HIV/Premature death rise in rural counties

In recent times the U.S. population has gotten healthier due to changes in behaviors and lifestyles, advances in automobile and workplace safety and reductions in infectious diseases. But even with all the advances the disparities in healthy individuals that exist in both urban and rural counties is large by a wide margin. According to a report from the 2016 County Health Rankings report it states that, “ rates of premature deaths has been higher in rural counties fore many years, and will continue to rise in those areas even as they drop in urban areas”.
Although the report doesn’t explain what factors contribute to the  disparities but some that may have an impact include behaviors such as smoking and drug abuse, diet and exercise, access to clinical care, education, socioeconomic factors and even physical environment (i.e. poor water quality and housing). Furthermore what the article suggests is that it important for people from across the community to come together to identify priorities and provide evidence informed strategies. Nurses can do this by counseling patients in healthy behaviors, work with health institutions to create policies that support these healthy behaviors and even serve on boards and work with local business to encourage economic development.
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Teen pregnancies, births, and abortions have seen decline

According to new data reports, teen pregnancy, birth and abortion rates have recently dropped to a historic low. One of the reasons as to why the rates are so low are because teens are using birth control more often and are waiting longer to have intercourse.

Another report shows that millennials are engaging in sexual activity less than their parents are, citing 41 percent of individuals born in the 1990s are sexually inactive. This abstinence and celibacy could be a factor in the decline of unwanted pregnancies, along with the education of HIV and other sexually transmitted diseases.  

TAVR

Transcatheter Aortic Valve Replacement (TAVR) is a relevantly new procedure to treat severe aortic valve stenosis in patients who are not cleared for an aortic valve replacement with sternotomy. Usually patients experiencing severe aortic valve stenosis will undergo open heart surgery. The TAVR procedure eliminates the sternotomy incision and is performed by threading a catheter through the femoral artery. This concept is similar to a cardiac catherization. Post-care of these patients include groin management same as post-cath patients.

Aortic stenosis causes the heart to work more which can cause weakening of the heart, chest pain, fatigue, and shortness of breath. The TAVR procedure is used to improve quality of life in these patients by eliminating these symptoms.

With any procedure there comes complications. The most common complication I have witnessed personally in patients who have had this procedure include heart block. This is where there is a disruption in the electrical activity of the heart. This is characterized by pauses of the heart beating on an electrical monitor to even asystole which is when the electrical activity ceases and the heart is not contracting. Many patients I have cared for have had this complication and require a permanent pacemaker before discharge.

Managing Stress

Stress is something I am sure we have all experienced in life. As we become older and take on more responsibilities it may feel like life is enclosing on you. Taking time to relieve stress is very important to maintain health and happiness. For instance, I am working full-time as a healthcare professional while attending a Doctorate program full-time and trying to balance a home life with my husband. Stress is something I feel on a daily basis.

All aspects of life demands something from us but it is essential to recognize we need to take care of our own needs to continue to be productive. Some ways to manage stress include exercising, maintaining a healthy diet, talk with someone you trust, listening to music, getting enough sleep, staying positive, practicing your faith and making time to treat yourself. I am sure there are a hundred other ways to manage stress but these are the ones I constantly use to manage stress. It is also important to recognize if you are using unhealthy methods to manage stress such as smoking, alcohol use, overeating, taking out your stress on others and withdrawing from family and friends.

When it feels like you are being engulfed by life, worries, and fear, remember you are not alone. Take steps to manage your stress and do not let it consume your life or get ahead of you. Make a plan and stick to it. Many times I look up into the sky and think about the universe and how the issues and problems we face daily are in reality so minuscule.

Viagra to treat Pulmonary Hypertension

The drug once used for erectile dysfunction (ED) and seen on commercials known as Viagra is now being used for the treatment of pulmonary hypertension. I noticed this practice when I began taking care of LVAD patients. These patients implanted with LVADs which stands for Left Ventricular Assist Device(picture below) were implanted due to severe heart failure.

According to MayoClinic, pulmonary hypertension is a type of blood pressure that affects the arteries in the lungs and in the heart. Symptoms of pulmonary hypertension include: shortness of breath, dizziness, and chest pressure. Viagra is now marketed as Revatio to treat pulmonary hypertension.

The mechanism of action for Revatio is relaxing the muscles found in the walls of the blood vessels which increasing blood flow. Common side effects include: insomnia, epistaxis (nose bleed), and rhinitis (runny nose). The dosage for this medication is either 5mg or 20mg three times a day by mouth.

Bedside Handoff Report

Bedside handoff is an essential component when it comes to nursing care. What I have observed with even working in the clinical setting is that bedside handoff is not being strictly implemented or done by any nurses during shift change. Report is still being given at the nurses station which leads to incorrect information, sentinel events and also excluding the patient from their own care.

The Joint Commission reported that about 70% of sentinel events were due to lack of communication during handoff report (Riesenberg, Leitzsch & Cunningham, 2010). What this tells us is that there has to be a change implemented to improve patient care and outcomes. Educating healthcare professionals on the importance of bedside handoff I believe will make this transition smoother.

Bedside handoff allows the nurses to look at the patient and check for important things such as lines, IV drips and rates, skin issues, and also allows the patient to have a say in their own care. As healthcare professionals it is our job to provide safe and effective care while also providing quality service to our patients. Practicing bedside handoff will increase patient satisfaction and raise hospital survey scores.

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Reference:

Riesenberg, L. A., Leitzsch, J., & Cunningham, J. M. (2010). Nursing handoffs: a systematic review of the literature. The American Journal Of Nursing, 110(4), 24-34. doi: 10.1097/01.NAJ.0000370154.79857.09

2016 Rio Olympic Mishaps

As the 2016 Olympics hosted in Rio, Brazil are in full swing many of the forewarned issues regarding Zika outbreaks, overwhelming water pollution and even increased crime have not been resolved making the event a disaster. What is even more worse is that what was initially reported about the issues were downplayed and  some athletes were shocked when they arrived about the conditions that could ultimately affect their health.

For instance Olympic rowers were warned about the dangers of having polluted water from the Rodrigo de Freitas Lagoon splashed into their eyes and mouths prompting officials to urge them to bleach the handles of their oars, and swish with anti-bacterial mouthwash, keep water bottles in plastic bags, all in efforts to avoid diarrhea and other long term gastrointestinal symptoms.

This is just one issue but the biggest and perhaps the most dangerous affecting a larger population is the growing  pandemic of the Zika virus, which produces a viral strain that can cause microcephaly in unborn fetuses in pregnant women. It is a major concern because many of the games are hosted outdoors to crowds of fans and the course of Zika carrying mosquitoes are difficult to predict, which made athletes think of creative ways to protect themselves. Many athletes skipped out in being a part of the Olympics this year because of the concern for Zika.

Superbug

A dreaded superbug found for the first time in a U.S. woman

Antimicrobial resistance is a term we are hearing more and more often. As a nurse I have seen these antimicrobial resistant bacteria in many patients I have taken care of. These include: Methicillin-Resistant Staphylococcus Aureus(MRSA); Vancomycin-Resistant Enterococcus(VRE); Antibiotic Resistant Mycobacterium Tuberculosis; Clostridium Difficile, and many more.

So what causes these bacterias to become resistant to the antibiotics that were so effective before ? Resistance can occur from mutation or by bacteria obtaining new DNA. The excessive and unnecessary use of antibiotics in humans and animals has also contributed to antimicrobial resistance. Limiting the over prescription of antibiotics for minimal complaints such as colds could decrease the risk of bacteria developing resistance.

Recently there has been cases in the U.S. of a superbug. This bacteria was resistant to the Colistin antibiotic which is the one used when no other antibiotics seem effective. It is estimated that superbugs cause 700,000 deaths each year. So what can we do to protect ourselves from these superbugs in the years to come ? Reducing the antibiotic use in humans and animals, promoting hygiene, and sending researchers out to find new antibiotics in our environment.

Increased incidence of C.diff with use of PPIs

In the hospital setting we see most, if not all patients on some sort of stomach ulcer prophylaxis. The most common medication seen inpatient for this is Pantoprazole, the trade name being Protonix. The problem that arises with over-utilizing Proton Pump Inhibitor’s(PPIs) is the associated increased incidence of Clostridium difficile colitis infections in patients. PPIs work by reducing the amount of acid in the stomach.

Clostridium difficile also known as C.diff is an infection caused by the disruption of normal healthy bacteria in the colon. Symptoms include frequent diarrhea, stomach pain and fever. C.diff is transmittable from person to person by spores. Patients who have been diagnosed with C.diff are placed on Contact precautions. Contact precautions include wearing protective equipment which are gowns and gloves. Hand washing pre and post care of all patients is another way of reducing infections.

According to the FDA, a diagnosis of C.diff should be considered when a patient who is on a PPI has diarrhea that does not improve. The treatment for C.diff includes oral antibiotics such as Vancomycin. The indications of this finding to healthcare is significant. There has been a over-utilization of PPIs for patients in the hospital setting. If the patient does not have a history of ulcer disease or acid reflux then these medications should not be used in them. This decreases their risk of contracting C.diff and saves the hospitals thousands as well.