Thursday, September 30, 2010

Pregnancy Ultrasound- Is it necessary?

The journal, Obstetrics and Gynecology, estimated that over half of all pregnant women in 1990 had undergone diagnostic ultrasound, yet research published in the New England Journal of Medicine suggest that 80 percent of all pregnant women are very low risk and do not need ultrasounds. The unnecessary ultrasounds cost about $1 Billion per year.

Any woman who is told she needs an ultrasound should ask about the potential benefits of the test and the risks of the procedure. She should ask if the results of the ultrasound will affect her care she would otherwise receive and how. If the result of the ultrasound will not affect her care, she may question the need for the test at all. Only after being completely informed about the need for the test, the benefits, and the risks, should she sign a consent for the procedure.


According to the ACOG patient education flier, "Ultrasound is not necessary for every woman or in every pregnancy." It is, however, being used more often as a standard procedure for every pregnant woman. Some common uses include diagnosing and detecting uterine or ectopic pregnancy, noting pelvic inflammatory disease, cysts, tumors uterine cancer, endometriosis and congenital abnormalities.

Ultrasound may compare fetal age and weight, note the placement of the placenta, amount of amniotic fluid that is present and diagnose certain birth defects such as neural tube defects. Ultrasound is used during an amniocentesis to verify the baby's position to be sure that the needle is placed properly. Some physicians use ultrasound for estimating the fetal weight. This is not a very accurate measurement unless numerous criteria and scans are checked. Head circumference is one measurement. However, incases of gestational diabetes, it is inaccurate because these babies gain the additional weight on their bodies only.

Ultrasounds are frequently used to date pregnancies. According to Otto and Platt, 1991, in the first trimester the error range is +5 days, in the second trimester it increases to +8 days and if done in the final trimester it is +22 days.

Tuesday, September 28, 2010

Drink water on an empty stomach

Drink Water on Empty Stomach

It is popular in Japan today to drink water immediately after waking up every morning. Furthermore, scientific tests have proven its value.. We publish below a description of use of water for our readers. For old and serious diseases as well as modern illnesses the water treatment had been found successful by a Japanese medical society as a 100% cure for the following diseases:
Headache, body ache, heart system, arthritis, fast heart beat, epilepsy, excess fatness, bronchitis asthma, TB, meningitis, kidney and urine diseases, vomiting, gastritis, diarrhea, piles, diabetes, constipation, all eye diseases, womb, cancer and menstrual disorders, ear nose and throat diseases.
1. As you wake up in the morning before brushing teeth, drink 4 x 160ml glasses of water
2. Brush and clean the mouth but do not eat or drink anything for 45 minutes
3. After 45 minutes you may eat and drink as normal.
4. After 15 minutes of breakfast, lunch and dinner do not eat or drink anything for 2 hours
5. Those who are old or sick and are unable to drink 4 glasses of water at the beginning may commence by taking little water and gradually increase it to 4 glasses per day.
6. The above method of treatment will cure diseases of the sick and others can enjoy a healthy life.
The following list gives the number of days of treatment required to cure/control/reduce main diseases:
1. High Blood Pressure (30 days)
2. Gastric (10 days)
3. Diabetes (30 days)
4. Constipation (10 days)
5. Cancer (180 days)
6. TB (90 days)
7. Arthritis patients should follow the above treatment only for 3 days in the 1st week, and from 2nd week onwards - daily.
This treatment method has no side effects, however at the commencement of treatment you may have to urinate a few times.
It is better if we continue this and make this procedure as a routine work in our life. Drink Water and Stay healthy and Active.
This makes sense .. The Chinese and Japanese drink hot tea with their meals ..not cold water. Maybe it is time we adopt their drinking habit while eating!!! Nothing to lose, everything to gain...
For those who like to drink cold water, this article is applicable to you.
It is nice to have a cup of cold drink after a meal. However, the cold water will solidify the oily stuff that you have just consumed. It will slow down the digestion.
Once this "sludge" reacts with the acid, it will break down and be absorbed by the intestine faster than the solid food.. It will line the intestine.
Very soon, this will turn into fats and lead to cancer. It is best to drink hot soup or warm water after a meal.
A serious note about heart attacks:
* Women should know that not every heart attack symptom is going to be the left arm hurting,
* Be aware of intense pain in the jaw line.
* You may never have the first chest pain during the course of a heart attack.
* Nausea and intense sweating are also common symptoms.
* 60% of people who have a heart attack while they are asleep do not wake up.
* Pain in the jaw can wake you from a sound sleep.. Let's be careful and be aware.. The more we know, the better chance we could survive...
A cardiologist says if everyone who gets this mail sends it to everyone they know, you can be sure that we'll save at least one life...

Born Aliens

Neonates have no psychology. If operated upon, for instance, they are not supposed to show signs of trauma later on in life. Birth, according to this school of thought is of no psychological consequence to the newborn baby. It is immeasurably more important to his "primary caregiver" (mother) and to her supporters (read: father and other members of the family). It is through them that the baby is, supposedly, effected. This effect is evident in his (I will use the male form only for convenience's sake) ability to bond. The late Karl Sagan professed to possess the diametrically opposed view when he compared the process of death to that of being born. He was commenting upon the numerous testimonies of people brought back to life following their confirmed, clinical death. Most of them shared an experience of traversing a dark tunnel. A combination of soft light and soothing voices and the figures of their deceased nearest and dearest awaited them at the end of this tunnel. All those who experienced it described the light as the manifestation of an omnipotent, benevolent being. The tunnel - suggested Sagan - is a rendition of the mother's tract. The process of birth involves gradual exposure to light and to the figures of humans. Clinical death experiences only recreate birth experiences.

The womb is a self-contained though open (not self-sufficient) ecosystem. The Baby's Planet is spatially confined, almost devoid of light and homeostatic. The fetus breathes liquid oxygen, rather than the gaseous variant. He is subjected to an unending barrage of noises, most of them rhythmical. Otherwise, there are very few stimuli to elicit any of his fixed action responses. There, dependent and protected, his world lacks the most evident features of ours. There are no dimensions where there is no light. There is no "inside" and "outside", "self" and "others", "extension" and "main body", "here" and "there". Our Planet is exactly converse. There could be no greater disparity. In this sense - and it is not a restricted sense at all - the baby is an alien. He has to train himself and to learn to become human. Kittens, whose eyes were tied immediately after birth - could not "see" straight lines and kept tumbling over tightly strung cords. Even sense data involve some modicum and modes of conceptualization (see: "Appendix 5 - The Manifold of Sense").

Even lower animals (worms) avoid unpleasant corners in mazes in the wake of nasty experiences. To suggest that a human neonate, equipped with hundreds of neural cubic feet does not recall migrating from one planet to another, from one extreme to its total opposition - stretches credulity. Babies may be asleep 16-20 hours a day because they are shocked and depressed. These abnormal spans of sleep are more typical of major depressive episodes than of vigorous, vivacious, vibrant growth. Taking into consideration the mind-boggling amounts of information that the baby has to absorb just in order to stay alive - sleeping through most of it seems like an inordinately inane strategy. The baby seems to be awake in the womb more than he is outside it. Cast into the outer light, the baby tries, at first, to ignore reality. This is our first defence line. It stays with us as we grow up.

It has long been noted that pregnancy continues outside the womb. The brain develops and reaches 75% of adult size by the age of 2 years. It is completed only by the age of 10. It takes, therefore, ten years to complete the development of this indispensable organ – almost wholly outside the womb. And this "external pregnancy" is not limited to the brain only. The baby grows by 25 cm and by 6 kilos in the first year alone. He doubles his weight by his fourth month and triples it by his first birthday. The development process is not smooth but by fits and starts. Not only do the parameters of the body change – but its proportions do as well. In the first two years, for instance, the head is larger in order to accommodate the rapid growth of the Central Nervous System. This changes drastically later on as the growth of the head is dwarfed by the growth of the extremities of the body. The transformation is so fundamental, the plasticity of the body so pronounced – that in most likelihood this is the reason why no operative sense of identity emerges until after the fourth year of childhood. It calls to mind Kafka's Gregor Samsa (who woke up to find that he is a giant cockroach). It is identity shattering. It must engender in the baby a sense of self-estrangement and loss of control over who is and what he is.

The motor development of the baby is heavily influenced both by the lack of sufficient neural equipment and by the ever-changing dimensions and proportions of the body. While all other animal cubs are fully motoric in their first few weeks of life – the human baby is woefully slow and hesitant. The motor development is proximodistal. The baby moves in ever widening concentric circles from itself to the outside world. First the whole arm, grasping, then the useful fingers (especially the thumb and forefinger combination), first batting at random, then reaching accurately. The inflation of its body must give the baby the impression that he is in the process of devouring the world. Right up to his second year the baby tries to assimilate the world through his mouth (which is the prima causa of his own growth). He divides the world into "suckable" and "insuckable" (as well as to "stimuli-generating" and "not generating stimuli"). His mind expands even faster than his body. He must feel that he is all-encompassing, all-inclusive, all-engulfing, all-pervasive. This is why a baby has no object permanence. In other words, a baby finds it hard to believe the existence of other objects if he does not see them (=if they are not IN his eyes). They all exist in his outlandishly exploding mind and only there. The universe cannot accommodate a creature, which doubles itself physically every 4 months as well as objects outside the perimeter of such an inflationary being, the baby "believes". The inflation of the body has a correlate in the inflation of consciousness. These two processes overwhelm the baby into a passive absorption and inclusion mode.

To assume that the child is born a "tabula rasa" is superstition. Cerebral processes and responses have been observed in utero. Sounds condition the EEG of fetuses. They startle at loud, sudden noises. This means that they can hear and interpret what they hear. Fetuses even remember stories read to them while in the womb. They prefer these stories to others after they are born. This means that they can tell auditory patterns and parameters apart. They tilt their head at the direction sounds are coming from. They do so even in the absence of visual cues (e.g., in a dark room). They can tell the mother's voice apart (perhaps because it is high pitched and thus recalled by them). In general, babies are tuned to human speech and can distinguish sounds better than adults do. Chinese and Japanese babies react differently to "pa" and to "ba", to "ra" and to "la". Adults do not – which is the source of numerous jokes.

The equipment of the newborn is not limited to the auditory. He has clear smell and taste preferences (he likes sweet things a lot). He sees the world in three dimensions with a perspective (a skill which he could not have acquired in the dark womb). Depth perception is well developed by the sixth month of life.

Expectedly, it is vague in the first four months of life. When presented with depth, the baby realizes that something is different – but not what. Babies are born with their eyes open as opposed to most other animal young ones. Moreover, their eyes are immediately fully functional. It is the interpretation mechanism that is lacking and this is why the world looks fuzzy to them. They tend to concentrate on very distant or on very close objects (their own hand getting closer to their face). They see very clearly objects 20-25 cm away. But visual acuity and focusing improve in a matter of days. By the time the baby is 6 to 8 months old, he sees as well as many adults do, though the visual system – from the neurological point of view – is fully developed only at the age of 3 or 4 years. The neonate discerns some colours in the first few days of his life: yellow, red, green, orange, gray – and all of them by the age of four months. He shows clear preferences regarding visual stimuli: he is bored by repeated stimuli and prefers sharp contours and contrasts, big objects to small ones, black and white to coloured (because of the sharper contrast), curved lines to straight ones (this is why babies prefer human faces to abstract paintings). They prefer their mother to strangers. It is not clear how they come to recognize the mother so quickly. To say that they collect mental images which they then arrange into a prototypical scheme is to say nothing (the question is not "what" they do but "how" they do it). This ability is a clue to the complexity of the internal mental world of the neonate, which far exceeds our learned assumptions and theories. It is inconceivable that a human is born with all this exquisite equipment while incapable of experiencing the birth trauma or the even the bigger trauma of his own inflation, mental and physical.

As early as the end of the third month of pregnancy, the fetus moves, his heart beats, his head is enormous relative to his size. His size, though, is less than 3 cm. Ensconced in the placenta, the fetus is fed by substances transmitted through the mother's blood vessels (he has no contact with her blood, though). The waste that he produces is carried away in the same venue. The composition of the mother's food and drink, what she inhales and injects – all are communicated to the embryo. There is no clear relationship between sensory inputs during pregnancy and later life development. The levels of maternal hormones do effect the baby's subsequent physical development but only to a negligible extent. Far more important is the general state of health of the mother, a trauma, or a disease of the fetus. It seems that the mother is less important to the baby than the romantics would have it – and cleverly so. A too strong attachment between mother and fetus would have adversely affected the baby's chances of survival outside the uterus. Thus, contrary to popular opinion, there is no evidence whatsoever that the mother's emotional, cognitive, or attitudinal state effects the fetus in any way. The baby is effected by viral infections, obstetric complications, by protein malnutrition and by the mother's alcoholism. But these – at least in the West – are rare conditions.

In the first three months of the pregnancy, the central nervous system "explodes" both quantitatively and qualitatively. This process is called metaplasia. It is a delicate chain of events, greatly influenced by malnutrition and other kinds of abuse. But this vulnerability does not disappear until the age of 6 years out of the womb. There is a continuum between womb and world. The newborn is almost a very developed kernel of humanity. He is definitely capable of experiencing substantive dimensions of his own birth and subsequent metamorphoses. Neonates can immediately track colours – therefore, they must be immediately able to tell the striking differences between the dark, liquid placenta and the colourful maternity ward. They go after certain light shapes and ignore others. Without accumulating any experience, these skills improve in the first few days of life, which proves that they are inherent and not contingent (learned). They seek patterns selectively because they remember which pattern was the cause of satisfaction in their very brief past. Their reactions to visual, auditory and tactile patterns are very predictable. Therefore, they must possess a MEMORY, however primitive.

But – even granted that babies can sense, remember and, perhaps emote – what is the effect of the multiple traumas they are exposed to in the first few months of their lives?

We mentioned the traumas of birth and of self-inflation (mental and physical). These are the first links in a chain of traumas, which continues throughout the first two years of the baby's life. Perhaps the most threatening and destabilizing is the trauma of separation and individuation.

The baby's mother (or caregiver – rarely the father, sometimes another woman) is his auxiliary ego. She is also the world; a guarantor of livable (as opposed to unbearable) life, a (physiological or gestation) rhythm (=predictability), a physical presence and a social stimulus (an other).

To start with, the delivery disrupts continuous physiological processes not only quantitatively but also qualitatively. The neonate has to breathe, to feed, to eliminate waste, to regulate his body temperature – new functions, which were previously performed by the mother. This physiological catastrophe, this schism increases the baby's dependence on the mother. It is through this bonding that he learns to interact socially and to trust others. The baby's lack of ability to tell the inside world from the outside only makes matters worse. He "feels" that the upheaval is contained in himself, that the tumult is threatening to tear him apart, he experiences implosion rather than explosion. True, in the absence of evaluative processes, the quality of the baby's experience will be different to ours. But this does not disqualify it as a PSYCHOLOGICAL process and does not extinguish the subjective dimension of the experience. If a psychological process lacks the evaluative or analytic elements, this lack does not question its existence or its nature. Birth and the subsequent few days must be a truly terrifying experience.

Another argument raised against the trauma thesis is that there is no proof that cruelty, neglect, abuse, torture, or discomfort retard, in any way, the development of the child. A child – it is claimed – takes everything in stride and reacts "naturally" to his environment, however depraved and deprived.

This may be true – but it is irrelevant. It is not the child's development that we are dealing with here. It is its reactions to a series of existential traumas. That a process or an event has no influence later – does not mean that it has no effect at the moment of occurrence. That it has no influence at the moment of occurrence – does not prove that it has not been fully and accurately registered. That it has not been interpreted at all or that it has been interpreted in a way different from ours – does not imply that it had no effect. In short: there is no connection between experience, interpretation and effect. There can exist an interpreted experience that has no effect. An interpretation can result in an effect without any experience involved. And an experience can effect the subject without any (conscious) interpretation. This means that the baby can experience traumas, cruelty, neglect, abuse and even interpret them as such (i.e., as bad things) and still not be effected by them. Otherwise, how can we explain that a baby cries when confronted by a sudden noise, a sudden light, wet diapers, or hunger? Isn't this proof that he reacts properly to "bad" things and that there is such a class of things ("bad things") in his mind?

Moreover, we must attach some epigenetic importance to some of the stimuli. If we do, in effect we recognize the effect of early stimuli upon later life development.

At their beginning, neonates are only vaguely aware, in a binary sort of way.

l. "Comfortable/uncomfortable", "cold/warm", "wet/dry", "colour/absence of colour", "light/dark", "face/no face" and so on. There are grounds to believe that the distinction between the outer world and the inner one is vague at best. Natal fixed action patterns (rooting, sucking, postural adjustment, looking, listening, grasping, and crying) invariably provoke the caregiver to respond. The newborn, as we said earlier, is able to relate to physical patterns but his ability seems to extend to the mental as well. He sees a pattern: fixed action followed by the appearance of the caregiver followed by a satisfying action on the part of the caregiver. This seems to him to be an inviolable causal chain (though precious few babies would put it in these words). Because he is unable to distinguish his inside from the outside – the newborn "believes" that his action evoked the caregiver from the inside (in which the caregiver is contained). This is the kernel of both magical thinking and Narcissism. The baby attributes to himself magical powers of omnipotence and of omnipresence (action-appearance). It also loves itself very much because it is able to thus satisfy himself and his needs. He loves himself because he has the means to make himself happy. The tension-relieving and pleasurable world comes to life through the baby and then he swallows it back through his mouth. This incorporation of the world through the sensory modalities is the basis for the "oral stage" in the psychodynamic theories.

This self-containment and self-sufficiency, this lack of recognition of the environment are why children until their third year of life are such a homogeneous group (allowing for some variance). Infants show a characteristic style of behaviour (one is almost tempted to say, a universal character) in as early as the first few weeks of their lives. The first two years of life witness the crystallization of consistent behavioural patterns, common to all children. It is true that even newborns have an innate temperament but not until an interaction with the outside environment is established – do the traits of individual diversity appear.

At birth, the newborn shows no attachment but simple dependence. It is easy to prove: the child indiscriminately reacts to human signals, scans for patterns and motions, enjoys soft, high pitched voices and cooing, soothing sounds. Attachment starts physiologically in the fourth week. The child turns clearly towards his mother's voice, ignoring others. He begins to develop a social smile, which is easily distinguishable from his usual grimace. A virtuous circle is set in motion by the child's smiles, gurgles and coos. These powerful signals release social behaviour, elicit attention, loving responses. This, in turn, drives the child to increase the dose of his signaling activity. These signals are, of course, reflexes (fixed action responses, exactly like the palmar grasp). Actually, until the 18th week of his life, the child continues to react to strangers favourably. Only then does the child begin to develop a budding social-behavioural system based on the high correlation between the presence of his caregiver and gratifying experiences. By the third month there is a clear preference of the mother and by the sixth month, the child wants to venture into the world. At first, the child grasps things (as long as he can see his hand). Then he sits up and watches things in motion (if not too fast or noisy). Then the child clings to the mother, climbs all over her and explores her body. There is still no object permanence and the child gets perplexed and loses interest if a toy disappears under a blanket, for instance. The child still associates objects with satisfaction/non-satisfaction. His world is still very much binary.

As the child grows, his attention narrows and is dedicated first to the mother and to a few other human figures and, by the age of 9 months, only to the mother. The tendency to seek others virtually disappears (which is reminiscent of imprinting in animals). The infant tends to equate his movements and gestures with their results – that is, he is still in the phase of magical thinking.

The separation from the mother, the formation of an individual, the separation from the world (the "spewing out" of the outside world) – are all tremendously traumatic.

The infant is afraid to lose his mother physically (no "mother permanence") as well as emotionally (will she be angry at this new found autonomy?). He goes away a step or two and runs back to receive the mother's reassurance that she still loves him and that she is still there. The tearing up of one's self into my SELF and the OUTSIDE WORLD is an unimaginable feat. It is equivalent to discovering irrefutable proof that the universe is an illusion created by the brain or that our brain belongs to a universal pool and not to us, or that we are God (the child discovers that he is not God, it is a discovery of the same magnitude). The child's mind is shredded to pieces: some pieces are still HE and others are NOT HE (=the outside world). This is an absolutely psychedelic experience (and the root of all psychoses, probably).

If not managed properly, if disturbed in some way (mainly emotionally), if the separation – individuation process goes awry, it could result in serious psychopathologies. There are grounds to believe that several personality disorders (Narcissistic and Borderline) can be traced to a disturbance in this process in early childhood.

Then, of course, there is the on-going traumatic process that we call "life".

Monday, September 27, 2010

Stretch Marks And Skin Changes In Pregnancy

There are countless physical changes to your skin, both pleasurable and painful attributed to your pregnancy only.

The common skin change that most pregnant woman experience is the stretch marks. Stretch marks are separations of the outer layers of skin caused by the overstretching of underlying layers.

Beside pregnant women, stretch marks are found on children who are obese, adolescents who have a sudden growth spurt during puberty and athletes and body builders who do constant exercises. The most commonly affected areas by stretch marks are hips, abdomen, breasts, thighs and buttocks. Stretch marks are itchy reddish marks.

In pregnancy, heredity plays an important role in determining who will have and will not have stretch marks. If your mother has had them, chances are that you will get them too, unless you were born with stretchy skin. There is no sure shot remedy for stretch marks as mostly they fade after delivery. The only way to avoid stretch marks is to prevent them. We recommend the following –

- Massage vitamin E or olive oil on the abdomen areas from the start of your pregnancy. Massage it liberally over the marks after a shower. Incase you skip a shower, clean the area with a wet cloth and then apply the oil.

- Regular exercise helps to tone your muscles and keep your skin firm.

- Maintain healthy diet and drink plenty of water. Plenty of proteins and vitamin C & E foods should be included in your diet. Increase your intake of minerals such as zinc and silica to maintain healthy skin.

- One ounce of sweet almond or jojoba oil with 7-8 drops of lavender and chamomile oils is a good homemade recipe.

- Avoid excessive weight gain in a short time span.

- Cocoa butter reduces stretch marks and helps to keep the skin supple.

- Wear a glove and massage your skin to increase circulation.

- While massaging your body with body oil, add coconut and almond oil. Daily massage with Olive oil, flaxseed oil, cod liver oil or vitamin E oil after shower or before sleeping is an excellent home remedy for either preventing or treating stretch marks.

- To avoid stretch marks around breasts, wear a supportive maternity bra.

- To make stretch mark cream, mix 1/2 cup cocoa butter, 1 tsp wheat germ oil, 1 tsp apricot kernel oil, vitamin E oil and 2 tsp grated beeswax. Heat the mixture until cocoa butter and beeswax melt, stir well and store in air tight conditioner.

Bob Ong

"Hindi lungkot o takot ang mahirap sa pag-iisa kundi ang pagtanggap na sa bilyon-bilyong tao sa mundo, wala man lang nakipaglaban upang makasama ka."

madaming teacher sa labas ng eskwelahan. desisyon mo kung kanino ka magpapaturo.”
“Nalaman kong hindi final exam ang passing rate ng buhay. Hindi ito multiple choice, identification, true or false, enumeration or fill-in-the-blanks na sinasagutan kundi essay na isinusulat araw-araw. Huhusgahan ito hindi base sa kung tama o mali ang sagot, kundi base sa kung may kabuluhan ang mga isinulat o wala. Allowed ang erasures.”

ayokong sabihing susubok naman ako ng iba. Walang “iba”. Wala akong iiwan, meron lang babalikan. Kung meron mang iba sa ginawa ko, yun ay ang Bobong Pinoy. Kung may magsasabi man sa hinaharap na: “Sana nagpatawa ka na lang!” Yun ay opinyong handa kong tanggapin. Marami ang kaya at pwedeng gumawa ng mga isinusulat ko ngayon para sa mga mambabasa, pero ang gusto kong isulat at gawin para sa sarili, walang pwedeng tumupad kundi ako. Inumpisahan ko ang dialogue sa ikatlong libro para ipakilala sa mambabasa ang fiction. Umatras pa ‘ko ng bahagya sa ikaapat para mas maging kumportable sila dito. Sa mga susunod pa, pwede na siguro ako magtangka ng maikling kwento o nobela. Tulad ng pagsusulat ko, ayoko rin kasi malimitahan ang pagbabasa ng mga tao sa iisang klase ng libro…” 

Sunday, September 26, 2010



It was in 1992 when the term Forensic nursing was first heard. But what is it exactly? Forensic nursing is a specialty field that deals with the care of crime victims, collecting evidences and providing health care services  in the prison system. It is a combined health care and judicial system profession to be precise. International Association of Forensic Nurses (IAFN) is the official association of forensic nurses established in 1992 by a team of nurses who specialize in sexual assault examination.

1. A Day In The Life

Contrary to popular belief forensic nurses don't spend their day hanging around with corpses. Examining victims of sexual assault and training colleagues how to treat violently injured patients eat up most of these nurses days. Another related job for a forensic nurse is providing counsel to schoolchildren who fired guns.

2. Training

Training as a Sexual Assault Nurse Examiner is the entry-level position you need to obtain in order to break into forensic nursing. The nurse should be a Registered Nurse (RN) before being able to complete the specialized training needed to meet the standards of the IAFN. Forty hours of didactics and forty hours of clinical work are also needed. The nurse should be trained in handling and collecting evidences like hairs, fibers and swabs of fluids for DNA testing.

Forensic nursing is not limited to helping rape victims. Forensic nurses also work with other types of interpersonal abuse such as domestic violence, child and elderly abuse, neglect and physiological, as well as psychological abuse. They could also examine victims of near-fatal or fatal traumas like shooting or stabbing.

A lot of forensic nurses work as nurse examiners in the emergency rooms in the hospitals. In cases like shooting or stabbing, the forensic nurse works in collecting bullets and other debris left in the body that will help in the investigation. Removing the clothes the victim is wearing and storing them in a special bags are also some of their duties. They also have to photograph and measure the wounds of the patients. In case the victim dies, the nurse has to work with the medical examiner (ME).

3. Other Considerations

Forensic nurses are qualified to testify in court as an expert witness or a fact witness. As an expert witness, the nurse is allowed to give his or her opinions while on the witness stands in order to shed light on the case. On the other hand, as a fact witness, the nurse is only to state the details and answer the questions. A forensic nurse should state the information in an objective manner. It means that he or she should not speak for or against either the victim or the accused. As the duty calls for it, the nurse only has to state the information he or she obtained, not make conjecture about what he or she thinks happened.

4. Tools of the Trade

A forensic nurse should also know how to use different tools in order to document what he or she has gathered during the examination or treatment process.

- A digital camera
- An Omnichrome
- A Coloscope

To date, specialty areas are being related to forensic nursing. This includes a Forensic Nurse Specialist, Forensic Nurse Investigator, Nurse Coroner or what is known as Death Investigator, Sexual Assault Nurse Examiner (SANE), Legal Nurse Consultant, Forensic Gerontology Specialist, Forensic Psychiatric Nurse and a Correctional Nursing Specialist. Forensic nursing is a growing industry in the field of nursing. More and more nurses are being drawn to it. Nursing schools are also taking notice of this need. Forensic Nurse Programs are now being offered in nursing schools.

Father sentenced to 14,400 years for rape

MANILA, Philippines – A Philippine court has sentenced a father to 14,400 years in prison after he was convicted of the near-daily rape of his teenage daughter over the course of a year.

A trial court originally condemned the man, a motorcycle taxi driver, to die in March 2006 after he was convicted of 360 counts of rape allegedly carried out during the year his wife worked in Hong Kong.

The Philippines repealed the death penalty in June 2006 and the Court of Appeals in Manila affirmed the conviction on Sept. 8 but lowered the sentence to 40 years' imprisonment _ the maximum now allowed by law _ for each count of rape, according to a copy of the decision obtained Friday.

The then-13-year-old victim, now 22, said her ordeal began in January 2001, when her mother left for work in Hong Kong as a domestic helper and left her three children with their father in Los Banos, a township just south of Manila.

She said he forced her to have intercourse with him almost every day, except when she had her period or on holidays, when he would make her perform oral sex.

The ordeal only ended after she and her siblings spent a vacation with their mother's relatives. Reluctant to return to her father at the end of the vacation, she broke down and told her family about the abuse. Her mother returned home from Hong Kong and helped her file the case.

The appeals court affirmed the lower court's dismissal of the defense's contention that the man's wife made up the allegations to get custody of the children and marry a foreigner.

Courts do not routinely announce their decision to reporters, and the little-known case escaped media attention until journalists checked the appellate court's recent decisions.

The defendant can still appeal to the Supreme Court. It was not clear if he would and calls to his lawyer's phone were unanswered.

Friday, September 17, 2010

5 Things You Didn't Know: Women

1- Women get blue balls

No one said you needed balls for them to go blue.

What are "blue balls," anyway? During sexual arousal, blood floods the genitals through dilated blood vessels, then struggles to leave the area because those departing vessels constrict -- this is known as vascocongestion. In men, the visible results are an erection and larger testicles. Orgasm and ejaculation (or a little time) will return things to normal, but if the vascocongestion is prolonged, pain and discomfort can set in -- enter the term "blue balls."

In women, vascocongestion operates in very much the same way, and if prolonged and unrelieved by an orgasm similar pain, heaviness or discomfort can affect them as well. However, whether the genders experience the same levels of discomfort is unknown. We only know that young men and women have been falsely socialized to think that male blue balls absolutely need to be relieved via orgasm, ideally with female assistance.

2- Female mechanics get paid more than male mechanics

In most professional fields women get the shaft, wage and salary-wise, often only earning three-fourths what men do. However, there’s money to be had in professions where women traditionally do not tread. One of the more lucrative jobs is as an auto mechanic, where women can earn almost one-third more than men.

Why are women rewarded this way as automotive service technicians and mechanics? For the answer we revert to stereotypes: Women are more verbal than men, they’re easier to approach and to talk to, and both genders agree that women instill more trust in others -- at least with car trouble.

3- One in 10 women has never had an orgasm

Science can’t say why this is the case, and if it ever does, the answer won’t apply to all of those women who have never had an orgasm. Yet, it seems, no one can even be certain as to why women orgasm in the first place. The fact that so many women can’t have one supports the notion that the female orgasm is not evolutionary, nor connected to reproductive success or fertility -- otherwise Darwin would’ve nudged them out long ago.

4- Women buy more cars than men

Another thing you didn’t know about women is that they are overtaking the car industry. The showroom damsel in distress, long a target of unscrupulous car salesmen, is becoming a thing of the past.

According to some estimates, women are driving off the lots with 52% of all new cars and 53% of used ones and carmakers are reflecting women's many preferences in new models every year. On average, women also spend three weeks longer than men on the car-buying process, displaying either a more thorough, attentive approach to car shopping or just a more thorough, attentive approach to shopping in general.

5- Women prefer unfaithful spouses to have meaningless sex

A word of warning to all the guys out there contemplating an affair: If you must cheat, keep in mind that whatever you do and whoever you do, don’t fall in love. Women in general have an "easier"’ time (for lack of a better term) coping with your one night of meaningless sex than they do if you've developed emotional feelings for the woman.

The opposite is true for men: meaningless sex is devastating to us. Women who cheat and develop emotional attachments -- or who don’t cheat per se but develop emotional bonds with another man -- are less likely to permanently damage their current relationship.

Monday, September 13, 2010

New Guidelines Issued for Insomnia and Other Sleep Disorders

News Author: Laurie Barclay, MD
CME Author: Hien T. Nghiem, MD

September 2, 2010 — The British Association for Psychopharmacology (BAP) has issued a consensus statement on evidence-based treatment of insomnia, parasomnias, and circadian rhythm disorders. The new recommendations, intended to guide psychiatrists and clinicians caring for those with sleep problems, are published online September 2 in the Journal of Psychopharmacology.
"Sleep disorders are common in the general population and even more so in clinical practice, yet are relatively poorly understood by doctors and other health care practitioners," write Sue J. Wilson, from the Psychopharmacology Unit, University of Bristol, Bristol, United Kingdom, and colleagues. "These ...BAP guidelines are designed to address this problem by providing an accessible yet up-to-date and evidence-based outline of the major issues, especially those relating to reliable diagnosis and appropriate treatment. We limited ourselves to discussion of sleep problems that are not regarded as being secondary to respiratory problems (e.g. sleep apnoea – see NICE Guidance TA139), as these fall outside the remit of the BAP."
These guidelines also do not cover neuropsychiatric disorders, such as narcolepsy and restless legs, for which recent sets of guidelines already exist. The new recommendations were developed after a consensus meeting in London in May 2009 of BAP members, as well as clinicians, experts, and advocates in sleep disorders, based on literature reviews and a description of standard of evidence.
Recommendations for Diagnosis and Treatment
Specific evidence-based recommendations for diagnosis and treatment of insomnia and other sleep disorders, and their accompanying level of evidence rating, are as follows:
  • The diagnosis of insomnia is primarily based on complaints provided in the clinical interview by the patient, family, and/or caregiver, ideally corroborated by a patient diary (level of evidence, A).
  • Referral to a specialist sleep center may be indicated for other tests in some cases, such as actigraphy for differential diagnosis of circadian rhythm disorder (level of evidence, A), polysomnography for suspected parasomnia or other primary sleep disorder (level of evidence, A), or in the case of treatment failure (level of evidence, D).
  • Insomnia should be treated because it impairs quality of life and many areas of functioning and is associated with an increased risk for depression, anxiety, and possibly cardiovascular disorders (level of evidence, A). Treatment goals are to reduce distress and to improve daytime function. Choice of treatment modality is based on the particular pattern of problem, such as sleep-onset insomnia or sleep maintenance, as well as on the evidence supporting use of specific treatments.
  • For chronic insomnia, cognitive behavioral therapy (CBT)-based treatment packages are effective and should be offered to patients as a first-line treatment (level of evidence, A). CBT, which may include sleep restriction and stimulus control, should be made available in more settings.
  • When prescribing hypnotic drug treatment, clinicians need to consider efficacy, safety, and duration of action (level of evidence, A). Other issues to consider may include previous efficacy or adverse effects of the drug and history of substance abuse or dependence (level of evidence, D).
  • Recommendations for long-term hypnotic drug treatment are to use it as clinically indicated (level of evidence, A). To discontinue long-term hypnotic drug therapy, intermittent use should first be attempted if feasible. Depending on ongoing life circumstances and patient consent, discontinuation should be attempted every 3 to 6 months or at regular intervals (level of evidence, D). During taper of long-term hypnotic drug treatment, CBT improves outcome (level of evidence, A).
  • When using antidepressants, clinicians should apply their knowledge of pharmacology (level of evidence, A). When there is a comorbid mood disorder, antidepressants should be used at therapeutic doses (level of evidence, A). However, clinicians should beware that overdose of tricyclic antidepressants can be toxic even when low-unit doses are prescribed (level of evidence, A).
  • Because of frequent adverse effects of antipsychotic drugs, as well as a few reports of abuse, there is no indication for use as first-line treatment of insomnia or other sleep disorders (level of evidence, D).
  • Antihistamines have a limited role in psychiatric and primary care practice for the management of insomnia (level of evidence, D).
Recommendations for Certain Populations
Specific evidence-based recommendations for management of insomnia and other sleep disorders in special populations and conditions are as follows:
  • After menopause, the incidence of sleep-disordered breathing increases, and the clinical presentation is different in women vs men and often includes insomnia. Informed, individualized treatment of symptoms is needed for use of hormone therapy, considering risks and benefits clarified in recent studies.
  • Behavioral strategies are recommended for children with disturbed sleep (level of evidence, A). In children with attention-deficit/hyperactive disorder not treated with stimulant drugs, melatonin administration may help advance sleep onset to normal values (level of evidence, A).
  • For children and adults with learning disabilities, clinical evaluation should describe the sleep disturbance and triggering and exacerbating factors (level of evidence, A). Recommended first-line therapy includes environmental, behavioral, and educational strategies (level of evidence, A). Melatonin is effective in improving sleep (level of evidence, A). The treatment plan should be based on a capacity/best-interests framework.
  • For management of circadian rhythm disorders, clinical evaluation is essential in delayed sleep-phase syndrome and free-running disorder (level of evidence, A/B). In delayed sleep-phase syndrome, free-running disorder, and jet lag, melatonin may be useful (level of evidence, A), but other strategies such as behavioral regimens and scheduled light exposure (in sighted individuals) can also be used (level of evidence, B/C).
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The costs of the meeting were partly defrayed by unrestricted educational grants from Lundbeck and GlaxoSmithKline. All attendees completed conflict-of-interest statements held at the BAP office.
J Psychopharmacol. Published online September 2, 2010.
Additional Resource

The National Institutes of Health, National Heart, Lung, and Blood Institute's Web site has more information online about sleep disorders.

Clinical Context

Sleep disorders are common in the general population and even more so in clinical practice, yet they are relatively poorly understood by physicians and other healthcare practitioners. One of the most frequent complaints is insomnia. In the general population, one third of adults in Western countries experience difficulty with sleep initiation or maintenance at least once a week. Prevalence is between 1.5 and 2 times higher in women vs men. Approximately half of all diagnosed insomnia is related to a psychiatric disorder. The symptom prevalence of insomnia changes with age.
The BAP guidelines are designed to address this problem by providing an accessible up-to-date and evidence-based outline of the major issues, especially those relating to reliable diagnosis and appropriate treatment. A consensus meeting was held in London in May 2009. The aim of this report was to discuss the diagnosis and treatment of insomnia as well as circadian rhythm disorders and the more common parasomnias.

Study Highlights

  • Insomnia is a subjective disorder and is usually long term.
  • The diagnosis of insomnia is primarily based on patient-derived and family or caregiver complaints, as determined by the clinical interview, ideally with a patient diary (level of evidence, A).
  • In some circumstances, referral to a specialist sleep center may be necessary for other investigations, such as diagnosis of circadian rhythm disorder (actigraphy; level of evidence, A) or parasomnia (polysomnography; level of evidence, A), or in the case of treatment failure (level of evidence, D).
  • Circadian rhythm disorders are sleep disorders in which there is a mismatch between circadian rhythms and required sleep-wake cycle.
  • Parasomnias are unusual episodes or behaviors occurring during sleep, which disturb the patient or others such as night terrors, sleepwalking, nightmares, and rapid eye movement behavior disorder.
  • It is important to treat insomnia because the condition causes decreased quality of life; is associated with impaired functioning in many areas; and leads to increased risk for depression, anxiety, and possibly cardiovascular disorders (level of evidence, A).
  • The goal of treatment is to lessen anguish and improve daytime function.
  • Choice of treatment modality is patient guided and is based on the particular pattern of problem, such as sleep-onset insomnia or sleep maintenance, as well as on the evidence supporting use of specific treatments.
  • CBT-based treatment packages for chronic insomnia including sleep restriction and stimulus control are effective and therefore should be offered to patients as a first-line treatment (level of evidence, A). Increased availability of this therapy is required.
  • Z-drugs (zaleplon, zolpidem, zopiclone, and eszopiclone) and short-acting benzodiazepines are efficacious for insomnia.
  • Factors that clinicians need to take into account when prescribing medications for insomnia are efficacy, safety, and duration of action of the drug (level of evidence, A). Additional factors are previous efficacy of the drug or adverse effects, and a history of substance abuse or dependence (level of evidence, D).
  • Hypnotic drug treatment encompasses the following guidelines:

    • Hypnotic drugs should be used when clinically indicated.
    • They should be limited to 2 to 4 weeks; however, they are often used for longer periods.
    • Safety (adverse events and carryover effects) are fewer and are less serious with decreasing half-lives (level of evidence, Ib).
    • Studies suggest that dependence (tolerance/withdrawal) is not inevitable with hypnotic therapy for up to 1 year with eszopiclone, zolpidem, and ramelteon. Intermittent dosing may reduce the risk for tolerance and dependence.
    • For discontinuation of hypnotics, intermittent use should be administered at first and then at regular intervals.
    • CBT during taper improves outcome.
  • Prolonged-release melatonin improves sleep-onset latency and quality of life in patients older than 55 years (level of evidence, Ib).
  • Antidepressants for insomnia should be considered when there is a coexistent mood disorder.
  • There is limited evidence for the efficacy of doxepin, trimipramine, trazodone, and paroxetine in insomnia. Clinicians should beware that overdose of tricyclic antidepressants can be toxic even when low-unit doses are prescribed (level of evidence, A).
  • There is no indication for use of antipsychotics as first-line treatment.
  • Antihistamines have a limited role in psychiatric and primary care practice for the management of insomnia.
  • For the treatment of circadian rhythm disorders, melatonin is effective in jet lag disorder (level of evidence, Ia), delayed sleep-phase syndrome (level of evidence, Ib), and free-running disorder (level of evidence, IIa). Light therapy is effective in delayed sleep-phase syndrome (level of evidence, III).
  • For parasomnias, drug treatment should be based on frequency and severity of events. Psychological treatments are effective for nightmares.

Clinical Implications

  • Insomnia is a common sleep disorder that affects up to one third of adults in Western countries, has a higher prevalence in women vs men, and is often associated with a psychiatric disorder.
  • Z-drugs and short-acting benzodiazepines are efficacious for insomnia, and CBT-based treatment packages should be offered to patients as a first-line treatment of chronic insomnia.

Medical-surgical bullets


Thursday, September 9, 2010

Microbleeds Increase Cerebral Hemorrhage Risk in Warfarin Users

NEW YORK (Reuters Health) May 18 - Cerebral microbleeds increase the risk of intracerebral hemorrhage (ICH) in patients taking warfarin, a new study suggests.
"These results have potentially worrying implications for warfarin users with microbleeds in particular," lead investigator Dr. Caroline E. Lovelock of John Radcliffe Hospital, Oxford, UK, told Reuters Health by e-mail.
But the results "do not allow us to make definite statements about whether or not patients with microbleeds should start warfarin," she added. "Many patients starting warfarin do so because they are at high risk of having a cardioembolic stroke, and this risk might still outweigh the risk of hemorrhage even in the presence of microbleeds."
In a systematic review of published and unpublished data, Dr. Lovelock and colleagues analyzed rates of microbleeds associated with ICH, stroke, and transient ischemic attacks (TIA), with results stratified by whether or not patients used antithrombotics. They also assessed prospective data to determine the risk of ICH in antithrombotic users with microbleeds.
The pooled data set included 1461 patients with ICH and 3817 with stroke or TIA.
In the June issue of Stroke, the researchers report that microbleeds were more frequent in warfarin users with ICH compared to nonusers (odds ratio, 2.7; p < 0.001). There was no excess of microbleeds in warfarin users versus non-users with stroke/TIA.
The authors saw a similar but weaker association in patients taking antiplatelet agents. Microbleeds were more frequent in antiplatelet users versus non-users with ICH (OR, 1.7; p < 0.001), but there was no excess of microbleeds with use of the drugs by patients with stroke or TIA.
In all treatment groups, microbleeds were more frequent in ICH versus stroke/TIA patients. The difference was greater among warfarin and antiplatelet users (ORs, 8.0 and 5.7, respectively) compared to nonantithrombotic users (OR, 2.8; p difference between pooled OR, 0.01).
The pooled prospective data set included 768 patients with stroke or TIA, with a mean follow-up of 27.7 months. Overall, baseline microbleeds significantly increased the risk of a recurrent ICH among all antithrombotic users (OR, 12.1; p < 0.001). Among warfarin users, microbleeds did not significantly increase the risk of recurrent ICH -- but there were only 5 such cases in warfarin users overall.
"We need tighter estimates of the risks of intracerebral hemorrhage on warfarin in people with microbleeds, and in particular we need to know what the risks are for patients with just one or two microbleeds versus many microbleeds," Dr. Lovelock said.
Even after pooling results of published and unpublished cohorts of patients, there are still very few data on warfarin users, and "more prospective studies of patients with microbleeds are therefore urgently required," Dr. Lovelock said.

Mandate Flu Vaccination for Healthcare Workers, Say Infectious Disease Experts

August 31, 2010 — Healthcare professionals should be required to get vaccinated against seasonal influenza or else lose their jobs and professional privileges, the Society for Healthcare Epidemiology of America (SHEA) says in a position paper released today.
The paper, endorsed by the Infectious Diseases Society of America, argues that allowing healthcare workers to go unvaccinated except for recognized medical contraindications is just as unacceptable as allowing physicians and nurses to forgo scrubbing before a surgical procedure.
"SHEA views influenza vaccination of HCP [healthcare personnel] as a core patient and HCP safety practice with which non-compliance should not be tolerated," according to the position paper, published in this month's Infection Control and Healthcare Epidemiology. "SHEA endorses a policy in which annual influenza vaccination is a condition of both initial and continued HCP employment and/or professional privileges."
The goal of HCP vaccination is not only preventing virus transmission to patients, but also reducing the risk for infection of HCPs, which in turn preserves an adequate healthcare workforce, the position paper notes. At the same time, HCPs who get vaccinated contribute to "herd immunity" and set a good example.
The position paper, which updates a SHEA statement issued in 2005, recommends mandatory vaccination of all HCP working in all healthcare settings, regardless of whether they come into contact with patients and whether they are directly employed by the facility. The recommendation extends to students, volunteers, and contract workers.
Mandated Vaccination Has Met Resistance
The recommendations from SHEA come on the verge of the 2010-2011 influenza season and follow a previous season in which seasonal influenza vaccination among HCP reached an all-time high of 62% as of mid-January 2010, according to the US Centers for Disease Control and Prevention. Physicians, physician' assistants, nurse practitioners, and dentists posted the highest immunization rate as a group among HCP — 77%. In contrast, the immunization rate among all HCP against the H1N1 influenza virus stood at 37%.
SHEA believes a voluntary approach will not dramatically increase HCP immunization rates. Its position paper points to several healthcare organizations such as Virginia Mason Medical Center (VMMC) in Seattle, Washington, and BJC Healthcare in St. Louis, Missouri, that have achieved immunizations rates surpassing 98% by mandating vaccination of HCPs.
The success of institutions like VMMC and BJC notwithstanding, some HCP have not taken kindly to vaccine mandates.
During the H1N1 influenza pandemic of 2009-2010, for example, the state of New York ordered its healthcare workers to get vaccinated against both seasonal and pandemic influenza only to rescind the requirement several months later. At the time, New York Gov. David Patterson said the mandate turned out to be impractical in light of a shortage of pandemic influenza vaccine, but the state also had encountered several lawsuits and opposition from a large healthcare union.
Noting the possibility of continued resistance by labor unions to vaccine mandates, the SHEA position paper states that requiring HCPs to get immunized is just as reasonable as requiring them to wear appropriate attire in the operating room or to care for patients "regardless of underlying disease, even when they have disease that might place the HCP at some risk."
"One hopes that, in the interests of protecting both patients and their members, these organizations will not oppose mandatory programs that are developed in collaboration with employees," the position paper states.
One author reports that he is a consultant for Joint Commission Resources. He and some other authors report various financial relationships with Avianax, BD Diagnostics, Care Fusions, CSL, Cubist, EMD Serono, Emergent BioSolutions, GlaxoSmithKline, Human Genome Sciences, Liquidia Technologies, MedImmune, Merck, Novartis Vaccines and Therapeutics, Novavax, OrthoMcNeil, PaxVax, Pfizer, Rymed Technology, Sage, Sanofi Pasteur, Theraclone Sciences (formally Spaltudaq Corporation), Vaxxinate, and/or Wyeth. All other authors have disclosed no relevant financial relationships.
Infect Control Hosp Epidemiol. Published online August 31, 2010.

Wednesday, September 8, 2010

NCP: pneumonia

Nursing Diagnosis:
Ineffective airway clearance related to decreased energy and fatigue resulting in decreased coughing and accumulation of secretions; tracheobronchial secretions related to inflammation resulting in increased mucus accumulation. Ineffective breathing pattern related to pain caused by positioning and coughing; decreased energy and fatigue caused by inflammatory process; decreased lung expansion caused by pain and fatigue resulting in hypoventilation.

Expected Outcomes: Adequate ventilation evidenced by respiratory rate, depth and ease within baseline limits.

Intervention and Rationale:
I. Assess for:
  1. Respiratory status including rate, depth, ease, shallow or irregular breathing, dyspnea, use of accesory muscles, and diminished breath sounds, rhonchi or crackles on auscultation - provides data baseline.
  2. Changes in mental status, skin color, cyanosis - indicates possible decrease in oxygenation.
  3. Quality of cough and ability to raise secretions including consistency and characteristics od sputum - removal of secretions prevents obstruction of airways and stasis leading to further infection and consolidation of lungs; clearing airways facilitates breathing.
II. Monitor, record, describe:
Respiratory rate, quality and breath sounds q2-q4 - indicates airway resistance, air movement, severity of disease.
  1. ABGs, oximeter reading - decreased oxygen levels result in hypoxemia.
III. Administer:
  1. Oxygen therapy via cannula - maintain optimal oxygen level.
  2. Antitussives/expectorants (terpin hydrate, guaifenesin) - acts on bronchial cells to increase fluid production and promote expectoration; guaifenesin reduces surface tension of secretions; both relieve non-productive cough
  3. Mucolytic (acetylcysteine) - decrease viscosity of mucus for easier removal.
  4. Antibiotic (ampicillin, cephalexin) - acts by binding to cell wall organisms preventing synthesis and destroying pathogens.
IV. Perform or Provide:
  1. Position of comfort in semi or high fowlers and change position q2h - facilitates breathng and allows for full expansion of lungs.
  2. Encourage coughing if sounds is moist; if dry and hacking, increase fluid intake and administer cough suppresant - reduces continual irritation to throat and liquefies secretions.
  3. Coughing and deep breathing exercise q2h; use incintive spirometer 5-10 breaths if tolerated - coughing clears airway by propelling secretions to mouth deep breathing promoes ventilation and prolongs expiratory phase.
  4. Assist with coughing by splinting chest; humidified air with cool mist - loosens seretions and improves ventilation, moistens mucous membranes
  5. Postural drainage and percussion PRN - mobilizes secretion.
  6. Suction secretions if cough ineffective - removal if unable to bring up secretions.
  7. Oral care after expectoration and provide tissues and bag for disposal - promotes comfort and prevents transmission of organisms to others.

Maternal nursing part 6

Maternal nursing part 5

Maternal nursing part 4

maternal nursing part 3

Maternal nursing part 2

Maternal nursing part 1

Tuesday, September 7, 2010


basic concepts in medical surgical nursing


medical surgical flash cards

Amazing facts about cats!

Did you know...

Ailurophilia is the "love of cats."

The nose pad of a cat is ridged in a pattern that is unique, just like the fingerprint of a human.

There are more than 500 million domestic cats in the world, with 33 different breeds.

The American cat population reached nearly 68 million in 1996.  American Demographics magazine estimates that's about 200 million kitty yawns per hour and a whopping 425 million catnaps each day!

A cat's heart beats twice as fast as a human heart, at 110 to 140 beats per minute.

25% of cat owners blow dry their cats hair after a bath.

The largest cat breed is the Ragdoll.   Males weigh twelve to twenty pounds, with females weighing ten to fifteen pounds.   The smallest cat breed is the Singapura.  Males weigh about six pounds while females weigh about four pounds.

Calico cats are almost always female.

If your cat is near you, and her tail is quivering, this is the greatest expression of love your cat can give you.   If her tail starts thrashing, her mood has changed --- Time to distance yourself from her.

Cats wag their tails when it is in a stage of conflict.  The cat wants to do two things at once, but each impulse blocks the other.  For example:   If your cat is in the doorway wanting to go outside, and you open the door to find it raining, the cat's tail will wag because of internal conflict.  The cat wants to go outside, but doesn't want to go into the rain.  Once the cat makes a decision and either returns to the house or leaves into the rain, the tail will immediately stop wagging.

Don't pick a kitten or a cat up by the scruff of its neck;  only mother cats can do this safely, and only with their kittens.

Cats knead with their paws when they're happy.

Your cat loves you and can "read" your moods.  If you're sad or under stress, you may also notice a difference in your cat's behavior.

The domestic cat is the only cat species able to hold its tail vertically while walking.  All wild cats hold their tails horizontally or tucked between their legs while walking.

An average cat has 1-8 kittens per litter, and 2-3 litters per year.

During her productive life, one female cat could have more than 100 kittens.

In 1952, a Texas Tabby named Dusty set the record by having more than 420 kittens before having her last litter at age 18.

The largest known litter (with all surviving) was that of a Persian in South Africa named Bluebell.  Bluebell gave birth to 14 kittens in one litter!

A single pair of cats and their kittens can produce as many as 420,000 kittens in just 7 years.

More than 35,000 kittens are born in the U.S. each year.  Spay or neuter your cat.

Cats have 290 bones in their bodies, and 517 muscles.

A cat has five more vertebrae in her spinal column than her human does.

There are three body types for a cat.   Cobby type is a compact body, deep chest, short legs and broad head.  The eyes are large and round.  Muscular type is a sturdy body and round, full-cheeked head.   Foreign type is a slender body, with long legs and a long tail.  The head is wedge-shaped, with tall ears and slanting eyes.

Sir Isaac Newton, discoverer of the principles of gravity, also invented the cat door.

A cat will amost never "meow" at another cat.  This sound is reserved for humans.

Know how old your cat really is.   If your cat is 3, your cat is 21 in human years.  If your cat is 8, your cat is 40 in human years.  If your cat is 14, your cat is 70 in human years.

The average age for an indoor cat is 15 years, while the average age for an outdoor cat is only 3 to 5 years.

The oldest cat on record was Puss, from England, who died in 1939 just one day after her 36th birthday.  (We wish we could have them all that long!)

The weirdest cat on record was a female called Mincho who went up a tree in Argentina and didn't come down again until she died six years later.  While treed, she managed to have three litters with equally ambitious dads.

A cat's normal body temperature is 101.5 degrees.  This is slightly warmer than a humans.

People who own pets live longer, have less stress, and have fewer heart attacks.

Cats love to chew on grass, catnip, parsley or sage.  Become a green thumb and plant an indoor garden for your cat!   But be careful -- many plants are toxic to your cat!

There are two species of wild cats in African and Europe that still hunt.  These two species both resemble the domestic tabbies.

The behaviors shown by most house cats have a parallel in the wild.

A cat will kill it's prey based on movement, but may not necessarily recognize that prey as food.  Realizing that prey is food is a learned behavior.

The greatest number of mice killed by one cat?  28,899!  Towser, a tortoise-shell tabby in charge of rodent control in Scotland, killed 28,899 mice in her 21 years.  This is about four mice per day, every day, for 21 years.  Towser died in 1987.

The first cat show was held in 1895 at Madison Square Garden in New York City, New York.

A falling cat will always right itself in a precise order.  First the head will rotate, then the spine will twist and the rear legs will align, then the cat will arch its back to lessen the impact of the landing.

"Sociable" cats will follow you from room to room to monitor your activities throughout the day.

What kind of "mood" is kitty in?  Her eyes, whiskers and ears will tell you.  Learn to read the signs she gives you.

The most popular names for female cats in the U.S. are Missy, Misty, Muffin, Patches, Fluffy, Tabitha, Tigger, Pumpkin and Samantha.

Give your cat a quality scratching post to deter her from scratching your furniture.  Still scratching?  Try putting lemon scent or orange scent on the area.  Cats hate these smells.

Try hanging an orange or lemon scented air freshener in the inner branches of your Christmas tree, if your cat is a seasonal "climber."

In English, cat is "cat."   In French, cat is "Chat."  In German, your cat is "katze."   The Spanish word for cat is "gato," and the Italian word is "gatto."  Japanese prefer "neko" and Arabic countries call a cat a "kitte."

Cats get their sense of security from your voice.  Talk to your cats!  And be mindful of your tone of voice.  Cats know when you're yelling at them (though they may not care).

The more cats are spoken to, the more they will speak to you.

The richest cat in the Guinness Book of World Records is a pair of cats who inherited $415,000 in the early '60s.  The richest single cat is a white alley cat who inherited $250,000.  (Now that will buy a lot of catnip!)

The Giraffe, Camel and Cat are the only animals that walk by moving both their left feet, then both their right feet, when walking.  This method of walking ensures speed, agility and silence.

It is believed that a white cat sitting on your doorstep just before your wedding is a sign of lasting happiness.  White cats are a symbol of good luck in America, while black cats are a sign of bad luck.

Cats can see in color!

Cats are partially color blind.   They have the equivalency of human red/green color blindness.  (Reds appear green and greens appear red;  or shades thereof.)

Cats don't see "detail" very well.  To them, their person may appear hazy when standing in front of them.

Cats need 1/6th the amount of light that humans do to see.  Their night vision is amazing!

Cats can see up to 120 feet away.   Their peripheral vision is about 285 degrees.

Cats eyes come in three shapes:   round, slanted and almond.

The color of a kitten's eyes will change as it grows older.

At birth, kittens can't see or hear.   Cats open their eyes after five days and begin to develop their eyesight and hearing at approximately 2 weeks.  They begin to walk at 20 days.

Kittens begin dreaming at just over one week old.

A cat's ear pivots 180 degrees.   They have 30 muscles in each ear, and use twelve or more muscles to control their ear movement.

A group of kittens is called a "kindle."

A group of grown cats is called a "clowder."

Cats rub up against other cats, and people, in an attempt to "mark" them with their scent glands.  They most often use the scent glands between their eye and ear (near the temple area) or their scent glands near the base of their tail.

Have you ever tried to feed your cat food that was just taken out of the refrigerator?  Most cats prefer their food at room temperature, and will boldly REFUSE any food that is too cold or too hot.

Many experts report that cats will purr when feeling any intense emotion (pleasure or pain).

Give your cat fresh water at least once a day.  If your cat refuses your tap water, it may be sensing (with it's superior sense of smell) the chlorine or other minerals in your water.  Many finicky felines demand bottled water, just like their human counterparts.

Don't put your cat on an all-vegetarian diet.  Cats need protein to survive.

Never feed your cat dog food.   Cats need five times more protein than dogs do.

If your cat misses one meal, a trip to the vet may be necessary.

Cats are the sleepiest of all mammals.   They spend 16 hours of each day sleeping.  With that in mind, a seven year old cat has only been awake for two years of its life!

Cats are more active during the evening hours.

Cats spend 30% of their waking hours grooming themselves.

95% of all cat owners admit they talk to their cats.

Backward-pointing spikes on a cat's tongue aid in their grooming.

The average cat weighs 12 pounds.

If you can't feel your cat's ribs, she's too heavy.

If an overweight cat's "sides" stick out further than her whiskers, she will lose her sense of perception and stability.  Don't be surprised if she starts to squeeze into an opening that the rest of her can't fit into, only to back herself back out quickly!

According to the Guiness Book of World Records, the heaviest cat on record was Himmy, an Australian cat, who weighed 46 pounds, 15.25 ounces in 1986.  Himmy's waist was 33 inches!  The previous record-holder had been Spice, a ginger-and-white tom cat from Connecticut, who weighed 43 pounds when he died in 1977.

The tiniest cat on record was Tinker Toy from Illinois.  A male Himalayan-Persian, he weighed 1 pound, 8 ounces fully grown and was 7.25" long and 2.75" tall!

Your cat is probably either a "righty" or a "lefty."  Only 40% of cats are ambidextrous while another 40% are either right-pawed or left-pawed.

Cats love high places.  They share this love with leopards and jaguars, who sleep in trees.  If a cat begins to fall, his inner ear canal (which controls balance) will help him right himself and land on his feet.

Domestic cats are essentially loners.   When placed in a group, they develop their own hierarchy.  As long as there is plenty of food on hand, a cat can learn to share it's domain with other cats.

Cats are more aggressive when they are not neutered or spayed.

21% of U.S. households have at least one cat.

The number of pet-owning households is expected to grow nearly 12% between 1993 and 2000, and another 5% between 2000 and 2010.

34% of cat-owning households have incomes of $60,000 or more.

32% of those who own their own home, also own at least one cat.

"Pair bonds" can develop between two cats who live together, or between a cat and a person.

A cat that bites you after you have rubbed his stomach, is probably biting out of pleasure, not anger.

An adult cat has 32 teeth.

Never leave your cat in a vehicle alone.  On summer days, temperatures in an automobile can reach 160 degrees in just minutes, even with the windows cracked.

"PSI trailings" attempt to explain a cat's ability to travel a long distance to return to their home.  It is said they use the earth's gravity to determine "their place" in the world, and to develop the ability to return there when necessary.

According to myth, a cat sleeping with all four paws tucked under means cold weather is coming.

Each year Americans spend four billion dollars on cat food.  That's one billion dollars more than they spend on baby food!

Expect to spend an average of $80 per year on vet bills, for the lifetime of each cat you own.

It costs $7000 to care for one household cat over its lifetime.  This covers only the necessities;  the pampered pet will carry a higher price.

In an average year, American cat owners spend $2.15 billion on cat food and $295 million on kitty litter.

There have been three different cats who have played the famed "Morris the Cat."  The first Morris was adopted from a shelter in 1968.  In 1969 he landed the role of Morris the Cat in the famous 9 Lives Cat Food commercials...and was an overnight success!  The first Morris died in 1978 and was subsequently replaced by two more cats who played "Morris."   All three of the "Morris the Cat" cats were rescued from shelters.

Choose your cat toys carefully.   Choose light toys (for tossing), soft toys (for teeth and claws) and toys large enough that they can't be swallowed.

A flashlight makes a great cat toy!   Turn the flashlight on in a dark room, and watch your feline "chase" the beam of light!

Cats love to hide!  If yours comes up "missing," be sure to check in the bathtub, in your closet, in the dresser drawers, under a blanket or rug...or anywhere else you can possibly think of!

A collar and tag can help your cat find his way home should he ever be lost.  Better yet -- outfit your cat with an electronic identification chip.

To make sure your cat's collar fits properly, make sure you can slip two fingers under the collar, between the collar and your cat's neck.

The easiest way to pick up cat hair?   Spray an anti-static spray on the area you want to clean.  Wait one minute, then wipe up the hair with a six inch brush.

Egyptians shaved their eyebrows as a sign of mourning when they lost a beloved cat.

Hebrew folklore believes that cats came about because Noah was afraid that rats might eat all the food on the ark.  He prayed to God for help.  God responded by making the lion sneeze a giant sneeze -- and out came a little cat!

Stings to the mouth can be very dangerous to cats.  If your cat is stung, or ever experiences any type of sting to the mouth, take her to the vet immediately.  As her mouth swells from the sting, she may be unable to breath.  Stings require urgent medical care.

Redecorating your home?  Let your cat explore after the decorating is done.  Paints, wallpaper pastes and paint thinners can be toxic to cats.  Play it safe!

Pet-proof your house by looking for items that may be dangerous to them.  These include cleaners, antifreeze, automobile coolant, and rat poison.

The fumes from moth balls destroy a cat's liver cells.  Use cedar in your closet instead.

There are many items in your household with are poisonous to cats!  Be careful with the following items:
acetaminophen (Tylenol) fungicides paint
antifreeze furniture polish paint remover
aspirin gasoline permanent-wave lotion
bleach hair coloring photographic developers
boric acid herbicides pine-oil disinfectants
brake fluid insecticides rubbing alcohol
carburetor cleaner kerosene de-icers for melting snow
dandruff shampoo laxatives shoe polish
deodorizers lye snail or bug bait
diet pills matches suntan lotion with cocoa butter
disinfectants metal polish
drain cleaner mineral sprits turpentine
dry-cleaning fluid mothballs windshield-washer fluid
dye nail polish wood preservatives
fire-extinguisher foam nail-polish remover
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