an acute viral illness characterized by fever, mild catarrhal inflammation of the respiratory tract, lymphadenopathy, and skin rashes similar to that of scarlet fever and measles. It is the mildest common form of viral exanthem and it usually affects children and young adults alike. Although it is the mildest form, german measles can be very dangerous especially if it affects pregnant women. German measles is classified into two: Postnatal Rubella Infection and Congenital Rubella Infection.

Postnatal Rubella Infection

Postnatal Rubella Infection usually starts with body malaise, low-grade fever, headache, red eyes, sore throat, runny nose and morbilliform rash appearing on the same day. This appearance of rashes coincides with the development of antibody. The rash starts on the face, extends over the trunk and the extremities which rarely lasts for three days thus the name 3-day measles. There is no specific feature of the rash that is pathognomonic for German measles. Temporary arthralgia and arthritis are common among adults especially for females.

German measles is mild and self limiting viral illness with no specific treatment indicated. Rare complications of this illness, includes: thrombocytopenia (decreased platelet count), encephalitis (Inflammation of the brain) and leucopenia (decreased white blood cell count).

Congenital Rubella Infection

Congenital Rubella Infection is an infection during pregnancy in the placenta and the fetus. The timing of the infection in regards with the age of gestation, determines the extent of teratogenic effects. In general, the earlier in pregnancy the infection has occurred, the greater damage it can cause the fetus. This infection can lead to spontaneous abortion and even fetal death.

Clinical features of this viral infection are divided into three: first, transient effects in the fetus; second, permanent manifestations that may be apparent at birth or through the first year; and third, developmental abnormalities that appear and progresses during childhood to adolescent. The classic triads of abnormalities expected in a fetus affected with this infection are as follows: cardiac abnormalities, deafness and cataracts.

There is no specific treatment indicated for Congenital Rubella Infection, however some result to therapeutic abortion when the infection occurred at the first trimester of the pregnancy.

Nursing Consideration

German measles can be prevented by childhood immunization with rubella vaccine to ensure that women of childbearing age is protected with such viral infection. It is the nurse responsibility to ensure that each child, during his immunization years, has received all the immunizations which he needs to receive. It is important to properly educate the mother of these children on the importance of submitting their child for immunizations and their strict compliance with the dates on when to back for the succeeding shots.

In case with pregnant mothers, it is the responsibility of the nurse to educate these mothers the importance of staying away from those people having an active German measles infection so as to prevent them from acquiring the infection.

Photo credits: www.health.allrefer.com

Paramyxoviruses: Mumps

Posted: 12 Jan 2011 09:36 PM PST

Paramyxoviruses include those viruses which cause respiratory infections in infants, young children and as well as the causative agents for mumps and measles, which are the common contagious infections in childhood.

Mumps is otherwise known as Epidemic Parotitis or Contagious Parotitis. It is an acute infectious and contagious viral disease characterized by inflammation and swelling of the parotid glands, and occasionally by inflammation of the testes, ovary, pancreas and meninges of the brain thus leading to meningitis in severe cases. Humans are the only natural host for mumps virus. It is transmitted via three methods: one, through direct contact with droplet nuclei; two, through airborne droplets; and three, through contaminated formites such as articles soiled with oral secretions. The incubation period of this infection usually lasts from 14 to 21 days and this is common among children 5 to 15 years of age. Immunity to this infection is permanent once experienced.

The pathognomonic sign of this infection is the swelling of the salivary glands which occurs in almost 50% of all patients. During the prodormal period of the infection, malaise and anorexia is evident and is followed by rapid enlargement of the parotid glands as well as the salivary glands. This enlargement of glands is usually associated with pain. Pain is usually at its worst when tasting acid substances. Before the swelling and enlargement of the parotid glands, headache and fever of usually 38° C is present.

Complications of this infection includes: orchitis, oophoritis, meningitis, pancreatitis and deafness.

Orchitis

It is an inflammation of the testes which occurs in pre-adolescent males having mumps infection. It is the most feared type of complication in males though not extremely painful but in rare cases may result to sterility.

Oophoritis

It is the inflammation of the ovary but does not lead to sterility because the ovary has no limiting membrane that can swell when inflamed. Oophoritis is only common in 5% of women experiencing mumps infection.

Meningitis

Meningitis is due to the invasion of the virus in the meninges of the brain. The symptoms include fever, headache, vomiting and nuchal rigidity.

There is no specific treatment for this viral infection. The treatment done is to address or to alleviate the symptoms experienced by the client. Acetaminophen or Paracetamol is used to relieve pain, fever and discomfort experienced. Ice pack application over the affected parotid gland is done to relieve the pain and swelling. Lukewarm liquids and bland diet is prescribed to help in swallowing.

Nursing Consideration

School nurses should be able to know if the child has completed his immunization which includes MMR (Mumps, Measles, and Rubella).If the child has not received his MMR when he was 15 months old, it is the nurse responsibility to educate the parents of children that mumps is preventable when the child is able to receive immunization with live attenuated mumps virus vaccine. It is also important to educate the parents of the child with mumps to isolate the child from other children without the disease. It is important to throw away or burn the tissue papers with secretions of the infected child than just allowing it to lie around. The nurse should also teach the child's parents on how to alleviate the symptoms experienced by the child. These teachings should include ice pack application over swelling glands, warm-salt water gargles to relieve pain in swallowing and complete bed rest for further recovery.

Photo credits: www.herbalgranny.com

Leptospira Icterohaemorrhagiae

Posted: 12 Jan 2011 09:23 PM PST

Leptospira Icteroheaemorrhagiae is a spirochete from the specie of Leptospira Interrogans. It is distributed worldwide like Leptospira canicola. Reservior hosts of this disease are mainly rats. Leptospira Icteroheaemorrhagiae is transmitted through contact with water contaminated with rat urine like in swimming pool, or accidental or occupational immersion with the infected water. In cases of occupational immersion, farmers, sewer workers, and miners are at greater risk of acquiring the infection.

Like any other species of Leptospira Interrogans, Leptospira Icteroheaemorrhagiae can also cause Leptospirosis which also known as Weil's disease. Weil's disease cannot be used interchangeably with other names called to describe Leptospirosis because it is solely used to describe those caused by Leptospira Icteroheaemorrhagiae.

In leptospirosis infection, the spirochete enters the body through an opening or cut in the skin and mucus membranes. After an incubation period of usually 10 days, onset of fever is present once these spirochetes enter the blood stream. After these spirochetes have logged into parenchymous organs such as the liver and kidneys, hemorrhage and tissue necrosis often results to dysfunction of organs which results to jaundice, hemorrhage and nitrogen retention. The second phase of the disease develops when the IgM antibody titer rises. The increase is manifested as aseptic meningitis with symptoms of headache and stiff neck.

Symptoms used to describe leptospirosis are as follows: headache, fever, chills, body malaise, muscle aches, vomiting and conjunctivitis. Meningeal irritation is true in cases of aseptic meningitis which is part of the pathophysiology of the disease. Jaundice and hemorrhage are the specific symptoms found in infections with Leptospira Icteroheaemorrhagiae. The disease usually lasts for a few days to a maximum of 3 weeks.

Leptospirosis is treated with penicillin and tetracycline. Doxycycline is also used to treat infections and at the same time prevent the disease to those who are exposed to contaminated water with urine of rats.

Nursing Consideration

Nursing care is mainly supportive. The disease is treated as to how and what symptoms are manifested by the patient. In cases of fever, tepid sponge bath and paracetamol is used. The role of nurses in prevention and control of the disease is education of the public on how the disease is transmitted and how to protect oneself from acquiring the disease. Rodent control at homes should also be observed to prevent the spread of disease. Those who are working in suspected contaminated water, they should use gloves and plastic boots so as the contaminated water will not penetrate the skin and cause the disease.

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