By: Practical Cures

Diabetes Management Fact vs. Fiction by Alyssa Frates

What is Diabetes?  

Diabetes is a medical condition that causes there to be too much sugar in the body. The body lacks the ability to make insulin, which helps break down sugars. There are so many people who have poor control of their blood sugar levels and have complications from it.

Signs and symptoms of Diabetes:

  • Polydipsia- increased thirst
  • Polyuria-increased urination
  • Polyphagia- excessive hunger/eating
  • unexplained weight loss, dehydration, lethargy/weakness, confusion, warm, dry, and flushed skin, recurrent infections or delayed wound healing and nausea vomiting, or abdominal
  • Hypoglycemia (low blood sugar)- shakiness, nervousness, diaphoresis, headache, confusion, dizziness, pallor, etc.
  • Hyperglycemia (high blood sugar)-confusion, lethargy, thirst, N/V, rapid respirations, & fruity breath

Complications that can occur:

  • kidney disease (nephropathy)
  • Eye conditions (retinopathy)
  • Nerve damage to the hands and/ or feet (Neuropathy)
  • Skin conditions: more likely to develop bacterial and fungal infections
  • Hearing loss
  • Heart disease
  • Stroke

 

Myth: As a type 2 diabetic I will only be able to take insulin to manage my blood sugars

Fact: As this is true for Type 1 Diabetics, this is not true for people who have type 2 diabetes.

Complications from diabetes arise from lack of proper glucose control. Each treatment plan is individualized to the patient. Most therapies require medications. Medications work by decreasing the blood glucose levels. Most times oral medications are used. Insulin is used for purposes of maintaining a longer acting agent to keep blood glucose levels decreased. The treatment goals for these medications are to maintain a patients A1c level with one medication. If levels are not maintained, then more than one medication can be used to reach an optimal A1C level. The video above focuses on diabetic treatment. It focused on the medications used to treat and manage diabetes.

Prevention and Management

Following a diabetic diet:

  • Carbohydrate counting and proper portion sizes. Eat smaller portions throughout the day
  • Carbs have the most sugars in them, so they have the biggest impact on your blood sugar levels
  • For portion sizes have a good mixture of starches, fruits and vegetables, proteins and fats.
  • Limit foods high in fat, sugar and salt
  • Avoid use of alcohol

Exercise and Weight Management

  •   Exercise at least 30 – 45 minutes a day
  •   Always set a goal when exercising
  •  Make sure you drink plenty of water and always have a snack available (just in case your blood sugar gets to low)
  •  Wear a necklace or bracelet that says you are a diabetic in case of an emergency
  •  Check your blood sugar before you exercise, check it during exercise if you are working out more than 45 minutes, and check it again right after exercise
  •  Weight management is a main goal in treating diabetes
  • A healthy weight can lead to less complications caused by diabetes and better blood sugar levels, it has also proven to reduce the amount medications needed to control blood sugar levels.

Treatment Plan:

  •  It is important to take any medications that your doctor orders for you.
  •  The treatment plan you doctor creates is individualized to you
  • Complications from diabetes can occur due to improper blood sugar control
  •  It is important to check your blood sugars while taking any medications. If your sugar remains high or drops to low the medication dosing may not be right for you
  •  Always take your medications at the same time everyday

Myth: I don’t have to follow the regimen the doctors gave me.

Fact: Every patient must follow the treatment plan their doctors have prescribed for them.

In the article: Factors associated with therapy noncompliance in type-2 diabetes patients  it focuses on patients that are non compliant with their diabetic regimen.  When a person is being non-compliant with their regimen it can mean a variety of things. They may have not started treatment or may not be taking their prescribed medications correctly. In this article s study was done with 79 patients. The study was to determine medication compliance. They observed this in 2 ways; one way was medication and the other lifestyle changes. Some weren’t compliant due to the fact of patients having underlying conditions. The results showed 42% of people studied were non-compliant with their regimens. This last video I found: Motivational Interviewing Diabetes Medication Compliance, interviewed a patient who had been diagnosed with diabetes but has trouble accepting the diagnoses. This patient speaks about the difficulties surrounding why he has trouble accepting the diagnosis and why he has trouble taking the medication the doctor has prescribed the medications. This is what most people deal with on a daily basis and why many people are not compliant with the treatment regimen doctors prescribe.

References:

Hernández-Ronquillo, L., Téllez-Zenteno, J. F., Garduño-Espinosa, J., & González-   Aceve  (2003). Factors associated with therapy noncompliance in type-2 diabetes patients.Salud Publica De Mexico, 45(3), 191-197.

http://library.neit.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db   =cmedm&AN=12870420&site=ehost-live

Newlin Lew, K. (2015). Pharmacotherapy of Type 2 Diabetes Mellitus: Navigating Current and New Therapies. MEDSURG Nursing, 24(6), 413-438.

http://library.neit.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=111669182&site=ehost-live

 

Schub T; Kornusky. Diabetes Mellitus Type 1. J CINAHL Nursing Guide
EBSCO Publishing 2014  from

http://library.neit.edu:2084/login.aspx?direct=true&db=nrc&AN=T700834&site=nrc-li
The management of adult diabetes services in the NHS: progress review. Operating Theatre Journal, (302), 2015

http://library.neit.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110799115&site=ehost-live

 

 

 

 

 

 

 

Hospital Acquired Infection

What is a Hospital Acquired Infection (HAI)?

An infection that is not active prior to healthcare interventions. Often a result of poor infection control compliance.

– Society for Healthcare Epidemiology of America

 

Why is this important? 

  • Increasing bacterial resistance to traditional antibiotic treatment.
    • Bacteria are tougher than ever!
  • Higher acuity of patients living in the community.
    • Increasing daily exposure to bacteria and other potential pathogens.

“In hospitals, 1 out of 20 patients develops an HAI.”

“Nationwide, 2 million people develop an HAI each year.”

“Nearly 99,000 of these patients die as a result of their infection.”

– Society for Healthcare Epidemiology of America

Healthcare Professional (HCP) Prevention 

  • Adhere to proper hand hygiene
  • Use of appropriate isolation precautions
  • Meticulous disinfection/sterilization of medical equipment
  • Proper use of aseptic technique
  • Proper disposal of biohazards materials and sharps
  • Surveillance and monitoring infections
  • Patient education

What can I do to protect myself? 

  • Hand washing
    • (the number on way to reduce the spread of infection!)
  • Maintain a healthy lifestyle, include exercise and nutritional diet.
  • Advocate for yourself! Ask your HCPs if they washed their hands!
  • Know signs and symptoms of infection and seek early treatment
  • Stay up to date on immunizations/vaccines
  • Minimize time spent in medical facilities

It’s in your hands! 

References

(2015). Fox News Should I worry about hospital-acquired infections? [mp3]. Available from YouTube https://youtu.be/OKfBUWt4RtQ.

Fox, C., Wavra, T., Drake, D., Mulligan, D., Jones, L., & Bennett, Y. (2015). Use of patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses’ hand washing. American journal of critical care, 24(3), 216-224. http://dx.doi.org/10.4037/ajcc2015898

Garrett Jr, J. H. (2015). A Review of the CDC Recommendations for Prevention of HAIs in Outpatient Setting. AORN Journal, 101(5), 519-528. http://dx.doi.org/10.1016/j.aorn.2015.02.007

Loffler, H., Bruckner, T., Diepgen, T., & Effendy, I. (2006). Primary prevention in health care employees: a prospective intervention study with a 3-year training period. Contact Dermatitis, 54, 202-209. http://dx.doi.org/10.1111/j.0105-1873.2006.00825

Paulo, L. (2008). Hospital-Acquired Infections can be deadly [mp3]. Available from YouTube https://youtu.be/OejyDFEd-2c.

Spruce, L. (2013). Back to basics: hand hygiene and surgical hand antisepsis. AORN, 98(50), 449-460. http://dx.doi.org/10.1016/j.aorn.2013.08.017

Walsh, M.D., E., & McCoy, N. (2008). PBS Second Opion Hospital Acquired Infection (Peter Seigal, M.D., Interviewer) [mp3]. Available from YouTube https://youtu.be/eHjWPkOtAaw.

Blood Clots

What are they, and how do we prevent them?

By: Internet Archive Book Images
*** If while in the hospital you begin to experience any of these symptoms, you must alert a health care provider at once. If you are at home when you notice an indication you should call your primary care physician and go straight to the Emergency Department. ***

Which blood clots are the most dangerous?

All blood clots are dangerous to your health and should be immediately followed up with by a medical professional but those in the lungs and in the legs can be life threatening.

  1. A blood clot that forms deep inside the veins of your legs are called Deep Vein Thrombosis (DVT).
  2. A DVT sometimes may break off and travel through our bloodstream and up into your lungs. This loose, free-flowing clot, called a Pulmonary Embolus (PE) sometimes finds itself in the lungs. This is a serious condition as it can cause damage to the body and even death.

 

By: annszyp

Watch for these signs as a serious indication:

Pulmonary Embolism (PE)

  • Shortness of breath
  • Chest pain
  • Cough
  • Bloody sputum

Deep Vein Thrombosis (DVT)

  • Swelling in thighs or calves
  • Pain
  • Warmth
  • Discoloration below blockage site

How can you prevent them from happening all together?

By: Phalinn Ooi
  • When you arrive to the hospital your risk of developing a blood clot will be assessed and a number of preventative measures will be put in place.
  • Use Sequential Compression Devices when in bed for at least 12 hours a day, more if bed-bound.
  • Wear anti-embolic hose, or TED hose when out of bed.
  • Take all blood thinning medications prescribed to you.
  • Exercise your feet and legs while resting in bed or up in a chair by doing foot pumps and ankle rotations.
  • When possible get out of bed and walk often.
By: douglas haase

What is a blood clot?

  • A blood clot is made of blood cells, platelets (small sticky cells that aid in the clotting process), and fibrin (a protein that traps cells), all normally inside of the blood stream. Sometimes due to health problems and lack of motion (like after surgery) they clog of veins and cause a lack of blood flow to certain parts of your body.
By: Ryan Moomey

What is a blood thinner?

  • A blood thinner is a medicine that acts to stop blood clotting processes in the body and prevent DVT’s and PE’s. They are sometimes given by injection and other times given by pill form. Bleeding is a complication of this medicine and you must take extra precautions to be safe.

    References:

  • FENG-FEI, L., CHAO-HUI, L., BIN, C., & KE, Z. (2016). COMBINATION PROPHYLAXIS VERSUS PHARMACOLOGIC PROPHYLAXIS ALONE FOR PREVENTING DEEP VEIN THROMBOSIS IN HIP SURGERY. HIP INTERNATIONAL26(6), 561-566.
  • BLOOD CLOTS IN THE LUNGS. (2012). MAYO CLINIC HEALTH LETTER30(9), 1-3.
  • BLOOD CLOTS: THE GOOD, THE BAD, AND THE DEADLY. (2012). HARVARD HEART LETTER22(8), 4-5.

Heart Disease and Women

 WOMEN & HEART DISEASE

Heart disease is alsknown as coronary heart disease (CHD) and is the number 1 cause of death in women in the United States. Is a disorder of the blood vessels of the heart that can lead to a heart attack. According to the American heart association, one in three U.S. women eventually succumbs to heart disease. And while the rates for men are declining, the rates for women are rising steadily (Cheek, Jensen, & Smith, 2004).  Women have a higher risk than men in developing CHD but why is this : Age becomes a risk factor at 55. and after menopause, women are more prone to get heart disease. This is because their body’s production of estrogen drops. Women who have gone through early menopause are twice as likely to develop heart disease as women of the same age who have not yet gone through menopause.

Other Risk Factors:

  • High Blood Pressure
  • High Cholesterol
  • Diabetes
  • Smoking
  • Lack of exercise
  • Obesity
  • Ethnic Group (African American and Hispanics)
  • Stress

The video clip above shows Dr. Tara Narula talking about the difference between men and women regarding heart disease. She explains the difference in biology between men and women on how heart attacks develops. During this clip video, she talks about an important point on how doctors can be blame for not testing women earlier for heart disease and how women and heart diseas has been “understudy”, “underdiagnosed and “undertreated”, which contributes to the higher numbers of heart diases in women. Awareness of the disease is also being ignore by women and ONLY 55% of women recognize the seriousness of the disease. Women are also ignoring and misinterpreting symptoms, it seems that women seem to put off medical attention when they are experiencing symptoms.

Knowing your numbers is a short video clip that explains the importance about knowing the numbers in your blood that can contribute to the irsk of heart diseas. Toral cholesterol <200, LDL cholesterol known as the BAD CHOLESTEROL, which we would want to be low: <100, HDL known as the GOOD CHOLESTEROL: >or equal to 50, triglyceride < 150 is  a type of fat which if is high can put you at a higher risk of stroke, Blood Presure (BP) 120/80, fasting glucose <100, Body mass index (BMI) <25 a high BMI can be consider obesity. If these numbers are above rangem changes can be made to lower them and lower the irsk of heart disease.

The healthy habits videos gives examples on how to improve your lifestyle. Heart disease can be preventable when lifestyle changes are made. Diet is an important change, reducing the intake of foods high in cholesterol, fat, sugar, salt can decrease the probability of having a heart attack or stroke. Instead add vegetables, fruits, fish, whole grain and lean meat. Exercise is key to keep you active and reduce weight gain, therefoe have a lower BMI, you can do 30 minutes of jogging, lifiting weights, playing sports and walking. A third lifestyle change is QUIT SMOKING, by doing so the risk of having a strokr or heart attack drops by HALF. Consume alcohol responsible, never is excess to reduce your risk for heart disease.

RECOMMENDATIONS

Heart disease is a serious disease that can lead to to death if not taking seriously. Women as we have learned have a higher risk of developing heart disease, and we should take the necessary precautions. If is known that there is a family history of heart disease your chances are higher, and precautions such as lifestyle changes can help to reduce the risks. It is important to know that men and women experience symptoms of heart attack different. If these symptoms present it is important to seek medical help by calling your primary care doctor or going to an Emergency Department. It is also important to educate ourselves, you can do this by asking your doctor for education or use other resources such as www.heart.org, www.goredforwomen.org.

References

Cheek, D., Jensen, L., & Smith, H. (2004). Preventing and treating heart disease in women. Nursing, 344-8.

De Vito, K. M., Baer, H. J., Dart, H., Chiuve, S. E., Rimm, E. B., & Colditz, G. A. (2015). Validation of a risk prediction tool for coronary heart disease in middle-aged women. BMC Women’s Health, 151-9. doi:10.1186/s12905-015-0250-x

Fact vs Fiction: Dementia

Is Dementia Just Memory Loss? 

Dementia is associated with a decrease in brain function that impacts memory and performance of daily tasks. It is not the same as memory loss associated with aging. Dementia is a general term used for conditions that result from changes to the brain such as Alzheimer’s disease, vascular dementia, and dementia with lewy bodies (2018).

Myth: All people with dementia don’t recognize their family members

Hollywood’s portrayal of dementia is often of a person who is able to speak, eat, and dress themselves with no difficulty. The only deficit is that they have no idea who their loved one’s are when they walk into a room. Dementia impacts everyone differently and there is a wide array of symptoms associated with the disease. Many people with dementia maintain fulfilling relationships with the people closest to them (2018).

Common dementia symptoms include:

  • Visual and perceptual difficulty
  • Problems with communicating verbally and/or in writing
  • Trouble performing tasks such as bathing and dressing
  • Changes in mood or personality
  • Decreased judgment
  • Confusion and disorientation

Myth: You should correct someone who has dementia when they say something that isn’t accurate

You may feel compelled to correct someone who has dementia when they talk about something that isn’t in the “here and now”. However, this can lead to increased confusion and feelings of depression. The most effective way to communicate with a person who has dementia is to join their reality and validate what they are saying (2018).

Example:

“When will my mother get here?”

Poor response: “Your mother isn’t alive anymore, It’s 2018.”

Good response: “I think she will be here later.”

Myth: There is nothing you can do to lower your risk of dementia

Recent studies have found that people with hypertension, and other conditions of the heart are at risk for Alzheimer’s disease and vascular dementia. The heart supplies blood to the brain, which provides nourishment. These conditions impact the flow of blood to the brain which can damage brain cells. Improving your diet, exercising, and avoiding habits such as smoking may decrease your risk of dementia (Singh, 2016).

References:

Alzheimer’s.org (2018) Retrieved February 21. 2018 https:// www.alz.org

Dementia.org (2018) Retrieved February 21. 2018 https://dementia.org

Singh, M et al. (2016) Using Multistate Observational Studies to Determine Role of Hypertension and Diabetes as Risk Factors for Dementia Journal of Neurosciences in Rural Practice Retrieved from http://library.neit.edu:2215/ehost/pdfviewer/pdfviewer?vid=27&sid=94062bcd-c58b-4ea6-9534-106adb609f9e%40sessionmgr120

 

 

Hypertension

What is Hypertension?

Also known as high blood pressure, hypertension is a condition in which the force of the blood against the artery walls is too high. Blood pressure is the force of blood pushing against the walls of the arteries, which carry blood from the heart to other parts of the body. Blood pressure normally rises and falls throughout the day. But if it stays high for a long time, it can damage the heart and lead to health problems. High blood pressure increases the risk for heart disease and stroke, which are leading causes of death in the United States.

Risk Factors

A number of risk factors increase the chances of having hypertension.

  • Age– Hypertension is more common in people over the age of 60 years.
  • Ethnicity– Some ethnic groups, such as African Americans are prone to hypertension.
  • Weight– Being overweight or obese is a key risk factor.
  • Alcohol & tobacco use– consuming alcohol regularly and smoking tobacco can increase a persons blood pressure.
  • Preexisting conditions– Cardiovascular disease, diabetes, chronic kidney disease and high cholesterol can lead to hypertension.

Lifestyle Changes

Hypertension can be managed through lifestyle & dietary changes.

  • Reduce the amount of salt- Average salt intake is between 9 grams and 12 grams; to help decrease the risk of hypertension, reducing intake to under 5 grams a day is recommended.
  • Moderating alcohol consumption-limiting alcohol consumption to two drinks/day for males and one drink/day for females can reduce the risk of hypertension.
  • More fruits and vegetables and less fats– avoiding saturated fats and total fat can reduce a persons risk for developing hypertension.
  • Exercise- Doctors recommend that people with hypertension or have significant risk factors for hypertension engage in 30 minutes of moderate-intensity, dynamic, aerobic exercise. This can include: walking, jogging, cycling, and swimming on 5 to 7 days of the week.
  • Stress Reduction- Avoiding stress or developing strategies for managing stress can help with blood pressure control. Avoiding the use of alcohol, drugs and tobacco to cope with stress will add to hypertensive problems. These should be avoided. Smoking can raise the blood pressure. Smoking cessation reduces the risk of hypertension, heart disease and other health issues.

Common Myths about Hypertension

High blood pressure myths vs facts

Myth: High blood pressure runs in my family. There is nothing I can do to prevent it.

Fact: High blood pressure can be hereditary. If your parents or family members have had high blood pressure, you are more likely to develop it, too.

Myth: I feel fine. I don’t have to worry about high blood pressure.

Fact: About 85 million U.S. adults have high blood pressure — and many of them don’t know it or don’t experience typical symptoms. High blood pressure is also a major risk factor for stroke. If uncontrolled, high blood pressure can lead to serious and severe health problems.

Myth: I read that wine is good for the heart, which means I can drink as much as I want.

Fact: If you drink alcohol, including red wine, do so in moderation. Heavy and regular use of alcohol can increase blood pressure dramatically. It can also cause heart failure, lead to stroke and produce irregular heartbeats.  If you drink, limit consumption to no more than two drinks per day for men and one drink per day for women. Generally, one drink equals a 12-ounce beer, a four-ounce glass of wine, 1.5 ounces of 80-proof liquor, or one ounce of hard liquor (100 proof).

Myth: I have high blood pressure and my doctor checks it for me. This means I don’t need to check it at home.

Fact: Because blood pressure can fluctuate, monitoring your blood pressure at home can provide your healthcare provider with valuable information to determine whether you really have high blood pressure and, if you do, whether your treatment plan is working.

Myth: I was diagnosed with high blood pressure, but I have been maintaining lower readings, so I can stop taking my medication.

Fact: High blood pressure can be a lifelong disease. Follow your healthcare professional’s recommendations carefully, even if it means taking medication every day for the rest of your life.

 

References

Hales, C. M., Carroll, M. D., Simon, P. A., Kuo, T., & Ogden, C. L. (2017). Hypertension Prevalence, Awareness, Treatment, and Control Among Adults Aged ≥18 Years – Los Angeles County, 1999-2006 and 2007-2014. MMWR: Morbidity & Mortality Weekly Report

Give Your Hypertension Coding a Clean Bill of Health With 7 Tips. (2018). Cardiology Coding Alert, 21(1), 3-5.

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/GettheFactsAboutHighBloodPressure/Common-High-Blood-Pressure-Myths_UCM_430836_Article.jsp#.Wo5xrEtG2CQ

Elmore, K. E. (2016). Hypertension: Facts and Forecasts. Med-Surg Matters, 25(3), 4-7.

INFLUENZA IN THE ELDERLY

People with multiple medical problems are at a higher risk to have complications if they contract the flu.

Older adults aged 65 and older have an increased risk of developing complications, being hospitalized, or dying from influenza.

Flu Symptoms

  1. FEVER
  2. COUGH
  3. SORE THROAT
  4. HEADACHES
  5. RUNNY NOSE
  6. BODYACHES AND PAINS
  7. FATIGUE

Frequent complications from the flu can include…

  • Pneumonia
  • Sepsis
  • Death or extended hospital stays

Influenza Prevention:

  • Avoid close contact
  • Get a flu shot
  • Cover your mouth & nose
  • Wash your hands
  • Eat healthy, drink plenty of fluids
  • Get an adequate amount of sleep

The flu shot is an inactivate vaccine made up of the dead virus. The viruses in the flu vaccine are dead, therefor the shot won’t cause you to get the flu. Some people have cold like symptoms following the flu because they were immuno-compromised at the time for the injection.

Places you can get a flu shot:

  • Your local pharmacy
  • Your primary care physician
  • Urgent care centers

    Do I need a flu shot each year?
  • Flu vaccines are updated each season to keep up with changing viruses. Immunity wares off each year so annual vaccination is needed to ensure the best possible protection against influenza.
Flu Treatment

Antivirals, such as Tamiflu: This medication works best when taken within 48 hours of your first symptoms.

  • One of the key things to do for people with the flu are to treat the symptoms, such as Tylenol for fevers/ pain and to drink plenty of fluids.

References

Alluheibi, S. M., Allehaiby, A. H., Ali Aseeri, T., Alqahtani, A. A., Althumali, J. A., Abdu Abudaia, O., & ... Modhish, M. M. (2017). A Review of Knowledge, Attitude and Prevalence of Flu Vaccination and Its Effect among Elderly. Egyptian Journal Of Hospital Medicine, 69(6), 2680-2684. doi:10.12816/0042248

Campos-Outcalt, D. (2017). Latest recommendations for the 2017-2018 flu season. Journal Of Family Practice66(9), 570-572.

Green, D. (2015). Fighting flu. Midwives, 1866-67.

Prevention of DVT’s with SCD’s

What is a DVT?

A deep vein thrombosis (DVT) occurs when a blood clot forms in one of the veins in your body, the most common site for this is usually in your legs. These clots can become very serious and dislodge and go to your lungs which can then cause a blockage of blood flow (this is then called a pulmonary embolism). More than 200,000 people per year experience DVT’s and of those patients, 50,000 experience complications from a pulmonary embolism (Larkin, Mitchell & Petrie, 2012).

What are symptoms of a DVT?

Some common symptoms of a DVT are:

  • Swelling in the affected leg
  • Redness
  • Pain
  • Feeling of warmth on the skin
  • DVT’s can also occur with no symptoms

What are common causes of a DVT?

The blood clots of DVT’s can be caused by anything that prevents your blood from circulating or clotting normally, such as injury to a vein, surgery, certain medications and limited movement.

  • Pregnancy increases the pressure in the veins in your pelvis and legs. The risk of blood clots from pregnancy can continue for up to six weeks after you have your baby.
  • Birth control pills or hormone replacement therapy increase your blood’s ability to clot.
  • Smoking affects blood clotting and circulation, which can increase your risk of DVT.
  • Sitting for long periods of time, such as when driving or flying. When your legs remain still for hours, your calf muscles don’t contract, which normally helps blood circulate. Blood clots can form in the calves of your legs if your calf muscles don’t move for long periods.

 

What are SCD’s and what are they used for?

A Sequential Compression Device (SCD) is a safe non-invasive therapy for the prevention of a DVT. The SCD sleeve is wrapped around the calf muscle and provides a gentle compression or squeeze to promote the flow of blood back to your heart. The Sequential Compression keeps the blood moving and helps to prevent it from clotting. The SCD mimics the contraction of the calf during walking. The units are to be used while resting or in bed and are placed on patients during surgery to help prevent DVT’s as well. SCD devices sequentially inflate and deflate air-filled sleeves on the lower extremities. With knee-high sleeves, pressure starts at the ankle and moves toward the knee; pressure is approximately 45 mm Hg at the ankle and 35 mm Hg at the knee. With thigh-high sleeves, pressure at the thigh is 30 mm Hg. Each compression lasts approximately 11 seconds.

 

How to properly apply a SCD?

  • Make sure the ankle lines up with the ankle indication on the sleeve.
  • Wrap the sleeve around the patient’s leg and secure it.
  • Place two fingers between the patient’s leg and the sleeve to ensure a correct fit.
  • Attach the sleeve to the mechanical pump unit.
  • To check connections, note the arrows that indicate accurate insertions from sleeve to pump on the pump side and on the patient side of the pump hose.
  • Turn on the mechanical pump and confirm it’s working properly.
  • Stay with the patient to assess sleeve inflation and deflation through one full cycle.
  • Remove the sleeve once every 8 hours to assess skin integrity and neurovascular status of the extremity and to reinforce patient education.
  • Know that the sleeve should be removed during bathing and when the patient ambulates.
  • Instruct the patient to call for assistance when preparing to ambulate.
  • Caution the patient never to ambulate with the sleeve in place due to the risk of falling.
  • Make sure the sleeve is removed only for a short time daily.

What is some evidence supporting the use of SCD’s?

  • In a study by Nagahiro et al that included 706 patients undergoing general thoracic surgery, 362 patients were given prophylactic sequential compression devices, and none of these patients developed a pulmonary embolism. Of the 344 patients who did not receive sequential compression prophylaxis, however, 7 developed a pulmonary embolism (Summerfield, 2006).
  • The use of the SCD for the prevention of DVT is covered by most insurances as a post-operative take-home therapy.
  • This method is effective in preventing thrombosis, and compares favorably with pharmacological prophylaxis.
  • In a study done to compare different SCD systems the results yielded that there is no reason to believe that any particular compression is more or less effective in preventing DVT than any other system, Intermittent compression prevents DVT and prevents venous stasis (Morris & Woodcock, 2004).

SCD’s in the media

A new trend in professional athletes has been utilizing the use of compression devices to help mobilize fluid and speed recovery. This technology has been modeled from the SCD’s that can be seen in hospitals and other healthcare facilities. An example of this brand is “Normatec”, the theory is that it provides graded compression in a circumferential manner, it brings away cell metabolites such as lactic acid that can make your muscles feel sore but it also brings increased blood flow to help quicken recovery. There is still more data needed on the research of this product. The trend has spread throughout professional sports such as the NFL and NBA where this product can be seen being used, Good Morning America also did a segment on Normatec and highlighted a few professional athletes such as Lebron James as being an athlete who is actively using this product. While it is apparent the usefulness that SCD’s have provided in preventing DVT’s it is very exciting that there are now products out there that could help to improve professional athletes overall recovery and performance! Technology is continuing to rapidly improve and grow so it will be interesting to see how these devices progress into the future.

http://abcnews.go.com/GMA/video/leg-bags-star-athletes-best-secret-44504916

 

 

Some useful links and resources for more information!

 

https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/diagnosis-treatment/drc-20352563

https://www.americannursetoday.com/enhancing-patient-outcomes-with-sequential-compression-device-therapy/

https://www.normatecrecovery.com/how-compression-works/how-and-science/

Morris, R. J., & Woodcock, J. P. (2004). Evidence-Based Compression: Prevention of Stasis and Deep Vein Thrombosis. Annals of Surgery, 239(2), 162–171. http://doi.org/10.1097/01.sla.0000109149.77194.6c

Ashworth, S. C. (2014). Sequential Compression Devices and Clots. Critical Care Nurse34(6), 68-69. doi:10.4037/ccn2014264

Larkin, B. G., Mitchell, K. M., & Petrie, K. (2012). Translating evidence to practice for mechanical venous thromboembolism prophylaxis. AORN Journal96(5), 513-527. doi:10.1016/j.aorn.2012.07.011

Summerfield, D. (2006). Decreasing the incidence of deep vein thrombosis through the use of prophylaxis. AORN Journal84(4), 642-645. doi:10.1016/S0001-2092(06)63943-4

 

Medical Marijuana & Health Care Providers

What is medical marijuana? 

As seen on the web, medical marijuana is the name given to dried buds and leaves of varieties of the Cannabis sativa plant. It has been known to be helpful in treating symptoms, illnesses and conditions. The most common use for medical marijuana in the United States is for pain control. At this time the U.S Food and Drug Administration (FDA) has not recognized medical marijuana as medicine. However they have found that the marijuana plant contains chemicals that have shown positive results in both reducing and decreasing symptoms in illnesses. At this time further research is being conducted to determine the benefits that medical marijuana has on patients.

Medical conditions positively effected from medical marijuana

  • Multiple Sclerosis
  • Lou Gehrig’s Disease/ALS
  • Parkinsons
  • Arthritis
  • Fibromyalgia
  • Endometriosis
  • Interstitial cystitis
  • Glaucoma
  • PTSD
  • HIV
  • Irritable bowel syndrome
  • Cancer
  • Anxiety
  • Alzheimer’s disease
  • Rheumatoid Arthritis

Benefits of Medical Marijuana

  • Helpful in treating nausea and vomiting from cancer chemotherapy
  • Can be helpful in treatment of neuropathic pain (pain caused by damage nerves)
  • Helps improve food intake
  • Those who use may require less pain medicine
  • THC and CBD slow growth/cause death in certain types of cancer cells growing in lab dishes and slow the spread of some forms of cancer
  • Helps in managing anxiety

Risks of Medical Marijuana

  • Can lower the users control over movement
  • Cause disorientation
  • Produce unpleasant thoughts or feeling of anxiety and paranoia
  • Delivers harmful substances to users and those close by including many of the same substance found in tobacco smoke
  • Marijuana plants come in different strains making it difficult to predict each users experience
  • Chronic users can develop a dependence

How to take the next step in considering if medical marijuana is a good option for you?

  1. Your doctor: Reaching out to your primary care physician is a good place to start. Your family doctor may be able to prescribe medical marijuana or refer you to someone to provide you with better medical advice.
  2. Medical Marijuana specialist: A specialist can provide you with better information and understanding of how it can improve you current condition!
  3. Medical Marijuana clinic: A clinic will provide you with staffed members who specialize in medical marijuana therapy. A clinic will also include a dispensary where you will be provided with more information on what strains would be appropriate for you.

Refer to Medicinal Marijuana Association for additional information on this topic : http://www.medicinalmarijuanaassociation.com/medical-marijuana-blog

Useful Resources for those considering medical marijuana

Marijuana legalization status:

http://www.governing.com/gov-data/state-marijuana-laws-map-medical-recreational.html

Medical Marijuana support groups:

https://www.marijuanadoctors.com/blog/medical-marijuana-support-groups/

https://www.mdjunction.com/medical-marijuana-patients

Research findings

In conclusion, at this time further research needs to be conducted to determine the value medical marijuana offers to those battling with an array of illnesses and conditions. After completing significant research on this topic, my findings both on the web and in scholarly journal articles have suggested similar conclusions. Research is weak. More research needs to be done to confirm whether medical marijuana is both safe, and useful. Many practicing doctors at this time are too unfamiliar with medical marijuana therefore not prescribing it to their patients. However as explained above in the video clips, medical marijuana is becoming much more popular and many patients are becoming increasingly interested in trialling medical marijuana for overall medical benefits!

References

Abuse, N. I. (n.d.). Marijuana as Medicine. Retrieved February 21, 2018, from https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine

Ali, E. (2016). Medical Marijuana. Alive: Canada;s Natural Health & Wellness        Magazine, (402), 49-   52.

Grinspoon, M. P. (2018, January 09). Medical marijuana. Retrieved February 21, 2018, from https://www.health.harvard.edu/blog/medical-marijuana-2018011513085

Spencer, N., Shaw, E., & Slaven, M. (2016). Medical cannabis use in an       outpatient   pallaiative care clinic: A retrospective char revicew. Journal of Pain  Management, 9(4) , 507-513.

Vin-Raviv, N., Akinyemiju, T., Meng, Q., Sakhuja, S., & Hayward, R. (2017).           Marijuana use and inpatient outcomes amongh hospitalized patients: analysis of   the   nationwide inpatient sample database. Cancer Medicine, 6(1), 320-329. Doi:10. 1002/ca4.968

Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a developmental disorder that develops before the age of three and involves impaired social interaction as well as communication. Also commonly seen is a small range of interests and activities for a person with ASD. Originally this disorder was discovered in 1943, by child psychiatrist Leo Kanner. The people with this disorder can have various levels of intelligence ranging from low to normal, as well as difference in severity of symptoms. The key component in all of these children is the lack of social and communication skills.

1 in 68 children in the US have ASD. This is a 30% increase from two years ago, in which it was 1 in 88 children were diagnosed. The reason for this dramatic incline is unknown, it is also possibly that awareness has made it easier for children to be diagnosed earlier during there development.According to Autism speaks many symptoms of the disorder consist of but are not limited to…

Possible signs of autism in babies and toddlers:                            By 6 months, no social smiles or other warm, joyful expressions directed at people
By 6 months, limited or no eye contact
By 9 months, no sharing of vocal sounds, smiles or other nonverbal communication
By 12 months, no babbling
By 12 months, no use of gestures to communicate (e.g. pointing, reaching, waving etc.)
By 12 months, no response to name when called
By 16 months, no words
By 24 months, no meaningful, two-word phrases
Any loss of any previously acquired speech, babbling or social skillsPossible signs of autism at any age:
Avoids eye contact and prefers to be alone
Struggles with understanding other people’s feelings
Remains nonverbal or has delayed language development
Repeats words or phrases over and over (echolalia)
Gets upset by minor changes in routine or surroundings
Has highly restricted interests
Performs repetitive behaviors such as flapping,                          rocking or spinning
Has unusual and often intense reactions to sounds, smells, tastes, textures, lights and/or colors

Children may demonstrate some of these behaviors, but not all. Also children who develop some of these behaviors, may not be autistic. If you believe your child may have ASD, contact your pediatrician for testing. Early intervention is extremly important for these children.

Many interventions for ASD are home bases therapies such as

  • Applied Behavioral Analysis
  • Occupational Therapy
  • Speech Therapy

Causes of ASD… These can be genetic in origin from either parent on chromosome 16 or even a spontaneous gene change during embryonic development. Increase age of either parent also increases the risk, as well as birth complications, premature birth and the birth of multiples such as twins and triplets. ASD is also linked to abnormal brain development at an early age. Women who have been exposed to German Measles or during the course of their pregnancy also put their child at t a higher risk of developing the disorder. Although it is a common myth, vaccines do NOT cause Autism Spectrum Disorder! 

These children are also at risk for many other comorbidities. Such as…Epilepsy, gastrointestinal problems, selective or restricted eating habits , sleep disturbances, Attention-deficit/hyperactivity disorder (ADD and ADHD), Anxiety, Depression, and Obsessive compulsive disorder (OCD). Those who have ASD also commonly engage in self injurious behaviors such as but not limited to…head-banging, hand-biting, and excessive self-rubbing and scratching. Which if not monitored can lead to concussions and life-long brain damage. These behaviors tend to be coping mechanisms for too much sensory stimulation, whether it be environmental or internal stressors. With help from early intervention sometimes these self-injuries behavior can be replaced with functional and non-destructive behaviors.

In Conclusion…ASD is a disorder of sensory processing. What may feel normal to a neurotypical brain could be extremly distressing to the ASD brain. These children can lead very happy and healthy lives with early intervention services as well as love and understanding. Remember April is ASD awareness month, more information about advocacy events can be found at www.autismspeaks.org.

Great Informational References  

Causes: https://www.autismspeaks.org/what-autism/learn-more-autism/what-causes-autism

Warning signs: https://www.autismspeaks.org/what-autism/from-first-concern-to-action/learn-signs

Services: https://www.autismspeaks.org/what-autism/from-first-concern-to-action/access-services

Autism Friendly Events: https://www.autismspeaks.org/autism-friendly-events

For those who are more audio or visual learners, I attached two great videos to help explain Autism Spectrum Disorder. The first is an animated explanation of the disorder. The second video is facts about ASD and even covers popular myths about the disorder as well.