What Medication Is This? Ranitidine Hydrochloride

Ranitidine

Ranitidine Hydrochloride is indicated for the treatment of ulcer in the stomach or duodenum and for the treatment of problems related to acid reflux from the stomach to the esophagus, excess stomach acid indigestion or heartburn.

How it works?

Ranitidine is a histamine H2 receptor antagonist remedy, thus inhibiting the production of acid by the stomach, induced by histamine and gastrin.

This favors the healing of gastritis, peptic ulcers of the stomach and duodenum, and prevents the onset of malaise and heartburn and other complications.

The Side Effects

Some of the side effects of Ranitidine may include wheezing, tightness in the chest, swelling of the eyelids, face, lips, mouth or tongue, hives or skin cracking, fever, feeling weak, nausea, loss of appetite, skin and eyes yellowing, heartbeat or irregular heartbeat, dizziness, excessive tiredness or weakness, blurred vision, hair loss, impotence, stomach pain, diarrhea, shortness of breath and fatigue, recurrent infections or bruising.

When Is It Contraindicated?

Ranitidine is contraindicated for women who are pregnant or intending to become pregnant, are breast-feeding, and are allergic to Ranitidine Hydrochloride or any of the ingredients in the formula.

In addition, Ranitidine tablets are also contraindicated for children and for people with kidney problems or with porphyria.

Nursing Care

  • The medication should be administered exactly as recommended and treatment should not be discontinued, without the physician’s knowledge, even if the patient achieves improvement;
  • The medication should not be used during lactation. In case of pregnancy (confirmed or suspected) or if the patient is breastfeeding, the doctor should be informed immediately. Caution is also recommended in cases of hepatic or renal dysfunction;
  • Inform the patient of the most frequent adverse reactions related to the use of the medication and in the occurrence of any one, especially the uncommon or intolerable, the doctor should be consulted. Also report the possible occurrence of alopecia;
  • During therapy, the patient should receive adequate hydration;
  • May cause dizziness or drowsiness. Recommend that the patient avoid driving and other activities that require alertness during therapy;
  • It recommends the patient to avoid smoking (to prevent any interference in the healing or decrease of the medication effect), the consumption of alcohol or caffeinated beverages (coffee, tea and cola drinks) and the concomitant use of acetylsalicylic acid, as well as of any other drug or medication, without the physician’s knowledge, during therapy;
  • During therapy, evaluate: Adverse reactions and, in the presence of hepatic or renal reactions, consider dose reduction;
  • Laboratory Tests: May cause increases in TGP;
  • Drug interactions: attention during concomitant use of other drugs;
  • OV: the medication should be given during meals and before bed;
  • IV: dilute 50mg in 20ml of saline 0.9% and infuse in 5min.;
  • Continuous infusion: dilute 50mg in 1400ml of 5% glycosated serum and infuse in 15-20min .; after dilution (saline 0.9% or 5% glycoside), the solution remains stable for 48 hours (room temperature).

Long Intestinal Tubes

Intestinal Tubes

The Long Intestinal TubesMiller-Abbott, Cantor Tube and Andersen Tube, are examples of tubes with weight at their end that are placed preoperatively or intraoperatively for gastrointestinal surgeries. The long length makes it possible to remove the intestinal contents for the treatment of an obstruction, which is not possible by means of a nasogastric tube.

These tubes can decompress the small intestine and separate it intraoperatively or postoperatively. As the progression of the tubes depends on intestinal peristalsis, its use is contraindicated in patients with paralytic ileus and severe intestinal mechanical obstructions.

Older appliances, such as Cantor and Miller-Abbott-type tubes, are rarely used today because the balloon at the distal end is filled with mercury, and the new Andersen probe has a tip filled with tungsten, which is the safest option.

Interventions used in patient care with a long intestinal tubes are similar to those used for the nasogastric tube and sengstaken blakemore: Balloon hyperinflation should be observed in the patient, which makes removal more difficult, rupture of the balloon that can lead to intestinal rupture, and reverse invagination if the probe is removed quickly. The intestinal probes should be removed slowly, usually around 2 inches of catheter should be removed every hour.

 

 

The Blood Flow in the Heart: The Diagram

Heart

The body’s valves allow blood to flow only in one direction. This supports the two cycles observed in human circulation: that of arterial blood, which has been oxygenated by the lungs and will be distributed throughout the body when the heart pumps, and venous blood, which returns to the deoxygenated heart and rich in carbon dioxide.

Deoxygenated blood enters the heart through the superior vena cava and inferior vena cava, flowing into the right atrium. The muscles of this chamber relax and the space is filled with the venous blood, and then it is controlled by an orifice to the right ventricle. Functioning like a pump, the right ventricle pushes the blood to the lungs.

Once restored and again rich in oxygen, the blood returns to the left side of the heart through the pulmonary veins. First it reaches the left atrium, following an orifice to the left ventricle. Being the most powerful chamber of the heart, it generates strong contractions to pump the blood to the whole body through the exit port: the aorta artery.

Although it is one of the major responsible for the distribution of oxygen to the body, the heart also needs to receive oxygen to function properly. In this way, your muscles are nourished by a network of arteries – the coronary arteries – that originate in the aorta.

To pump blood properly, the organ relies on electrical signals sent by the sinoatrial node (the “natural pacemaker”) to the heart cells. In response, these cells produce the contractions necessary to push the blood to all tissues in the body.

Pressure Injury

Pressure injury

On April 13, 2016, NPUAP announced the change in terminology Pressure Ulcer for Pressure Injury and updating the nomenclature of the stages of the classification system.

According to NPUAP, the term more accurately describes this type of injury, both on intact and ulcerated skin. In the previous NPUAP system, Stage 1 and Deep Tissue Lesion described lesions on intact skin while the other categories described open lesions.

This caused confusion because the definition of each stage referred to pressure ulcer. Besides this change, in the new proposal, Arabic numerals are now used in the nomenclature of the stages rather than the Romans.

The term “suspected” was removed from the diagnostic category Deep Tissue Injury. During the NPUAP meeting, other definitions of pressure lesions were agreed upon and added: Medical Device-related Pressure Injury and Membrane Membrane Pressure Injury.

Reference: NPUAP

 

Vasoactive drugs

Vasoactive Drugs

Vasoactive drugs refers to substances that present peripheral, pulmonary or cardiac vascular effects, either direct or indirect, acting in small doses and with dose response dependent on short and rapid effect, through receptors located in the vascular endothelium. They are commonly used in an intensive care unit (ICU) mainly to regulate heart rate and systolic volume.

In most cases, it is necessary to perform hemodynamic and invasive monitoring during the use of these substances, since their potent actions determine drastic changes in both circulatory and respiratory parameters, and may cause serious side effects if their use is inadequately done, including permanent damage, seizures, death.

The most used vasoactive drugs are catecholamines, also called vasoactive amines or sympathomimetic drugs. Among them, the following stand out:

  • noradrenaline
  • Adrenaline
  • dopamine
  • dopexamine
  • dobutamine
  • isoproterenol

There is also the vasoconstrictor class called Anti-diuretic Hormone:

  • vasopressin

And the group of vasodilators most used in ICU:

  • Sodium nitroprusside
  • nitroglycerine

KNOWING EACH VASOTIVE DRUG:

CATECHOLAMINES:

Noradrenaline: is the neurotransmitter of the sympathetic nervous system and precursor of adrenaline. Norepinephrine has activity in both the alpha and beta 1 adrenergic receptor, with little action on beta 2 receptors. Depending on the dose used, there is an increase in systolic volume, a decrease in heart rate and an important peripheral vasoconstriction, with an increase in blood pressure . Noradrenaline is also a potent visceral and renal vasoconstrictor, which limits its clinical use. It is also vasoconstricting on the vascular, systemic and pulmonary network and should be used with caution in patients with pulmonary hypertension. On the other hand, it is a drug of choice in septic shock, whose purpose is to raise BP in hypotensive patients, who did not respond to volume resuscitation and other less potent inotropes.

Adrenaline: is a potent alpha and beta adrenergic stimulator whose vasopressor effect is well known. The mechanism of elevated blood pressure caused by adrenaline is due to direct action in the myocardium, with increased ventricular contraction, an increase in heart rate and vasoconstriction in many vascular beds (arterioles of the skin, kidneys, and venules). In the smooth muscle, its predominant action is relaxation through the activation of alpha and beta adrenergic receptors. The drug also exerts bronchodilation, through interaction with beta2 receptors of the bronchial smooth muscle, combined with the inhibition of mast cell degranulation. Adrenaline also raises glucose concentrations (increased neoglycosis and inhibition of insulin secretion) and serum lactate. The main indications of epinephrine include states of circulatory shock that do not respond to the other less potent catecholamines, in particular in cardiogenic shock, when combined with post-load reducing agents. This drug is recommended in the treatment of severe borcospasm. It is also indicated for the treatment of anaphylaxis and, during cardiopulmonary resuscitation maneuvers, is the most effective vasoconstricting agent.

Dopamine: is the immediate precursor of noradrenaline. It has numerous effects, since it stimulates all types of receptors, being these dose-dependent. In low doses, it has a predominant dopaminergic effect, causing an increase in cardiac output; decreased vascular resistance and renal and mesenteric vasodilation. At medium doses, it has a predominant beta effect, increasing the cardiac output; blood pressure and diuresis. At high doses, the predominant effect is alpha, causing increased systemic vascular resistance and blood pressure and decreased renal blood flow. Thus, the main indications for dopamine are related to low-flow states with controlled or increased blood volume (beta adrenergic effect). Because this vasoactive drug has a low-dose renal vasodilator effect, it is also indicated in situations in which the hemodynamic parameters are stable, but with persistent oliguria (dopaminergic effect). It can also be used in shock conditions with decreased peripheral resistance (alpha adrenergic effect).

Dobutamine : is a synthetic sympathomimetic drug with a predominantly beta 1 agonist action. This drug has low affinity for beta 2 receptors and is almost devoid of alpha adrenergic effects. Dobutamine has few effects on heart rate, increases myocardial contractility and cardiac index, not acting on peripheral vascular resistance. The drug is used to improve ventricular function and cardiac performance in patients in whom ventricular dysfunction results in decreased systolic volume and cardiac output such as cardiogenic shock and congestive heart failure. Myocardial oxygen consumption, under the use of dobutamine, is lower than under the action of other catecholamines.

Dopexamine: is a synthetic catecholamine with dopaminergic and beta 2 agonist activity, with a weak beta 1 adrenergic effect and absence of effects on alpha receptors. When compared to dopamine, dopexamine has less potency in stimulating dopaminergic receptors, while its beta 2 effects are about sixty times more potent. Thus, beta receptor stimulation results in increased cardiac output, decreased systemic vascular resistance, and increased urinary volume and sodium excretion by dopaminergic stimulation. In addition, the drug potentiates the effects of endogenous noradrenaline by blocking its reuptake. Dopexamine can be used in the treatment of acute and congestive heart failure and in postoperative patients of cardiac surgery, who develop with low output. In addition, dopexamine may also be used in septic shock in combination with noradrenaline in an attempt to prevent acute renal failure and to increase mesenteric flow and gastrointestinal perfusion.

Isoproterenol: is a synthetic catecholamine, similar in structure to adrenaline. It is a potent beta adrenergic agonist, with very low affinity for alpha receptors. Therefore, it exerts potent effects on the cardiovascular system, such as increased contractility, frequency and conduction velocity of the cardiac electrical stimulus. There is an increase in cardiac output and in myocardial oxygen consumption. Stimulation of beta adrenergic receptors results in relaxation of the vascular smooth muscle at the same time as systemic vascular resistance and diastolic pressure fall. The smooth muscle of the bronchial and pulmonary vascular airways are also relaxed by isoproterenol, causing a decrease in pulmonary vascular resistance and reversal of bronchospasm. It is indicated mainly in the low flow syndromes with high filling pressures and also elevated peripheral and pulmonary resistance (cardiogenic shock). It is also indicated to treat cases of bradycardia with hemodynamic repercussion until definitive therapy (pacemaker) is used.

VASODILATORS:

Sodium nitroprusside : is a mixed vasodilator with effects on the arterial and venous territories. Acts directly on vascular smooth muscle. It does not present direct effect on the cardiac muscle fibers, being its increase in the cardiac output due to the vasodilating action. Renal blood flow and glomerular filtration rate are maintained and the secretion of renin by the body is increased.

The drug then promotes a decrease in total peripheral resistance, blood pressure and myocardial oxygen consumption, low heart rate changes, and decreased pulmonary vascular resistance. The active metabolite of the drug is nitric oxide, which appears to be responsible for the vasodilatory action. Sodium nitroprusside is an unstable molecule that undergoes decomposition under alkaline conditions and when exposed to light. It is indicated in the treatment of hypertensive emergencies and as an auxiliary drug in states of circulatory shock, with increased ventricular filling pressures and peripheral resistance.

The low-throughput states associated with severe cell dysfunction are relatively common in Intensive Care Units. The use of vasoactive drugs is of vital importance for the reversal of this situation, improving the prognosis and the survival of the patients. These drugs generally have a fast and potent action, but their therapeutic index is low and should be administered through adequate hemodynamic and laboratory monitoring.

Nitroglycerine: Nitroglycerin is a derivative of organic nitrate that is rapidly metabolized in the liver by a nitrate reductase. The drug acts on the systemic veins and the great arteries. In angina pectoris increases the capacity of the veins, which decreases the venous return to the heart and the diastolic pressure in the LV, which is why the oxygen needs are lower. In the coronary arterial circulation, dilates vessels of low resistance, which gives rise to a distribution of coronary flow. If the atheroma is located eccentrically, it dilates atherosclerotic stenoses. It also dilates the arteriocular bed, with a decrease in systemic vascular resistance. It is indicated in cases of Angina pectoris, as monotherapy or in combination with other antianginosos, as beta-blockers or antagonists of the calcium channels. Heart failure in patients who do not respond to conventional treatment with digital and other positive inotropic drugs and diuretics.

ANTI-diuretic hormone:

Vasopressin : is a human hormone secreted in cases of dehydration and drop in blood pressure; causing the kidneys to conserve water in the body, concentrating and reducing the volume of urine. This hormone is called vasopressin because it increases blood pressure by inducing moderate vasoconstriction on the body’s arterioles. The drug acts in the nephron, favoring the opening of the water channels (aquaporins) in the cells of the tubule of connection and tubule collector.

Basic rules for the administration of dVAS:

Bolus – smaller / equal to 1 minute 
rapid infusion – 1 and 3 min 
slow infusion – 30 to 60 minutes 
Continuous infusion – more time to 60 minutes 
infusion Intermittent – longer than 60 minutes does not continue

INTENSIVE CARE OF NURSING WITH VASOTIVE DRUGS:

Avoid administration with alkaline solution to avoid extravasation. Bolus medicine should never be given via vasoactive drugs. And perfusion evaluation should be done on the extremities.

  • Establish drug dilution criteria through institutional protocols;
  • Observe appearance of the solution before and after administration;
  • Administer drugs to the infusion pump;
  • Calculate the dose of drug in .mu.g / kg / min;
  • Control of drug infusion rate;
  • Keep the weight of the current patient;
  • Pay attention to signs of dehydration before starting the infusion of the drug;
  • Know the action, stability and drug interactions of drugs;
  • Knowing which photosensitive drugs;
  • Knowing drugs which adhere or are adsorbed by the plastic (in this case using polyethylene or glass bottles and Mans polyethylene);

Monitoring of vital data

  • Paying attention to variations of patient signals through the measurement and continuous monitoring;
  • Pay attention to changes in the ECG tracing;
  • Performing reading PVC as every hour or nursing prescription;
  • Monitoring of urine output;
  • Control urine volume each time, or as nursing prescription;
  • Pay attention to changes in kidney function such as decreased or increased urine output, monitoring of urea values, creatinine and creatinine clarence;
  • Perform rigorous water control;
  • Carry water balance;
  • Monitoring of blood perfusion;
  • Follow the variations of the wrist and peripheral perfusion;
  • Keeping the ends protected from heat losses;
  • Pay attention to not tourniquet members;
  • Perform caster blood pressure cuff;
  • To evaluate the capillary fill;

Care venous access

  • Use central venous catheter;
  • If possible via exclusive;
  • Rinse the track with least possible;
  • Restricting the number of extensions and devices at the drug means;
  • Maintain patency of venous device;
  • Prefer caliber veins like the cephalic or basilica in case of peripheral access;
  • Do not inject drugs bolus via used for infusion of the drug;
  • Note infiltration signals and local signals hyperemia .;

nursing records

  • Write down everything that was performed with the patient;
  • Note complications;

Colostomy

Colostomy

The term colostomy designates the union of the anterior abdominal wall of a portion of the colon, in order to permit evacuation of gases and feces. This evacuation is given by a hole called stoma.

Stoma is a surgical treatment that corrects intestinal disorders, it is usually recommended for patients who have blocked part of the intestine or other pathology that prevents the elimination of stool from the rectum.

Colostomy bags Disposable X Reusable: The Differences

The disposable bag has its validity every cleaning colostomy because it lacks a mechanism for internal cleaning thereof, and reusable colostomy bag, popularly called karaya bag, an outlet for neglect and clean the internal bag, and its validity after installed within 7 days.

Stomatherapy: Did you know?

There is a qualified professional especially for this type of procedure. This is the
nurse stoma, ie it is an area of specialization in nursing, recognized since 1980, which is responsible for the study and treatment of acute and chronic wounds. It is also the specialty care to patients with ostomy and incontinence, to guide, more clearly the steps to be carried out with different types of ostomy, such as colostomy, ileostomy, urostomy, etc. in the home environment.

What care we should take with reusable bags?

  • Empty the bag (at least once per shift and whenever necessary), releasing only the clamp that closes at the bottom;
  • Wash it with saline each time they discard the contents into the toilet. The clamp can be reused in the exchanges from the same patient;
  • The exchange of the bag is recommended between 5 and 7 days, or as needed (if any
    leaks, bad strong smell, dirt), redness and pain peristoma indicates skin irritation problems;
  • The deposit of the stool collection bag begins around 72 hours after surgery;
  • The drain can be continuous and constant, for there is no restraint control (sphincter) of waste around the stoma;
  • The collecting bag may be emptied every 4 or 6 hours. It should be noted the amount of draining material with constant and not allow it to be filled beyond its half;

The fill beyond this limit jeopardizes the integrity of Stoma, causing lesions and high risk of infection.

What care we should have with the stoma?

  • The skin on the Stoma should stay pink or vivid and bright red;
  • Observe the skin around the collection bag, and the setting and its appearance. If very dirty around the attachment, you must make the switch from the collection bag;
  • It is in the intestine that occurs most of the absorption of fluids and electrolytes dispersed derived from the patient’s nutrition. It is prudent to note fluid intake and monitor specific laboratory tests with proper absorption of electrolytes and regulate hydration. dehydration symptoms such as dry skin and headache (headache) intense and the applicant must be informed;

What are the general care nursing with a colostomy?

  • Clear region colostomy with 0.9% saline, in a circular motion;
  • Dry the area around with sterile gauze;
  • Mark the bag with the circle jig, according to the diameter of the fistula, or drain the ostomy;
  • Cut the marked hole;
  • Observe that the hole is not too tight garrotando ostomy, or too big facilitating contact direct secretion skin damaging it;
  • Remove the adhesive;
  • Remove the protective covering the upper surface of the plate;
  • Apply the plate with the rim of the region;
  • Adapting the plastic bag to the bottom rim of the plate in cephalocaudal position;
  • Exerting a slight pressure to the wheel from the bottom of the plastic bag until it is safe, asking the patient to stiffen the region;
  • Gently pull the bag down, to confirm that it is properly seated.
  • Register in the chart: characteristic of colostomy output, volume, odor, color, etc …

The Importance of Oral Hygiene in Hospital Scope

Oral Hygiene

Oral Hygiene in the hospital setting is much more important than you might think. Think of one day, of those corridos, that a professional correctly sanitizes the patient, but forgets the most important: The oral cleaning. Yes! Unfortunately it is still a reasonable number of situations in which several professionals fail to perform this simple act when giving that bath or intimate hygiene in the patient.

Did you know that the lack of oral hygiene of bedridden patients creates an environment conducive to the proliferation of bacteria in the oral cavity? The bacterial plaque ends up acting as a reservoir for the colonization of respiratory bacteria. In cases of incidence in Intensive Care Units, for example in a certain Institution, there were 33.3% of incidences due to Mechanical Ventilation-Associated Pneumonia. After the implementation of the Prevention Bundle by the CCIH, there was a sudden drop in infections, to 3.5%.

But it’s not just pneumonia that prevails! There are several changes, such as: Lip changes such as Simple Herpes, contact dermatitis, actinic cheilitis, in cases of mouth changes such as leukoplakia, lichen planus, candidiasis, aphthous stomatitis, and Kaposi’s sarcoma ; and in cases of gum changes, we have gingivitis and periodontitis.

Patients with certain heart problems or an artificial joint are considered at high risk for the development of a heart infection called infective endocarditis (IE), and receive preventive antibiotics before a dental procedure. Poor oral hygiene leads to chronic and acute infections such as abscesses. The patient is at risk of frequent bacteremia and presumed endocarditis if he has a heart problem or other condition that puts him at risk.

Complications of Oral Hygiene: Alternative Methods

Due to the variation of the level of dependence of the patient, and to the problems in the oral cavity, some special methods are used for the oral hygiene by the nursing technician. In cases of patients admitted to hospital beds, toothpaste and brush can be used, and in cases where the patient can help, it is easier to expel the buccal contents in a kidney tub. When the patient is totally dependent, one can use the aspiration brushing method (there are special brushes), or the method of dolls for oral hygiene, as non-alcoholic antiseptic products, and using chlorhexidine.

In cases of critical patients in ITU beds (most are intubated and unconscious), the method of brushing with aspiration is very used, and the oral antiseptic with chlorhexidine is used. Because they are in situations where intubation makes swallowing difficult, saliva accumulates in the oral cavity, thus increasing the chances of getting a respiratory tract infection.

Saliva contains certain enzymes, such as lactoferrin, lysozyme and the peroxidase system, which strengthen the immune system of the mouth. Microorganisms present on the bacterial plaque can be released into the salivary secretions and then aspirated into the lower respiratory tract (lung). Therefore, the use of mouthwashes with these enzymes will reinforce the oral hygiene of bedridden patients, and perform aspiration whenever necessary.

CARIES

The first thing that comes to mind when we think of diseases caused by lack of hygiene are caries. They arise from food residues that remain in contact with the teeth, attracting bacteria and causing acid production that can destroy the structures of the teeth.

If not treated quickly, caries can evolve and cause tooth pulp death, abscess formation or even infection. Remember that poor diet (high sugar intake) and some medicines used as antibiotics can make teeth more vulnerable to cavities.

HALITOSIS

Bad breath is related to poor oral hygiene, dry mouth and the ingestion of certain foods. Usually this problem worsens in the morning, due to the lower production of saliva during the sleep period.

CANKER SORES

Although there is no specific cause for the onset of canker sores, it is well known that poor oral hygiene can contribute to its appearance and make healing difficult. Injuries to the mucous membrane of the mouth have a white and reddish color around them and often cause pain and discomfort, especially at feeding time.

GINGIVITIS

An oral problem also very common in the population, which can progress to periodontitis if not treated correctly. Gingivitis arises when there is plaque buildup, causing inflammation of the gums, which can result in redness, swelling and bleeding. If the plaque is not removed, it begins a hardening process, forming the tartar, which adheres to the tooth and can progressively destroy the structures that support the teeth.

PERIODONTITIS

The inflammation caused by the evolution of untreated gingivitis is called periodontitis, and has symptoms like bleeding, tenderness, bad breath, receding gums and can result in tooth loss.

BACTERIAL ENDOCARDITE

One of the most serious problems stemming from lack of oral hygiene, bacterial endocarditis is an infection that directly affects the heart, and can lead to death. A simple bleeding in the mouth can allow mouth bacteria to enter the blood system and reach for valves or tissues, causing damage to the lining of the heart.

Nursing Care with Oral Hygiene

Materials to be used:

  • Toothbrush;
  • Dentifrice;
  • Disposable cup with water;
  • Face towel;
  • Kidney bowl;
  • Spatula;
  • Straw;
  • Lubricant for lips;
  • Oral antiseptic;
  • Procedure glove;
  • Gauze.

Patient procedure with little limitation:

  • In Fowler’s position and with the lateralized head;

  • Protect the chest with the face towel;
  • Put the kidney bowl under the cheek;
  • Ask her to open her mouth or open it with the aid of the spatula;
  • Use the brush with root movements towards the end of the teeth. Do about 6 to 10 movements on each tooth surface, with constant brush pressure;
  • Repeat this movement on the buccal and lingual surface, tractioning the tongue with a spatula protected with gauze;
  • Offer glass with water to rinse the mouth;
  • Use straw.

Procedure in patient with prosthesis:

  • Request that you remove the prosthesis or make it through the gauze;
  • Put it in the kidney bowl;
  • Brush the gingiva, palate and tongue if the patient can not do it;
  • Offer it for the patient to put still wet.

Procedure in an intubated or unconscious patient:

  • For an unconscious patient, the best position is lateralized with the patient’s head facing the side where you are, semi Fowler or with the head of the bed at normal level. Placing the patient in one of these positions allows fluids or any oral secretions to accumulate on the dependent side of the mouth and flow out;
  • Use a soft bristled brush and antiseptic solution to brush your patient’s teeth and remove any buildup of dirt and plaque;
  • A doll made of gauze or gauze soaked in antiseptic can also be used to clean the patient’s tongue and gums. Remove possible crusts and dirt;
  • Perform aspiration of the contents of the oral cavity with a smaller caliber aspiration probe to prevent injury to the oral mucosa;
  • Because the unconscious patient can not report pain or discomfort, perform a thorough assessment of the oral cavity each time you perform oral hygiene;
  • Enjoy the oral care to observe the presence of inflammations, infections, ulcerations or bleeding. Communicate to the nurse responsible and the doctor for immediate treatment, since oral health problems can affect the overall health of the patient.

What does the abnormal color of urine say about your health?

color urine

It can be alarming to see red blood color of urine in the bowl, or green, blue, cloudy, or frothy liquid coming out of your body. Most of the time, however, there is a non-threatening explanation for the urine that comes in all the colors of the rainbow.

Experts tell us that a healthy body of urine is straw colored. It’s just a little yellow and transparent. From time to time, however, urine comes in different colors. In general, strange-colored urine is benign in origin, but occasionally it is a sign that it is time to go to the doctor.

Yellow Urine Straw

Healthy urine is 96 percent water, with just a few other waste products. The body excretes an acidic compound called urea when excess amino acids have to be converted to sugar. The sugar remains in the body, and urea, otherwise it causes the blood’s pH to drop.

Urea itself is colorless. The small amount of yellow pigment in the healthy urine is a compound called urochrome, it is made from recycled bile salts. Bile is a liquid produced by the liver to dissolve the fats in the digestive tract. Excess bile salts are eliminated in urine and feces.

If you put urine in a bottle, you should be able to see its true color if you return a white paper or a newspaper. If your urine is dark, it is possible that you are not drinking enough water.

Completely Clear Urine (Clear)

If the urine is completely clear, it is usually the result of excess water being drinking. Athletes who drink lots of water during sports competitions, for example, and people in the ten-cup water tables daily tend to have clear urine. Clear urine usually only means that the urochrome is so diluted that it is not visible. If you stop drinking so much water, and it returns to normal color.

Clear urine is also common in people who take diuretics, in general, for high blood pressure or edema. When the medication is stopped, it returns the color. The doctor will probably carry a urine sample as part of regular health surveillance.

In rare cases, clear urine can result from diabetes insipidus, the pituitary gland’s failure in the brain to make a substance called antidiuretic hormone. This is caused by an injury to the brain or certain metabolic conditions. The kidneys do not get the message to keep it in the middle of the night, so sleep becomes difficult, and dehydration, despite the clear urine, is a constant concern. This condition increases thirst as it increases urination, but it is very difficult to keep up with the hyperactivity of the kidneys for the day. Diabetes insipidus is diagnosed by depriving the patient of water, which should not decrease urine production, as much as expected the opposite.

Urine orange

Orange urine can be dyed by beta carotene, the most generous antioxidant compound in carrots. People who consume large amounts of carrots may have orange urine. Orange urine can also be a sign of hepatitis, as inflammation in the liver makes bile to travel directly to the kidneys. However, dehydration is the most common cause of orange urine. The kidneys work all night long, when they do not lift me to drinking water, and keep urochrome elimination (mentioned above) without removing the water to dilute.

The meaning of other colors abnormal urine

  • Bright Yellow Urine

Sometimes the urine is bright, almost yellow “Neon”. In general, this is a result of taking vitamins nutritional supplements. The body can not store large amounts of vitamin B2, so it pours into the urine where it has a very noticeable color. As an isolated chemical compound, Vitamin B2 is more yellow orange, but because it also absorbs blue light, it has a bright and yellow appearance in the urine. Vitamin B2 is slightly soluble in water, so the color is generally sensitive first micturition after taking the supplement, in excess tends to be excreted at the same time.

  • Blue Urine

If you have blue urine, the most likely explanation is that you have consumed foods made with blue dyes, such as icing or candy? The liver processes the staining and sends more or less directly to the kidneys excrete. Blue urine is also caused by the use of methylene blue, which is injected in the event of accidental cyanide poisoning or is used to treat urinary tract infections.

  • Urine of Green color

Green urine is most commonly a by-product of a type of bacteria called Pseudomonas aeruginosa. This bacteria lives in the gut, but can be transferred into the urinary tract when applied with a toilet paper moving forward instead of with a backward movement. Some people who have liver cancer may also have green urine, such as some people who drink large amounts of green tea. Green urine is sometimes observed after exposure to toxic substances.

Propofol anesthetic can make green urine as well as certain medicines for Parkinson’s disease.

  • Urine of Purple Color

Purple urine tends to be the result of a disease called porphyria, this affects about 30,000 people, mainly in the UK and South Africa. Porphyria was the cause of the “madness of the infamous King George III” of Great Britain, while now it can be treated.

  • Urine Red or Pink

Most people are alarmed by the urine of red in the basin. Sometimes discoloration is caused by plant pigments, particularly beet, but is most often due to bleeding in any part of the urinary tract. You need only 1 ml of blood to give the pink urine. Bleeding from the urinary tract can be caused by kidney stones, bladder or kidney blast, the in rare cases, bladder cancer.

  • Brown or Black Urine

Equally worrisome is the presence of brown or black urine in the vessel. Fortunately, it usually has a benign cause. Consumption of certain types of beans, especially beans or velvet beans, causes darkening of the urine due to its dopamine content. Certain medicines for Parkinson’s disease also, they have this effect, based on sena laxatives (in the United States and the United Kingdom, Sennecot) you can also darken the urine.

  • Blurred or White Urine

Turbid urine usually indicates a bacterial infection. When the urinary tract is infected, the immune system sends white blood cells to attack the germs. Some of them appear in the urine after awakening.
Men sometimes have dark or foamy urine after intercourse, or when they do not ejaculate for long periods of time. Semen can be in the urinary tract, and in the prostate, and may appear whitish or opaque in the urine.

  • Foam Urine

It may be the result of the same white or cloudy urine causes, or may indicate excess protein from severely diseased kidneys. If kidney disease is the problem, there will be other symptoms besides foamy urine.

 

Epistaxis

Epistaxis

The term Epistaxis is the name given to any type of blood loss through the nose, often through the nostrils, or through the nose through the mouth.

There are two types of epistaxis:

  1. Anterior – (approximately 90% cases), that is, closer to the outside of the nose.
  2. Posterior – (approximately 10%), that is, more in the interior: less common, but with more severe effects.

How does bleeding happen?

Epistaxis occurs when small vessels (veins or arteries) that pass through the mucous membranes of the nose rupture.

Why do these little vessels break?

In general, vessels become fragile and more susceptible to rupture by local factors, which can be identified by otorhinolaryngological examination, or by systemic factors as listed below.

Local Factors:

  • Anatomic deformities Inhalation of chemicals Inflammation (secondary to acute respiratory tract infections such as chronic sinusitis, allergic rhinitis and environmental irritants);
  • Foreign bodies;
  • Intranasal tumors;
  • Use of nasal medications;
  • Previous Surgeries;
  • Trauma;

Systemic Factors:

  • Use of certain medications (aspirin, warfarin, clopidogrel, desmopressin);
  • Alcohol intoxication;
  • Allergies;
  • Blood clotting disorders;
  • Heart problems;
  • Tumors of the blood (leukemia);
  • Arterial hypertension;
  • Infectious diseases;
  • Malnutrition (especially anemia);
  • Use of narcotics;
  • Vascular diseases;

What to do when you have Epistaxis?

If you have frequent episodes of epistaxis, it is worthwhile to seek the otolaryngologist before even a new event to discover the cause, clarify any doubts and start treatment.

If you are bleeding at this time, initially stay calm, most epistaxis improve spontaneously within a few minutes and do not require urgent medical attention.

Pinch the side of the nose against the septum on the affected side for a few minutes, sit erect, do not lift, and do not lower your head. A cotton swab soaked in vasoconstrictor solution (Afrin, Sorine…) may be placed into the nostril and then continued for at least 5 to 10 minutes. After bleeding stops, do not force the nose to blow because it may cause new bleeding. Do not insert anything into the nostrils. Do not try to clean them with a cotton swab, finger, tweezers, tissues, toilet paper. Use humidifiers or wet towels to humidify the environment.

How is the treatment done?

The otolaryngologist can perform the cauterization (chemical or thermal) of the affected blood vessels and control their healing. Sometimes it is necessary to perform a nasal packing in the most varied forms (cotton, gauze, sponges or expandable materials) for a period of 24 to 48 hours. When removed, wounds are usually already healing. Patients with blood clotting disorders or chronic use of medicinal products that affect coagulation (aspirin, oral anticoagulants or injectables) should be dosed appropriately or suspended momentarily.

Patients on chemotherapy, with leukemia, or post-radiotherapy frequently suffer from epistaxis and should seek the specialist. Bleeds of greater proportions, longer or with maintenance of bleeding even with tampon, can be treated with surgery for ligature or electro cauterization of these arteries under general anesthesia.

 

 

Cardinal Sign or Cardinal Symptom

Inflammation Cardinal Sign

Inflammation is a local defense mechanism, exclusive of damaged mesenchymal tissues (connective tissue, bone and cartilaginous tissue, blood and lymphatic vessels, and tissue).

It is the local response of the damaged vascularized tissue, characterized by alterations of the vascular system, the liquid and cellular components, also by adaptations of the neighboring connective tissue.

There are some basic phenomena common to any type of inflammation and no matter what the inflammatory agent.

Although these phenomena are divided into five phases they all happen as a single, joint process, which makes inflammation a dynamic process.

Check out what these stages are and what happens most important in each one of them:

  • Irritative phase: Morphological and functional modifications of the damaged tissues occur that promote the release of chemical mediators, which will trigger the other inflammatory phases.
  • Vascular phase: hemodynamic changes of the circulation and vascular permeability at the site of the aggression.
  • Exudative phase: This phase is characteristic of the inflammatory process, and is formed by the cellular and plasma exudates (migration of fluids and cells to the inflammatory focus) from increased vascular permeability.
  • Degenerative-necrotic phase: composed of cells with reversible or non-reversible degenerative changes (in this case, originating a necrotic material), derived from the direct action of the aggressor agent or from the functional and anatomical modifications consequent to the previous three phases.
  • Productive-reparative phase: increase in the quantity of the tissue elements – mainly cells, result of the previous phases. The objective is to destroy the aggressor agent and repair the battered tissue.

Clinical Manifestations

There are also five classic signs of the inflammatory process, called Flogistic or Cardinal Signs.

They are: edema, heat, redness, pain and loss of function.

Edema is caused mainly by the exudative and productive-reparative phase, because of the increase of liquid and of cells.

The heat comes from the vascular phase, where there is arterial hyperemia (which is the increase of the blood volume in the local) and, consequently, increase of the local temperature.

Redness is redness, which also results from hyperemia.

Pain is caused by more complex mechanisms including compression of local nerve fibers due to edema, direct aggression to nerve fibers and pharmacological action on nerve endings. It involves at least three phases of inflammation (irritative, vascular and exudative).

Finally, loss of function is due to edema (especially in joints, preventing movement) and pain, which hamper local activities.

Nursing Care with the presence of Cardinal Sign

Health-care-related infections are considered preventable by simple measures, with proper hand washing (considered the most efficient measure of prevention) before and after all procedures.

They are the hands that carry the largest number of microorganisms to patients, through direct contact, procedures or the handling of objects. Employee training can improve the knowledge of techniques, increase the quality of care provided to the patient, and decrease the rate of infections related to peripheral or central catheters.

The catheter may be colonized by microorganisms on its external surface, by the subcutaneous tunnel of the surrounding skin or by the microbiota itself, by the hands of contaminated professionals and antiseptics, as the higher the number of bacteria, the greater the likelihood of infection .

There are important risk factors associated with the use of intravascular catheters, which may be related to the host such as: primary diagnosis (baseline disease), comorbidities, antibiotic therapy (dose and duration), use of immunosuppressants and length of stay. And related to the catheter: the type of catheter implanted, technique of insertion of the catheter, length of stay, place of insertion and care with the catheter (with the dressing).

In the presence of a suspicion of infection related to a peripheral or central catheter, the tip of the catheter should be removed, upon request of a medical prescription (when polyurethane, teflon or silicone, which are more recommended because they are thrombogenic materials) and request order to examine catheter tip cultures and refer them to the laboratory.

It can be done through the exudate with staining by the Gram method and submitted to culture, if there are phlogistic signs at the insertion of the catheter.

Performing a dressing with aseptic technique in place removed the catheter in order to prevent the proliferation of bacterial infection in other locations.