Tuesday, November 30, 2010

50 Interesting Facts

hi everyone!! I have here some interesting facts that I hope would amaze you.. The site where I got this is posted at the bottom of this info.

1. If you are right handed, you will tend to chew your food on your right side. If you are left handed, you will tend to chew your food on your left side.

2. If you stop getting thirsty, you need to drink more water. For when a human body is dehydrated, its thirst mechanism shuts off.
--akala ko the other way around?

3. Chewing gum while peeling onions will keep you from crying.
--ma-try nga!

4. Your tongue is germ-free only if it is pink. If it is white, there is a thin film of bacteria on it.
--go check your tongue in the mirror!

5. The Mercedes-Benz motto is “Das Beste oder Nichts” meaning “The Best or Nothing”.

6. The Titanic was the first ship to use the SOS signal.

7. The pupil of the eye expands as much as 45 percent when a person looks at something pleasing.
--dilates and contracts.

8. The average person who stops smoking requires one hour less sleep a night.

9. Laughing lowers levels of stress hormones and strengthens the immune system. Six-year-olds laugh an average of 300 times a day. Adults only laugh 15 to 100 times a day.
-- oh ano pa hinihintay nyo? tawa na!

10. The roar that we hear when we place a seashell next to our ear is not the ocean, but rather the sound of blood surging through the veins in the ear.

11. Dalmatians are born without spots.

12. Bats always turn left when exiting a cave.

13. The ‘v’ in the name of a court case does not stand for ‘versus’, but for ‘and’ (in civil proceedings) or ‘against’ (in criminal proceedings).

14. Men’s shirts have the buttons on the right, but women’s shirts have the buttons on the left.

15. The owl is the only bird to drop its upper eyelid to wink. All other birds raise their lower eyelids.

16. The reason honey is so easy to digest is that it’s already been digested by a bee.

17. Roosters cannot crow if they cannot extend their necks.

18. The color blue has a calming effect. It causes the brain to release calming hormones.

19. Every time you sneeze some of your brain cells die.
-- lagot. cx

20. Your left lung is smaller than your right lung to make room for your heart.

21. The verb “cleave” is the only English word with two synonyms which are antonyms of each other: adhere and separate.
-- ....processing. xDD

22. When you blush, the lining of your stomach also turns red.
--yun pla yung sinasabi nilang butterflies in the stomach

23. When hippos are upset, their sweat turns red.
-- bloody sweat.!

24. The first Harley Davidson motorcycle was built in 1903, and used a tomato can for a carburetor.

25. The lion that roars in the MGM logo is named Volney.
--haha, pineke yan ng Tom and Jerry Show ee.

26. Google is actually the common name for a number with a million zeros.

27. Switching letters is called spoonerism. For example, saying jag of Flapan, instead of flag of Japan.

28. It cost 7 million dollars to build the Titanic and 200 million to make a film about it.

29. The attachment of the human skin to muscles is what causes dimples.
--abnormality daw yan.

30. There are 1,792 steps to the top of the Eiffel Tower.
-- ansipag nung nagmeasure.

31. The sound you hear when you crack your knuckles is actually the sound of nitrogen gas bubbles bursting.
-- Uo.

32. Human hair and fingernails continue to grow after death.
-- ang gulo, ang sabi dun sa isang libro hindi na daw. after death, magiging rigid daw yung whole body a process called Rigor Mortis. this is the reason why we mistakenly interpret that hair and nails grow after death.

33. It takes about 20 seconds for a red blood cell to circle the whole body.

34. The plastic things on the end of shoelaces are called aglets.
--first ko nalaman to sa Phineas and Ferb! do u watch that?

35. Most soccer players run 7 miles in a game.

36. The only part of the body that has no blood supply is the cornea in the eye. It takes in oxygen directly from the air.
-- Oo, whew, buti nakikinig ako nun sa Bio Class.

37. Every day 200 million couples make love, 400,000 babies are born, and 140,000 people die.
--Oh my.

38. In most watch advertisements the time displayed on the watch is 10:10 because then the arms frame the brand of the watch (and make it look like it is smiling).

39. Colgate faced big obstacle marketing toothpaste in Spanish speaking countries. Colgate translates into the command “go hang yourself.”
-- waah, tlga?!

40. The only 2 animals that can see behind itself without turning its head are the rabbit and the parrot.

41. Intelligent people have more zinc and copper in their hair.
--sandamak2 na zinc siguro ang nasa utak ko ngayon...ay este kang Einstein pla!

42. The average person laughs 13 times a day.
--lampas na siguro ako nyan ng dahil sa triviang ito.

43. Do you know the names of the three wise monkeys? They are: Mizaru (See no evil), Mikazaru (Hear no evil), and Mazaru (Speak no evil)

44. Women blink nearly twice as much as men.
--napablink 2loi ako.

45. German Shepherds bite humans more than any other breed of dog.
-- Felines Rule!!! meow.

46. Large kangaroos cover more than 30 feet with each jump.

47. Whip makes a cracking sound because its tip moves faster than the speed of sound.

48. Two animal rights protesters were protesting at the cruelty of sending pigs to a slaughterhouse in Bonn. Suddenly the pigs, all two thousand of them, escaped through a broken fence and stampeded, trampling the two hapless protesters to death.
--how ironic.

49. If a statue in the park of a person on a horse has both front legs in the air, the person died in battle; if the horse has one front leg in the air, the person died as a result of wounds received in battle; if the horse has all four legs on the ground, the person died of natural cause.
-- dko napansin eun aah. haha. nice.

50. The human heart creates enough pressure while pumping to squirt blood 30 feet!
-- so if I poke my heart while lying down, i'll have this really cool blood fountain?


Monday, November 22, 2010

Benefits of Honey and cinnamon

Benefits of honey and cinnamon
View more presentations from Edison Reyes.

Benefits of honey and cinnamon - Presentation Transcript

  1. Honey and Cinnamon A MIXTURE FOR CURES
    • It is found that a mixture of Honey and Cinnamon cures most diseases.
    • Honey is produced in most of the countries of the world.
    • Ayurvedic, as well as Yunani medicine, have been using honey as a vital medicine for centuries.
    • Scientists of today also accept honey as a Ram Ban (very effective) medicine for all kinds of diseases.
    • Honey can be used without any side effects for all kinds of diseases.
    • Today's science says that, even though honey is sweet, if taken in the right dosage as a medicine, it will not harm diabetic patients.
    • A famous magazine named Weekly World News published in Canada dated 17 January, 95 has given a list of diseases that can be cured by Honey and Cinnamon as researched by western scientists.
    • Take one part honey to two parts of luke warm water and add a small teaspoon of cinnamon powder. Make a paste and massage it on the itching part of the body slowly.
    • The pain should recede within fifteen minutes in most cases.
    • Arthritis patients can take one cup of hot water with two spoons of honey and one small teaspoon of cinnamon powder every day.
    • If drunk regularly, even chronic arthritis can be cured.
    • In a recent research done at Copenhagen University, it was found that when the doctors treated their patients with a mixture of one tablespoon honey and half a teaspoon of cinnamon powder before breakfast, they found that within a week, out of the 200 people treated, 73 patients were totally relieved of pain within a month. Mostly of these patients could not walk or move around freely, but after the therapy, they started walking with less pain.
    • Those suffering from hair loss or baldness, may apply a paste of hot olive oil, one tablespoon of honey, one teaspoon of cinnamon powder before a bath and keep it for approximately 15 minutes, and then wash the hair.
    • It was found very effective if kept for 5 minutes as well.
    • Take two tablespoons of cinnamon powder and one teaspoon of honey in a glass of luke warm water and drink it. It destroys the germs of the bladder.
    • Make a paste of one teaspoon of cinnamon powder and five teaspoons of honey, and apply on the aching tooth. This may be done 3 times a day (daily) till such time, that the tooth has stopped aching.
    • Two tablespoons of honey and three teaspoons of cinnamon powder mixed in 16 ounces of tea, when given to a cholesterol patient, reduces the level of cholesterol in the blood by 10% within 2 hours.
    • As mentioned for arthritic patients - If taken 3 times a day, it lowers the cholesterol level.
    • As per the information received in a Medical Journal, pure honey taken with food daily relieves complaints of cholesterol.
  8. COLDS
    • Those suffering from common or severe colds should take one tablespoon of luke warm honey with 1/4 teaspoon cinnamon powder daily for 3 days.
    • This process will cure most chronic cough, cold and clear the sinuses.
    • Yunani and Ayurvedic have been using honey for years in medicine to strengthen the semen of men.
    • If impotent men regularly take two tablespoons of honey before sleeping, their problem will be solved.
    • In China, Japan and the Far East, women who do not conceive, and to strengthen the uterus, have been taking cinnamon powder for centuries.
    • Women who cannot conceive may take a pinch of cinnamon powder in half a teaspoon of honey, and apply it on the gums frequently throughout the day, so that it slowly mixes with the saliva and enters the body.
    • A couple in Maryland (USA) had no children for 14 years and had left hope of having a child of their own. When told about this process, both husband and wife started taking honey and cinnamon as stated above, The wife conceived after a few months and had twins at full term.
    • Honey taken with cinnamon powder cures stomach ache and also clears stomach ulcers from the root.
    • GAS : According to the studies done in India and Japan, it is revealed that honey, if taken with cinnamon powder, relieves gas and pain in the stomach.
    • Make a paste of honey and cinnamon powder. Apply on bread or chapatti instead of jelly and jam, and eat it regularly for breakfast.
    • It reduces the cholesterol in the arteries and saves the patient from the risk of a heart attack.
    • For those who have had an attack in the past, follow this process daily and avoid the risk of another attack.
    • Regular use of the above process relieves loss of breath and strengthens the heartbeat.
    • In America and Canada, various nursing homes have treated patients successfully and have discovered that the arteries and veins lose their flexibility and get clogged. Honey and Cinnamon improves blood flow.
    • Daily use of honey and cinnamon powder strengthens the immune system and protects the body from bacteria and viral attacks.
    • Scientists have found that honey has various vitamins and iron in large amounts.
    • Constant use of honey strengthens the white blood corpuscles to fight bacteria and viral diseases.
    • Cinnamon powder sprinkled on 2 tablespoons of honey taken before food, relieves acidity and digests the heaviest of meals.
    • A scientist in Spain has proved that honey contains a natural ingredient which kills influenza germs and saves the patient from flu.
    • Tea made with honey and cinnamon powder, and when taken regularly, arrests the ravages of old age.
    • Take 4 spoons of honey, 1 spoon of cinnamon powder and 3 cups of water and boil to make like tea.
    • Drink 1/4 cup, 3 to 4 times a day. It keeps the skin fresh and soft and arrests old age.
    • Life span also increases, and you begin to feel younger!
    • Take three tablespoons of honey and one teaspoon of cinnamon powder paste. Apply this paste on the pimples before sleeping and wash it the next morning with warm water. If done daily for two weeks, it removes pimples from the root.
    • Eczema, ringworm and all types of skin infections are cured by applying honey and cinnamon powder in equal parts on the affected parts.
    • Every morning, on an empty stomach, half an hour before breakfast, and again at night before sleeping, drink honey and cinnamon powder boiled in one cup water.
    • If taken regularly it reduces the weight of even the most obese person.
    • Also drinking of this mixture regularly does not allow the fat to accumulate in the body, even though the person may eat a high calorie diet.
  19. CANCER
    • Recent research in Japan and Australia has revealed that advanced cancer of the stomach and bones have been cured successfully.
    • Patients suffering from these kinds of cancer should daily take one tablespoon of honey with one teaspoon of cinnamon powder for one month, 3 times a day and continue with the Oncologist’s treatment. No harm lost!
    • Recent studies have shown that the sugar content of honey is more helpful than detrimental to one’s body strength.
    • Senior citizens who take honey and cinnamon power in equal parts are more alert and flexible.
    • Dr. Milton, who has carried out extensive research on this subject, says that, half a tablespoon of honey taken in a glass of water and sprinkled with cinnamon powder taken daily after brushing, and again in the afternoon around 3.00 p.m. when the vitality of the body starts decreasing, increases the vitality of the body within a week.
    • People of South America :
    • The first thing in the morning they gargle with one teaspoon of honey and cinnamon powder mixed in hot water. so their breath stays fresh throughout the day.
    • Honey and Cinnamon powder taken in equal parts daily, restores hearing .
  23. While you try the therapy… Forward this and let others also benefit.

Healthy Juice

healthy juice

Myths and facts about Tuberculosis

Tuberculosis: Myths and facts
Tuberculosis is an infectious disease, caused by a bacterium called mycobacterium
tuberculosis. It spreads through the air. Dr Vasundhara Atre debunks some myths
associated with it.

Myth: Tuberculosis is hereditary
Fact: Tuberculosis is not hereditary. The tuberculosis bacteria are carried as
droplets in the air and enter the body through the airways. The spread occurs when
those having active,untreated infection in the lungs,cough, sneeze or speak, and
send the germs into the air, those around breathing in the air get infected.

Myth: Smoking causes tuberculosis
Fact: The cause of the infection is the mycobacterium tuberculosis. Smoking can
aggravate TB.

Myth: BCG vaccination protects against developing TB.
Fact: While the vaccine prevents the severe forms of TB in childhood, it does not
protect adults from developing the adult forms of pulmonary TB.

Myth: Tuberculosis affects only the lungs.
Fact: Tuberculosis primarily affects the lungs (80 percent) however other parts of
the body that can be affected include the genitor urinary tract,heart
(pericardium),brain,bones, lymph nodes,gastro intestinal tract,joints,skin almost
all parts except the nails and hair.

Myth: An individual who has been infected with the mycobacterium tuberculosis will
develop tuberculosis.

Fact: A tuberculosis infection does not always develop into tuberculosis
disease.It is estimated that only about 10 percent of infected people develop
tuberculosis sometime in their lives.

Myth: A positive tuberculosis test means that an individual has tuberculosis.
Fact: A positive Mantoux/ PPD tuberculosis skin test is only an indication that
there is an infection with a strain of the Mycobacterium. It is not a confirmation
that the disease is present.The positive TB skin test is only a confirmation of
exposure, to tuberculosis.

Myth: Individuals suffering from tuberculosis should be hospitalised.
Fact: Most patients suffering from tuberculosis can be treated at home and they
can continue to work.

Eric Berne's Transactional Analysis

Transactional analysis

Saturday, November 20, 2010

Nursing Diagnosis: Disturbed Body Image (with Rationale)

Related Factors:
  • Situational changes (e.g., pregnancy, temporary presence of a visible drain or tube, dressing, attached equipment)
  • Permanent alterations in structure and/or function (e.g., mutilating surgery, removal of body part [internal or external])
  • Malodorous lesions
  • Change in voice quality
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
  • Body Image                      
  • Self-Esteem
NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels
  • Body Image Enhancement
  • Grief Work Facilitation
  • Coping Enhancement                             
  • Assess perception of change in structure or function of body part (also proposed change).--The extent of the response is more related to the value or importance the patient places on the part or function than the actual value or importance. Even when an alteration improves the overall health of the individual (e.g., an ileostomy for an individual with precancerous colon polyps), the alteration results in a body image disturbance.
  • Assess perceived impact of change on activities of daily living (ADLs), social behavior, personal relationships, and occupational activities.
  • Assess impact of body image disturbance in relation to patient’s developmental stage.--Adolescents and young adults may be particularly affected by changes in the structure or function of their bodies at a time when developmental changes are normally rapid, and at a time when developing social and intimate relationships is particularly important.
  • Note patient’s behavior regarding actual or perceived changed body part or function.--There is a broad range of behaviors associated with body image disturbance, ranging from totally ignoring the altered structure or function to preoccupation with it.
  • Note frequency of self-critical remarks.

Therapeutic Interventions
  • Acknowledge normalcy of emotional response to actual or perceived change in body structure or function.--Stages of grief over loss of a body part or function is normal, and typically involves a period of denial, the length of which varies from individual to individual.
  • Help patient identify actual changes.--Patients may perceive changes that are not present or real, or they may be placing unrealistic value on a body structure or function.
  • Encourage verbalization of positive or negative feelings about actual or perceived change.--It is worthwhile to encourage the patient to separate feelings about changes in body structure and/or function from feelings about self-worth.
  • Assist patient in incorporating actual changes into ADLs, social life, interpersonal relationships, and occupational activities.--Opportunities for positive feedback and success in social situations may hasten adaptation.
  • Demonstrate positive caring in routine activities.--Professional caregivers represent a microcosm of society, and their actions and behaviors are scrutinized as the patient plans to return to home, to work, and to other activities.
  • Teach patient about the normalcy of body image disturbance and the grief process.
  • Teach patient adaptive behavior (e.g., use of adaptive equipment, wigs, cosmetics, clothing that conceals altered body part or enhances remaining part or function, use of deodorants).--This compensates for actual changed body structure and function.
  • Help patient identify ways of coping that have been useful in the past.--Asking patients to remember other body image issues (e.g., getting glasses, wearing orthodontics, being pregnant, having a leg cast) and how they were managed may help patient adjust to the current issue.
  • Refer patient and caregivers to support groups composed of individuals with similar alterations.--Lay persons in similar situations offer a different type of support, which is perceived as helpful (e.g., United Ostomy Association, Y Me?, I Can Cope, Mended Hearts).

Nursing Diagnosis: Chronic Pain

Nursing Diagnosis: Chronic Pain
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
* Pain Control
* Quality of Life
* Family Coping

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Pain Management
* Medication Management
* Acupressure
* Heat/Cold Application
* Progressive Muscle Relaxation
* Transcutaneous Electrical Nerve Stimulation (TENS)
* Simple Massage

NANDA Definition: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain); sudden or slow onset of intensity from mild to severe; constant or recurring without an anticipated or predictable end and a duration of greater than 6 months

Chronic pain may be classified as chronic malignant pain or chronic nonmalignant pain. In the former, the pain is associated with a specific cause such as cancer. With chronic nonmalignant pain the original tissue injury is not progressive or has been healed. Identifying an organic cause for this type of chronic pain is more difficult.

Chronic pain differs from acute pain in that it is harder for the patient to provide specific information about the location and the intensity of the pain. Over time it becomes more difficult for the patient to differentiate the exact location of the pain and clearly identify the intensity of the pain. The patient with chronic pain often does not present with behaviors and physiological changes associated with acute pain. Family members, friends, coworkers, employers, and health care providers question the legitimacy of the patient’s pain complaints because the patient may not look like someone in pain. The patient may be accused of using pain to gain attention or to avoid work and family responsibilities. With chronic pain, the patient’s level of suffering usually increases over time. Chronic pain can have a profound impact on the patient’s activities of daily living, mobility, activity tolerance, ability to work, role performance, financial status, mood, emotional status, spirituality, family interactions, and social interactions.

* Defining Characteristics: Weight changes
* Verbal or coded report or observed evidence of protective behavior, guarding behavior, facial mask, irritability, self-focusing, restlessness, depression
* Atrophy of involved muscle group
* Changes in sleep pattern
* Fatigue
* Fear of reinjury
* Reduced interaction with people
* Altered ability to continue previous activities
* Sympathetic mediated responses (e.g., temperature, cold, changes of body position, hypersensitivity)
* Anorexia

* Related Factors: Chronic physical or psychosocial disability

* Expected Outcomes Patient verbalizes acceptable level of pain relief and ability to engage in desired activities.

Ongoing Assessment

* Assess pain characteristics:
o Quality (e.g., sharp, burning)
o Severity (1 to 10 scale)
o Anatomical location
o Onset
o Duration (e.g., continuous, intermittent)
o Aggravating factors
o Relieving factors
Gathering information about the pain can provide information about the extent of the chronic pain.
* Assess for signs and symptoms associated with chronic pain such as fatigue, decreased appetite, weight loss, changes in body posture, sleep pattern disturbance, anxiety, irritability, restlessness, or depression. Patients with chronic pain may not exhibit the physiological changes and behaviors associated with acute pain. Pulse and blood pressure are usually within normal ranges. The guarding behavior of acute pain may become a persistent change in body posture for the patient with chronic pain. Coping with chronic pain can deplete the patient’s energy for other activities. The patient often looks tired with a drawn facial expression that lacks animation.
* Assess the patient’s perception of the effectiveness of methods used for pain relief in the past. Patients with chronic pain have a long history of using many pharmacological and nonpharmacological methods to control their pain.
* Evaluate gender, cultural, societal, and religious factors that may influence the patient’s pain experience and response to pain relief. Understanding the variables that affect the patient’s pain experience can be useful in developing a plan of care that is acceptable to the patient.
* Assess the patient’s expectations about pain relief. The patient with chronic pain may not expect complete absence of pain, but may be satisfied with decreasing the severity of the pain and increasing activity level.
* Assess the patient’s attitudes toward pharmacological and nonpharmacological methods of pain management. Patients may question the effectiveness of nonpharmacological interventions and see medications as the only treatment for pain.
* For patients taking opioid analgesics, assess for side effects, dependency, and tolerance. Drug dependence and tolerance to opioid analgesics is a concern in the long-term management of chronic pain.
* Assess the patient’s ability to accomplish activities of daily living (ADLs), instrumental activities of daily living (IADLs), and demands of daily living (DDLs). Fatigue, anxiety, and depression associated with chronic pain can limit the person’s ability to complete self-care activities and fulfill role responsibilities.

Therapeutic Interventions

* Encourage the patient to keep a pain diary to help in identifying aggravating and relieving factors of chronic pain. Knowledge about factors that influence the pain experience can guide the patient in making decisions about lifestyle modifications that promote more effective pain management.
* Acknowledge and convey acceptance of the patient’s pain experience. The patient may have had negative experiences in the past with attitudes of health care providers toward the patient’s pain experience. Conveying acceptance of the patient’s pain promotes a more cooperative nurse-patient relationship.
* Provide the patient and family with information about chronic pain and options available for pain management. Lack of knowledge about the characteristics of chronic pain and pain management strategies can add to the burden of pain in the patient’s life.
* Assist the patient in making decisions about selecting a particular pain management strategy. Guidance and support from the nurse can increase the patient’s willingness to choose new interventions to promote pain relief. The patient may begin to feel confident about the effectiveness of these interventions.
* Refer the patient to a physical therapist for evaluation. The physical therapist can help the patient with exercises to promote muscle strength and joint mobility, and therapies to promote relaxation of tense muscles. These interventions can contribute to effective pain management.

Education/Continuity of Care

* Teach the patient and family about using nonpharmacological pain management strategies:
o Cold applications Cold reduces pain, inflammation, and muscle spasticity by decreasing the release of pain-inducing chemicals and slowing the conduction of pain impulses. This intervention requires no special equipment and can be cost effective. Cold applications should last about 20 to 30 min/hr.
o Heat applications Heat reduces pain through improved blood flow to the area and through reduction of pain reflexes. This is a cost-effective intervention that requires no special equipment. Heat applications should last no more than 20 min/hr. Special attention needs to be given to preventing burns with this intervention.
o Massage of the painful area Massage interrupts pain transmission, increases endorphin levels, and decreases tissue edema. This intervention may require another person to provide the massage. Many health insurance programs will not reimburse for the cost of therapeutic massage.
o Progressive relaxation, imagery, and music These centrally acting techniques for pain management work through reducing muscle tension and stress. The patient may feel an increased sense of control over his/her pain. Guided imagery can help the patient explore images about pain, pain relief, and healing. These techniques require practice to be effective.
o Distraction Distraction is a temporary pain management strategy that works by increasing the pain threshold. It should be used for a short duration, usually less than 2 hours at a time. Prolonged use can add to fatigue and increased pain when the distraction is no longer present.
o Acupressure Acupressure involves finger pressure applied to acupressure points on the body. Using the gate control theory, the technique works to interrupt pain transmission by "closing the gate." This approach requires training and practice.
o Transcutaneous Electrical Nerve Stimulation (TENS) TENS requires the application of 2 to 4 skin electrodes. Pain reduction occurs through a mild electrical current. The patient is able to regulate the intensity and frequency of the electrical stimulation.
Knowledge about how to implement nonpharmacological pain management strategies can help the patient and family gain maximum benefit from these interventions.
* Teach the patient and family about the use of pharmacological interventions for pain management:
o Nonsteroidal antiinflammatory agents (NSAIDs) These drugs are the first step in an analgesic ladder. They work in peripheral tissues by inhibiting the synthesis of prostaglandins that cause pain, inflammation, and edema. The advantages of these drugs are they can be taken orally and are not associated with dependency and addiction.
o Opioid analgesics These drugs act on the central nervous system to reduce pain by binding with opiate receptors throughout the body. The side effects associated with this group of drugs tend to be more significant that those with the NSAIDs. Nausea, vomiting, constipation, sedation, respiratory depression, tolerance, and dependency are of concern in patients using these drugs for chronic pain management.
o Anti-depressants These drugs may be useful adjuncts in a total program of pain management. In addition to their effects on the patient’s mood, the antidepressants may have analgesic properties apart from their antidepressant actions.
o Antianxiety agents These drugs may be useful adjuncts in a total program of pain management. In addition to their effects on the patient’s mood, the antidepressants may have analgesic properties apart from their antidepressant actions.
* Assist the patient and family in identifying lifestyle modifications that may contribute to effective pain management. Changes in work routines, household responsibilities, and the home physical environment may be needed to promote more effective pain management. Providing the patient and family with ongoing support and guidance will increase the success of these strategies.
* Refer the patient and family to community support groups and self-help groups for people coping with chronic pain. Adding to the patient’s network of social support can reduce the burden of suffering associated with chronic pain and provide additional resources.

Friday, November 19, 2010

Drug study guide

  1. cardiac glycoside  -  digoxin
  2. betablocker  -  inderal
  3. betablocker -   lopressor
  4. betablocker -   corgard
  5. calcium channel blocker -   verapamil
  6. calcium channel blocker -   nifedipine
  7. antihypertensive  -  catapres
  8. vasodilator  -  nitroglycerin/nitrates
  9. antihypertensive -   aldomet
  10. ace inhibitor -   vasotec
  11. ace inhibitor  -  captopril
  12. calcium channel blocker -   cardizem
  13. ace inhibitor  -  cozaar
  14. local anesthetic -   lidocaine
  15. antiarrhythmic (1a)  -  procainamide
  16. antiarrhythmic (1a)  -  quinidine
  17. antiarrhythmic (1c) -   tambocor
  18. antiarrhythmic (3) -   amiodarone
  19. bile acid sequestrant (lipid lowering agent for hypercholestemia)  -  Questran
  20. HMG-CoA reductase inhibitor (lipid lowering agent)  -  lipitor
  21. cholesterol lowering agent  -  Niacin
  22. antiarrhythmic  -  adenosine
  23. anticoagulant  -  heparin
  24. anticoagulant  -  coumadin
  25. salicylate (antipyretic, nonopioid analgesic, anticoagulant)  -  aspirin
  26. water soluble vitamin (involved in hematopoiesis)  -  B12
  27. iron (prevents anemia)  -  ferrous sulfate
  28. antianemic hormone  -  aranesp
  29. colony stimulating factor (neutrophil stimulation)  -  neulasta
  30. antiheparin (neutralizes heparin by forming heparin-protamine complex) -   protamine sulfate
  31. fat soluble vitamin (antidote for coumadin)  -  vitamin k
  32. trace metal (management of zinc-deficient slow wound healing)  -  zinc
  33. water soluble vitamin (ascorbic acid prevents scurvy) -   vitamin c
  34. mineral (heart beat regulation)  -  potassium
  35. mineral (nerve transmission activator)  -  calcium
  36. water soluble vitamin (bone and eye health)  -  vitamin d
  37. loop diuretic -   lasix
  38. loop diuretic -   edecrin
  39. potassium sparing diuretic -   aldactone
  40. opioid analgesic (agonist)  -  morphine
  41. opioid analgesic  -  demerol
  42. opioid analgesic -   vicodin
  43. (acetaminophen) nsaid  -  tylenol
  44. (ibuprophen) nsaid  -  motrin
  45. nsaid  -  naprosyn
  46. nsaid  -  toradol
  47. antispasticity agent (skeletal muscle relaxant-centrally acting) -   lioresal
  48. skeletal muscle relaxant (direct acting)  -  dantrium
  49. skeletal muscle relaxant (centrally acting)  -  flexeril
  50. opioid antagonist (reversal) -   narcan
  51. diuretic -   mannitol
  52. antacid  -  maalox
  53. antacid  -  milk of magnesia
  54. bulk forming laxative  -  metamucil
  55. histamine 2 antagonist (antacid)  -  zantac (ranitidine)
  56. proton pump inhibitor -   prilosec (omeprazole)
  57. mucosal protectant  -  carafate
  58. GI stimulant (increase GI motility/stomach emptying) -   reglan
  59. phenothiazine antihistamine  -  phenergen (promethazine)
  60. phenothiazine antihistamine -   compazine
  61. centrally acting antiemetic  -  tigan
  62. stool softener -   doculax
  63. stool softener  --  docusate sodium
  64. bile salt (artificial to dissolove fats)    actigal
  65. serotonin blocker antiemetic  -  zofran
  66. serotonin blocker antiemetic  -  aloxi
  67. antiemetic  -  amend
  68. hyperosmotic agent (increases water in feces, causing elimination) -   Colyte
  69. alkylating agent (cancer)  -  cytoxan
  70. antimetabolite (5-fluorouracil)  -  5-FU
  71. plant alkaloid  --  vincristine
  72. alkylating agent  -  carboplatin
  73. antineoplastic cytoxic antibiotics -   doxorubicin
  74. antineoplastic (taxoid)  -  taxol
  75. antiestrogen agent (hormonal therapy)  -  tamoxifen
  76. antineoplastic progestin (hormone therapy)  -  megace
  77. antiandrogenic agent (hormonal therapy) -   eulexin
  78. biological response modifier (immunotherapy)  -  interferon
  79. biological response modifier (immunotherapy)  -  interleukin
  80. reverse transcriptase inhibitor (HIV/AIDS)  -  AZT
  81. antiandrogenic agent (hormonal therapy)  -  Lupron
  82. antimetabolite  -  methotrexate
  83. anti-infective (for eyes)  -  tobrex
  84. anti-inflammatory (eyes)  -  decadron
  85. local anesthetic (eye)  -  pontocaine
  86. vasoconstrictor (eye) -   visine
  87. miotic (cholinergic makes pupil small) -   pilocarpine HCL
  88. parasympathomimetic (reduces aqueous humor)  -  physostigmine salicylate
  89. betablocker (blocks adrenalin in glaucoma pt) -   timoptic
  90. betablocker (blocks adrenalin in glaucoma pt)  -  betagan (xalatan)
  91. cycloplegic (mydriatics- widens pupil for examination)  -  cyclogyl
  92. adrenergic mydriatic (dilates pupil) -   neo-synephrine
  93. anti-infective (antimicrobal for eye)  -  polymyxcin
  94. local anesthetic (for ear)  -  auralgan
  95. cerumenolytic (softens ear wax) -   debrox
  96. anti-infective (for skin) -   acetic acid
  97. anti-infective (  for ear)  -  swimmer's ear solution
  98. UV block (or absorbs Ex. zinc oxide for skin)  -  sunscreen
  99. antibacterial antifungal (skin)  -  silvadine
  100. antibiotic (skin) -   elase
  101. triple antibiotic (skin)  -  neosporin
  102. thyroid hormone replacement  -  synthroid
  103. parathyroid hormone (decreases bone turnover rate) -   calcitonin
  104. beta agonist (adrenal hormone)  -  epinephrine
  105. sulfonyluria (controls blood sugar level)  -  glucatrol (glipizide)
  106. pancreatic hormone -   insulin
  107. pancreatic hormone (elevates blood sugar)  -  glucagon
  108. somatotropin (anterior pituitary hormone) -   growth hormone (hGH)
  109. androgen hormone  -  depo-testosterone
  110. estrogen (female sex hormone)  -  estrogen (premarin)
  111. progesterone (female sex hormone)  -  progesterin
  112. thioamide (thyroid hormone blocker) -   PTU (Propylthiouracil)
  113. expectorant and antithyroid  -  SSKI (potassium iodide)
  114. progestin (birth control) -   norplant
  115. oxytocic prostaglandin -   cervadil
  116. mineral (anticonvulsant, anticholinergic) -   magnesium sulfate
  117. posterior pituitary female hormone (stimulates contractions/milk production)  -  oxytocin
  118. adrenergic bronchodilator -   brethine (terbutaline)
  119. short acting corticosteroid  -  prednisone
  120. short acting corticosteroid  -  solucortef


Wednesday, November 17, 2010

funny love and dating vocabulary

Here's what I recently read from another website. Thanks to the author. I think its funny and informative. Hope you'll have fun reading it too.

ATTRACTION the act of associating lust with a particular person.

LOVE AT 1st SIGHT what occurs when two extremely lusty, but not entirely choosy people meet.

DATING the process of spending enormous amounts of money, time, and energy to get better acquainted with a person whom you don't especially like in the present and will learn to like a lot less in the future.

BIRTH CONTROL avoiding pregnancy through such tactics as swallowing special pills, inserting a diaphragm, using a condom,and dating repulsive men.

EASY a term used to describe a woman who follows masculine ideals of lust .

EYE CONTACT a method utilized by a single woman to communicate to a man that she is interested in him. Despite being advised to do so, many woman have difficulty looking a man directly in the eyes, not necessarily due to the shyness, but usually due to the fact that a woman's eyes are not located in her chest.

FRIEND a member of the opposite sex in your acquaintance who has some flaw which makes sleeping with him/her totally unappealing.

INDIFFERENCE a woman's feeling towards a man, which is interpreted to by the man as "playing hard to get."

INTERESTING a word a man uses to describe a woman who lets him do all the talking.

IRRITATING HABIT what the endearing little qualities that initially attract two people to each other turn into after a few months together.

LAW OF RELATIVITY how attractive a given person appears to be is directly proportionate to how unattractive your date is.

SOBER condition in which it is almost impossible to fall in love.

Tuesday, November 16, 2010

Bizarre Body Modification

This is scary guys. I found this on one of the websites i follow.. I still have goosebumps whenever i look at this people. GRRRRR...

1. Eyeball tatoo

Corneal tattooing - is not only possible, but it has been known and done now for over 2,000 years — it became almost commonplace in the late 19th century and into the 20th century to correct defects such as corneal scarring and leucomas. These days, it is done less often because contact lenses are very effective at covering these defects, and prosthetic technology is also more accessible. However, not everyone can wear contact lenses, and not everyone wants their eyeball popped out even if it is blind; hence cosmetic tattooing of the eye.

2. 3D-Art Implant

3D-Art implant - is any object implanted fully under the skin for the purpose of affecting a sculptural change of the surface. The "invention" and popularization of implants as 3D-Art is credited primarily to Steve Haworth. Implants can be stretched just like piercings. A good example of this are horn implants—they start as smaller implants, and are then taken out when healed and replaced with slightly larger ones. This process is repeated to achieve the final size. There are some risks of irritation to the skin above the implant if this process is pushed too fast, as with all stretching.

3. Scarification

Scarification - is the creative and artistic application of scars in a controlled manner to achieve an aesthetically or spiritually pleasing result. In the process of body scarification, scars are formed by cutting the skin. Even though many people hold that scarification is no more painful than tattooing, it is somehow more "intense" to most of them.

4. Corset Piercings

One of the newest trends in body modification comes in the form of corset piercings. They are a series of surface piercings arranged up the back in two vertical columns. The piercing is located in the spot where the eyelets would be if one was wearing a corset. It is a symmetrical piercing with an equal number of holes on each side. As few as four holes can be used (two on each side) up to as many as the expanse of skin will allow.
5. Branding

Human Branding - is, perhaps, the most painful of all body modifications. In full-scale branding, the iron is heated hot enough and applied long enough that the resulting wound is a third degree burn, which destroys the nerve. These third-degree burns never regain sensitivity. It will make a silver scarred area in the shape of the third degree burn, due to destruction of the entire dermis layer of the skin. The surrounding skin will eventually fill in areas that haven’t been severely damaged, which takes years.
6. Body Suspension

Body suspension - is the act of suspending the human body via temporary piercings made just before the suspension process. The body is then raised either partially or completely from the ground by especially modified fishing hooks.
7. Tongue bifurcation

One of the newest body modifications to hit the scene is tongue splitting, or tongue bifurcation. The process involves literally cutting the tongue in half directly down the center. Once the tongue is split it is possible to move both sections independently of one another.

8. Pointy Ears

New York plastic surgoen Dr. Lajos Nagy created a surgical procedure to make human ears pointed, like a mythological creature. According to the doc, "ears becoming pointed as a result of plastic surgery not only enhance the attractiveness of the face, but also improve the experience of listening to music."
NOTE: our reader Allie wrote us explaining the procedure itself is possible, but Dr. Nagy's services are a hoax.


Neuropsychaitry (part 2)

Here's the part to of what ive recently posted regarding neuropsychiatry: This really will help student nurses and nurses alike in their review in understanding psychiatric nursing. Enjoy and learn:

What are some other terms for “pseudoseizure”?
Conversion reaction, hysteroepilepsy, and nonepileptic seizure (the preferred term).

How can a seizure disorder be distinguished from schizophrenia?
Altered mentation from a seizure tends to be ego-dystonic, and the patient can talk about the symptoms in a detached manner. There is generally no evidence of interictal changes on the mental status examination, and the premorbid social histories are generally good. The seizure disorder is characterized with abrupt rather than gradual alterations in personality, mood, and ability to function that are unresponsive to psychiatric or psychological intervention. The patient generally does not quite meet DSM-IV criteria for schizophrenia.

How can a seizure disorder be distinguished from a panic disorder?
Often a difficult distinction, because both conditions have overlapping symptoms—depersonalization, fear, d´ej`a vu and jamais vu, dizziness, illusions, paresthesias, chills, and flushes, which are in part mediated by a similar underlying limbic dysfunction (the temporal lobe modulates fear, for example) and amenable to similar pharmacologic intervention, i.e., benzodiazepines. However, in panic disorders, consciousness is preserved, an EEG will be normal, there are seldom olfactory hallucinations, family history is usually positive, there are no
automatisms, and a positive response is found not to anticonvulsants but to antidepressants (which would typically worsen complex partial symptoms). In addition, panic attacks usually last longer than seizures, and agoraphobia is a prominent symptom in panic but not seizure.

Is there a particular personality type associated with seizure disorder?
Of the qualities traditionally associated with the “epileptic personality type”—dependency, humorlessness, hypergraphia, hyposexuality, religiosity, viscosity, paranoia, and a preoccupation with philosophical or moral concerns—evidence exists only for hyposexuality, as a reflection of a secondary endocrine abnormality evoked by seizures.

Are seizures associated with aggression?
Aggression during a seizure is very unusual, and when it does occur is typically disordered, uncoordinated, undirected, and associated with restraint or postictal paranoid psychosis.

What strategies can be used in treating psychiatric symptoms associated with a seizure disorder?
Strategies that can be used to treat the neuropsychiatric aspects of seizure disorders include assessment of the social factors that aggravate the seizure disorder; adjustment of the anticonvulsant as necessary to minimize seizures, using monotherapy if possible; use of psychotropic medications to target specific psychiatric symptoms, anticipating interactions, using low initial dosages, and waiting for a response plateau before changing the dose again; targeting psychotherapeutic approaches to specific behaviors or stressors; and finally collaboration with all caregivers.
What are the symptoms of Parkinson’s disease?
Parkinson’s is a progressive, nongenetic disorder that presents with both motor and cognitive symptoms. The motor symptoms typically have an asymmetric onset, and consist of bradykinesia and muscular rigidity, flexion at trunk and neck leading to postural instability, difficulty initiating movements, lack of facial expression, and a 4 to 6 Hz resting tremor. Ninety-three percent of those with Parkinson’s suffer cognitive deficits—reduced verbal fluency and naming difficulties, deficits in visual analysis and constructional praxis, and executive dysfunction similar to frontal lobe syndrome—difficulties in selective attention and set maintenance. Recognition memory is usually unimpaired, but procedural memory shows deficits.

What is the etiology of Parkinson’s disease?
The etiology is unknown, although some hypothesize that it is related to exposure to environmental toxins. The bradykinesia and rigidity can be related to progressive loss of neurons in the substantia nigra. There is reduced
dopamine uptake in the putamen. In addition to dopamine, neurotransmitter abnormalities are found in the somatostatin and CRF systems. There is an increase in the number of muscarinic cholinergic receptors (unlike in Alzheimer’s) but a decrease in nicotinic. Pathology shows Lewy bodies in the locus ceruleus, substantia
nigra, and hypothalamus (in contrast to Lewy body dementia, in which Lewy bodies are found in the cortex also).
What are the neuropsychiatric symptoms in Parkinson’s disease?
Depression occurs in 40% to 60%, often before the onset of motor symptoms, and is unrelated to either the duration or severity of the disease or the response to medications, but is associated with dementia. Parkinson’s depression is characterized more by dysphoria, sadness, irritability, pessimism, and suicidal ideation, less by guilt and self-blame. Actual suicide is rare, unlike in Huntington’s chorea. Psychotic symptoms are common (occurring in up to 50% of patients at some point of the disease) usually as a side effect of anticholinergic medications, but can also occur as a result of mood disturbance, other medications, sleep deprivation, or the dementia associated with Parkinson’s disease. The psychotic symptoms can range in severity from hallucinations that cause no distress to delusional states with agitation and terrifying hallucinations of all types.

What tests can help diagnose Parkinson’s?
PET scans show decreased uptake in the striatum, while CT scan and MRI show decreased volume in the substantia nigra of advanced cases. EEG shows nonspecific slowing.

What percentage of patients with Parkinson’s disease manifest dementia?
From 10% to 40%, the risk rising with age. Other risk factors for dementia in Parkinson’s disease are family history, depression, and motor disability.

What are some treatments for Parkinson’s and its associated neuropsychiatric symptoms?
l-Dopa is a dopamine agonist that can help compensate for the bradykinesia and rigidity, as do anticholinergics, but there is no treatment for the postural instability except for physical and occupational therapy. Antidepressants work normally on Parkinson’s patients, but this population is very sensitive to the anticholinergic, sedating, and orthostatic effects of these drugs. ECT is effective for both the affective and motor symptoms. If antipsychotics must be used, atypicals with minimal extrapyramidal side effects will have the least effect on motor symptoms. Quetiapine and clozapine have been shown to be the most effective in controlling psychotic symptoms in Parkinson’s-related psychosis, while aripiprazole is minimally effective and can exacerbate motor function. Risperdal is generally poorly tolerated in these patients and should be avoided. Whenever the use of atypicals is indicated in patients with Parkinson’s disease, monitoring for neuroleptic malignant syndrome–like symptoms is essential, and can be very difficult to distinguish from baseline symptoms. Again, the use of typical neuroleptics such as haloperidol is generally contraindicated, although may be necessary when agitation becomes a safety issue.

What symptoms can occur as a side effect of treating a patient with Parkinson’s disease?
Anticholinergic drugs, while being the most effective in suppressing the parkinsonian tremor, are also the most prone to induce psychosis. Delusions are usually dose related, frequently persecutory, and preceded by vivid dreams or visual hallucinations. Risk factors for delusions are age and concurrent dementia. Thirty percent of treated Parkinson’s patients will hallucinate fully formed animal or human figures, typically at night and with the hallucinations associated with sleep disturbance. These differ from typical anticholinergic hallucinations in that
they are less threatening, more fully formed, not combined with tactile or auditory stimuli, and not associated with delirium. Delirium occurs in 5% to 25% of patients as a medication side effect, with bromocriptine and pergolide particularly implicated. l-Dopa can cause anxiety.

What is delirium?
Delirium is a pattern of diffuse, reversible cognitive deficits with acute onset, and a waxing and waning course. The deficits can include delusions (20%–70%), perceptual disturbances, mood alterations, language (50%–90%) and thought disorders (95%), sleep/wake disturbance (50%–95%), hallucinations (30%), and psychomotor alterations. Disorientation is common, to time (80%), place (70%), and person (20%). Twenty percent of hospital patients will become delirious, and if elderly, the 1-year mortality will be 40%. Some clinicians distinguish between acute confusional state, a disorder of attention associated with frontostriatal dysfunction, and acute agitated delirium, a disorder of emotion associated with middle temporal gyrus dysfunction, but many patients present with a mixed picture.

Sunday, November 14, 2010

Some scientific informations about sex

Sex is a beauty treatment.
scientific tests find that when women
make love they produce amounts of
the hormone estrogen, which makes
hair shine and skin smooth.


Gentle, relaxed lovemaking reduces
your chances of suffering dermatitis,
skin rashes and blemishes.
The sweat produced cleanses the pores
and makes your skin glow.


Lovemaking can burn up those calories
you piled on during that romantic dinner.


Sex is one of the safest sports you can take up.
it stretches and tones up just about every muscle
in the body. It's more enjoyable than swimming
20 laps, and you don't need special sneakers!


Sex is an instant cure for mild depression.
It releases endorphins into the bloodstream,
producing a sense of euphoria and leaving
you with a feeling of well-being.


The more sex you have, the more you will
be offered. The sexually active body gives
off greater quantities of chemicals called
pheromones. These subtle sex perfumes
drive the opposite sex crazy!


Sex is the safest tranquilizer in the world.


Kissing each day will keep the dentist away.
Kissing encourages saliva to wash food from
the teeth and lowers the level of the acid that
causes decay, preventing plaque build-up.


Sex actually relieves headaches.
A lovemaking session can release the
tension that restricts blood vessels
in the brain.


A lot of lovemaking can unblock a
stuffy nose. Sex is a natural antihistamine.
It can help combat asthma and hay fever.

What can you say?

Pacquiao "The Mexecutioner"

This one's for you!!! Kiss my glove!!

Are you crying Anton?


Saturday, November 13, 2010

10 facts about kissing

Some facts about kissing:

1. Two out of every three couples turn their heads to the right when they kiss.

2. A simple peck uses two muscles; a passionate kiss, on the other hand, uses all 34 muscles in your face. Now that’s a rigorous workout!

3. Like fingerprints or snowflakes, no two lip impressions are alike.

4. Kissing is good for what ails you. Research shows that the act of smooching improves our skin, helps circulation, prevents tooth decay, and can even relieve headaches.

5. The average person spends 336 hours of his or her life kissing.

6. Ever wonder how an “X” came to represent a kiss? Starting in the Middle Ages, people who could not read used an X as a signature. They would kiss this mark as a sign of sincerity. Eventually, the X came to represent the kiss itself.

7. Talk about a rush! Kissing releases the same neurotransmitters in our brains as parachuting, bungee jumping, and running.

8. The average woman kisses 29 men before she gets married.

9. Men who kiss their partners before leaving for work average higher incomes than those who don’t.

10. The longest kiss in movie history was between Jane Wyman and Regis Tommey in the 1941 film, You’re in the Army Now. It lasted 3 minutes and 5 seconds. So if you’ve beaten that record, it’s time to celebrate!

Health Alert: Cigarettes are bad for you

Thursday, November 11, 2010

Pacquiao vs Margarito: Who would you pick?

Para sa mga mang iinom

How hangover affects your health:

Philippine Travel advisory

Safety and Security - Local Travel - Mindanao
We advise against all travel to south west Mindanao and the Sulu archipelago covering the following areas Autonomous Region of Muslim Mindanao (ARMM), including the islands of Basilan, Sulu and Tawi-Tawi, plus the western provinces of Sarangani, North and South Cotabato, Sultan Kudarat, Lanao del Norte, Zamboanga del Sur and Zamboanga Sibugay, because of ongoing terrorist and insurgent activity. We advise against all but essential travel to the remainder of Mindanao.

If you intend to travel to the provinces of Zamboanga del Norte and Misamis Occidental you should use air or sea routes as we advise against all travel to neighbouring provinces.

There have been terrorist attacks against civilian targets in Mindanao. There is also criminal activity in Mindanao, including the use of kidnapping and explosions. The most recent was on 21 October 2010 when an explosion on a bus in North Cotabato Province killed ten people and injured thirty others.. Other recent significant explosions include:

* On 5 August 2010 at Zamboanga airport an explosion killed two people and injured 24 people including a British national.

* On 13 April 2010 in Basilan separate explosions near a school and cathedral in Isabela City killed 14 people and injured 16 others.

On 7 July 2009, in Jolo, an explosion in the main commercial area killed two people and injured at least 17 others.

On 5 June 2009, in Cotabato City, an explosion at a food stand near the Cathedral killed six people and critically injured eight others.

On 3 April 2009, in Isabella City, Basilan, an explosion in the central plaza near a fast food restaurant killed two people and injured eight others.

There are ongoing clashes between the military and insurgent groups in the Sulu archipelago including Basilan, Tawi-Tawi and Jolo. There is currently a ceasefire between the government and the MILF armed group. The situation has deteriorated with little warning in the past, most recently in August 2008 when clashes in Maguindanao, North Cotabato, Lanao del Sur and Lanao del Norte lead to civilian casualties and thousands of people being displaced.

Extortion and kidnap for ransom gangs, that have targeted public transport with armed hold-ups and explosions, operate in Mindanao. We advise against using public transport throughout Mindanao.

There is also a threat of kidnapping in south west Mindanao and the Sulu archipelago. Most recently, a Swiss national was kidnapped in Zamboanga City on 5 April 2010 and was subsequently released unharmed. Previous incidents include the kidnapping of an Irish priest from Pagadian City in Zamboana del Sur in October 2009 and three members of the International Red Cross, including two foreign nationals, were kidnapped in Sulu in February 2009. In these cases the victims were subsequently released unharmed.

You should be aware that is is the long-standing policy of the British Government not to make substantive concessions to hostage takers. The British Government considers that paying ransoms and releasing prisoners increases the risk of further hostage taking.

Source: http://www.fco.gov.uk/en/travel-and-living-abroad/travel-advice-by-country/asia-oceania/philippines

Tuesday, November 9, 2010

Excess Fluid Volume Hypervolemia; Fluid Overload

Nursing Diagnosis: Excess Fluid Volume
Hypervolemia; Fluid Overload
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Fluid Balance

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Fluid Monitoring
* Fluid Management

NANDA Definition: Increased isotonic fluid retention

Fluid volume excess, or hypervolemia, occurs from an increase in total body sodium content and an increase in total body water. This fluid excess usually results from compromised regulatory mechanisms for sodium and water as seen in congestive heart failure (CHF), kidney failure, and liver failure. It may also be caused by excessive intake of sodium from foods, intravenous (IV) solutions, medications, or diagnostic contrast dyes. Hypervolemia may be an acute or chronic condition managed in the hospital, outpatient center, or home setting. The therapeutic goal is to treat the underlying disorder and return the extracellular fluid compartment to normal. Treatment consists of fluid and sodium restriction, and the use of diuretics. For acute cases dialysis may be required.

* Defining Characteristics: Weight gain
* Edema
* Bounding pulses
* Shortness of breath; orthopnea
* Pulmonary congestion on x-ray
* Abnormal breath sounds: crackles (rales)
* Change in respiratory pattern
* Third heart sound (S3)
* Intake greater than output
* Decreased hemoglobin or hematocrit
* Increased blood pressure
* Increased central venous pressure (CVP)
* Increased pulmonary artery pressure (PAP)
* Jugular vein distension
* Change in mental status (lethargy or confusion)
* Oliguria
* Specific gravity changes
* Azotemia
* Change in electrolytes
* Restlessness and anxiety

* Related Factors: Excessive fluid intake
* Excessive sodium intake
* Renal insufficiency or failure
* Steroid therapy
* Low protein intake or malnutrition
* Decreased cardiac output; chronic or acute heart disease
* Head injury
* Liver disease
* Severe stress
* Hormonal disturbances

* Expected Outcomes Patient maintains adequate fluid volume and electrolyte balance as evidenced by vital signs within normal limits, clear lung sounds, pulmonary congestion absent on x-ray, and resolution of edema.

Ongoing Assessment

* Obtain patient history to ascertain the probable cause of the fluid disturbance. This can help to guide interventions. May include increased fluids or sodium intake, or compromised regulatory mechanisms.
* Assess or instruct patient to monitor weight daily and consistently, with same scale and preferably at the same time of day. Instruction facilitates accurate measurement and helps to follow trends.
* Monitor for a significant weight change (2 pounds) in 1 day.
* Evaluate weight in relation to nutritional status. In some heart failure patients, weight may be a poor indicator of fluid volume status. Poor nutrition and decreased appetite over time result in a decrease in weight, which may be accompanied by fluid retention even though the net weight remains unchanged.
* If patient is on fluid restriction, review daily log or chart for recorded intake. Patients should be reminded to include items that are liquid at room temperature such as Jell-O, sherbet, and Popsicles.
* Monitor and document vital signs. Sinus tachycardia and increased blood pressure are seen in early stages. Elderly patients have reduced response to catecholamines, thus their response to fluid overload may be blunted, with less rise in heart rate.
* Monitor for distended neck veins and ascites. Monitor abdominal girth to follow any ascites accurately.
* Auscultate for a third sound, and assess for bounding peripheral pulses. These are signs of fluid overload.
* Assess for crackles in lungs, changes in respiratory pattern, shortness of breath, and orthopnea. These are early signs of pulmonary congestion.
* Assess for presence of edema by palpating over tibia, ankles, feet, and sacrum. Pitting edema is manifested by a depression that remains after one’s finger is pressed over an edematous area and then removed. Grade edema from trace (indicating barely perceptible) to 4 (severe edema). Measurement of an extremity with a measuring tape is another method of following edema.
* Monitor chest x-ray reports. As interstitial edema accumulates, the x-rays show cloudy white lung fields.
* Monitor input and output closely. Although overall fluid intake may be adequate, shifting of fluid out of the intravascular to the extravascular spaces may result in dehydration. The risk of this occurring increases when diuretics are given. Patients may use diaries for home assessment.
* Evaluate urine output in response to diuretic therapy. Focus is on monitoring the response to the diuretics, rather than the actual amount voided. At home, it is unrealistic to expect patients to measure each void. Therefore recording two voids versus six voids after a diuretic medication may provide more useful information. NOTE: Fluid volume excess in the abdomen may interfere with absorption of oral diuretic medications. Medications may need to be given intravenously by a nurse in the home or outpatient setting.
* Monitor for excessive response to diuretics: 2-pound loss in 1 day, hypotension, weakness, blood urea nitrogen (BUN) elevated out of proportion to serum creatinine level.
* Monitor serum electrolytes, urine osmolality, and urine-specific gravity.
* Assess the need for an indwelling urinary catheter. Treatment focuses on diuresis of excess fluid.
* During therapy, monitor for signs of hypovolemia. Monitoring prevents complications associated with therapy.
* If hospitalized, monitor hemodynamic status including CVP, PAP, and PCWP, if available. This direct measurement serves as optimal guide for therapy.

Therapeutic Interventions

* Institute/instruct patient regarding fluid restrictions as appropriate. This helps reduce extracellular volume. For some patients, fluids may need to be restricted to 1000 ml/day.
* Provide innovative techniques for monitoring fluid allotment at home. For example, suggest that patients measure out and pour into a large pitcher the prescribed daily fluid allowance (e.g., 1000 ml); then every time patient drinks some fluid, he or she is to remove that amount from the pitcher. This provides a visual guide for how much fluid is still allowed throughout the day.
* Restrict sodium intake as prescribed. Sodium diets of 2 to 3 g are usually prescribed.
* Administer or instruct patient to take diuretics as prescribed. Diuretic therapy may include several different types of agents for optimal therapy, depending on the acuteness or chronicity of the problem. For chronic patients, compliance is often difficult for patients trying to maintain a normal lifestyle.
* Instruct patient to avoid medications that may cause fluid retention, such as over-the-counter nonsteroidal antiinflammatory agents, certain vasodilators, and steroids.
* Elevate edematous extremities. This increases venous return and, in turn, decreases edema.
* Reduce constriction of vessels (e.g., use appropriate garments, avoid crossing of legs or ankles). This prevents venous pooling.
* Instruct in need for antiembolic stockings or bandages as ordered. These help promote venous return and minimize fluid accumulation in the extremities.
* Provide interventions related to specific etiological factors (e.g., inotropic medications for heart failure, paracentesis for liver disease).

* For acute patients: Consider admission to acute care setting for hemofiltration or ultrafiltration. This is a very effective method to draw off excess fluid.
* Collaborate with the pharmacist to maximally concentrate IVs and medications. This decreases unnecessary fluids.
* Apply saline lock on IV line. This maintains patency but decreases fluid delivered to patient in a 24-hour period.
* Administer IV fluids through infusion pump, if possible. This ensures accurate delivery of IV fluids.
* Assist with repositioning every 2 hours if patient is not mobile. This prevents fluid accumulation in dependent areas.

Education/Continuity of Care

* Teach causes of fluid volume excess and/or excess intake to patient or caregiver.
* Provide information as needed regarding the individual’s medical diagnosis (e.g., congestive heart failure [CHF], renal failure).
* Explain or reinforce rationale and intended effect of treatment program.
* Identify signs and symptoms of fluid volume excess.
* Explain importance of maintaining proper nutrition and hydration, and diet modifications.
* Identify symptoms to be reported.
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