Professionalism in Nursing

Dr. Nora Ahmad PhD is Assistant Professor College of Nursing PAAET - Kuwait. In the celebrate of Nursing Day 2009, Indonesian National Nurses Association in Kuwait (INNA-K) made a seminar for their members in the Indonesian Embassy with topic Professionalism in Nursing.

What is Professionalism? Professionalism is a calling which requires specialized knowledge and often long and extensive academic preparation.


Professional Nursing is "the process in which substantial specialized knowledge derived from the biological, physical, and behavioral sciences is applied to: the care, diagnosis, treatment, counsel and health teaching of persons who are experiencing changes in the normal health processes or who require assistance in the maintenance of health or the prevention or management of illness, injury or infirmity…” (ksbn, 2003).

What is Professional Responsibility? There are two big point they have to mention on their job regarding to the their profession :

• They should be responsible to the area of legal practice that encompasses the duties of an attorney to act in a professional manner, obey the law, avoid conflicts of interest, and put the interests of clients ahead of their own interests.
• All professionals in every field are expected to act in this legally binding manner in all their relationships with the client

As a Nurse, you should understand about responsibility of the Nursing Professional Body :

• Participates in determining individual members and group responsibilities and conduct
• Regulation of its members adherence to its own professional standards

What makes nursing a profession? There are many criteria which can makes the nursing become a profession :

1. There is an educational background required to ensure safe and effective practice. A practitioners must complete Board certified educational programs or meet minimum criteria to be eligible for licensure.
2. Members are accountable for continuing education and competency.
3. Members of the profession adhere to a code of ethics.
4. Members participate in professional organizations.
5. members publish and communicate their knowledge and advances in the profession.
6. Members of the profession are autonomous and self- regulating
7. Members of the profession are involved in research They are involved in community service
8. The profession develops, evaluates and uses theory as a basis for practice

So, the question is.... Do we meet the criteria(s) above?

Do we have the criteria of professional nursing values and behaviors?

• Professional Values ; Altruism (humanity), Equality, Aesthetic, Freedom/Autonomy, Human, dignity, Justice and Truth.
• Professional Behaviors ; Dependability, Professional presentation, Initiative, Empathy, Cooperation, Organization, Clinical reasoning, Supervisory process, Verbal and written Communication (Kasar, et al, 1996).

The challenges in Nursing Professionalism are :

• Membership
• Communication
• Changes in Nursing practice
• Diversity in the population
• Lack of autonomy
• Lack of leadership skills
• Nature of the job : long hours, health care risks, emotional load and undervalue by society.
• Shortage of the nurses
• Limited opportunities

Ok, Now we talk about Professionalism and Competency.

A. Professional Competencies

Professional competency is defined as the values, attitudes and practices that competent nurses embody and may share with members of other professions. Nursing care competency is defined as relationship capabilities that nurses need to work with clients and colleagues. the knowledge and skills of practicing the discipline and competencies that encompass understanding of the broader health care system.

B. Core Values of Nursing Competency

A competent nurse’s personal and professional actions are based on a set of shared core nursing values through the understanding that nursing is a humanitarian profession based on a set of core nursing values, including Social justice, Caring, Advocacy, Respect for self and others, Collegiality, and Ethical behaviour.

C. Foundations of Nursing Competency

Develops insight through reflection, self-analysis, and self-care through the understanding that by using ongoing reflection, critical examination and evaluation of one’s professional and personal life improves nursing practice.

Nurse engages in ongoing self-directed learning with the understanding that knowledge and skills are dynamic and evolving; in order to maintain competency one must continuously update the knowledge.

Demonstrates leadership in nursing and health care through the understanding that an effective nurse is able to take a leadership role to meet client needs, improve the health care system and facilitate community problem solving.

Collaborates as part of a health care team through the understanding that successful health care depends on a team effort, and collaboration with others in a collegial team is essential for success in serving clients.

Practices within, utilizes, and contributes to the broader health care system through the understanding that professional nursing has a legally defined standard of practice .

Each nurse has the responsibility and Accountability for effective and efficient management and utilization of health care resources.

Practices relationship-centered care through the understanding that the effectiveness of nursing interventions and treatment plans depends, in part, on the attitudes, beliefs and values of clients and these are influenced both by how professionals interact with clients and by the intervention.

Communicates effectively through the understanding that effective use of therapeutic communication, to establish a caring relationship, to create a positive environment, to inform clients, and to advocate is an essential part of all interventions

Makes sound clinical judgments through the understanding that effective nursing judgment is not a single event, but concurrent and recurrent processes that include assessment (data collection, analysis and diagnosis), community and client participation in planning, implementation, treatment, ongoing evaluation, and reflection

In making practice decisions, locates, evaluates and uses the best available evidence, coupled with a deep understanding of client experience and preferences, through the understanding that there are many sources of knowledge, including research evidence, standards of care, community perspectives, practical wisdom gained from experience, which are legitimate sources of evidence for decision-making


What we can do to promote Professionalism?

• Provide strategic directions and programs that enhance the competencies of nurses to be globally competitive.
• Passionately sustain the quality work life and collegial interactions with and among nurses.
• Encourage staff to develop their knowledge and skills by participating in a wide variety of both formal and informal activities.
• Enthusiastically explore possibilities of collaboration.
• Maintain nursing educational standards
• Promote professional behaviour in the professional nurse
• Practice evidence-based care delivery

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Epistaxis (Nosebleeds)

Epistaxis is the relatively common occurrence of bleeding (hemorrhage) from the nose, usually noticed when the blood drains out through the nostrils.

A. Type of Epistaxis

There are two types ; Anterior from the nasal septum (Kiesselbach’s plexus) as most common cases. Anterior bleeding may also originate anterior to the inferior turbinate. Posterior from the nasal septum as less common cases. Posterior hemorrhage originates from branches of the sphenopalatine artery in the posterior nasal cavity or nasopharynx.

Sometimes in more severe cases, the blood can come up the nasolacrimal duct and out from the eye. Fresh blood and clotted blood can also flow down into the stomach and cause nausea and vomiting.


B. Sign and Symptoms

A common sign, epistaxis can be spontaneous or induced from the front or back of the nose. Bleeding usually occurs from only one nostril. If the bleeding is heavy enough, the blood can fill up the affected nostril and overflow into the nasopharynx (the area inside the nose where the two nostrils converge), causing simultaneous bleeding from the other nostril as well.

Blood can also drip into the back of the throat or down into the stomach, causing a person to spit up or even vomit blood. Signs of excessive blood loss include dizziness, weakness, confusion and fainting. Excessive blood loss from nosebleeds does not often occur.


C. Causes Of Epistaxis

1. Most cases of epistaxis do not have an easily identifiable cause.
2. Local trauma (ie, nose picking) is the most common cause, followed by facial trauma, foreign bodies, nasal or sinus infections, and prolonged inhalation of dry air. A disturbance of normal nasal airflow, as occurs in a deviated nasal septum, may also be a cause of epistaxis.
3. Latrogenic causes include nasogastric and nasotracheal intubation.
4. Children usually present with epistaxis due to local irritation or recent upper respiratory infection (URI).
5. Oral anticoagulants and coagulopathy due to splenomegaly, thrombocytopenia, platelet disorders, or AIDS-related conditions predispose to epistaxis.
6. The relationship between hypertension and epistaxis is implicated. Epistaxis is more common in hypertensive patients, and patients are more likely to be acutely hypertensive during an episode of epistaxis. Hypertension, however, is rarely a direct cause of epistaxis, and therapy should be focused on controlling hemorrhage before blood pressure reduction.
7. Epistaxis is more prevalent in dry climates and during cold weather.

Vascular abnormalities that contribute to epistaxis may include the following:

• Sclerotic vessels
• Hereditary hemorrhagic telangiectasia
• Arteriovenous malformation
• Neoplasm
• Septal perforation, deviation
• Endometriosis

D. Pathophysiology Of Epistaxis

Nosebleeds are due to the rupture of a blood vessel within the richly perfused nasal mucosa. Rupture may be spontaneous or initiated by trauma. Nosebleeds are reported in up to 60% of the population with peak incidences in those under the age of ten and over the age of 50 and appears to occur in males more than females.

An increase in blood pressure (e.g. due to general hypertension) or local blood flow (for example following a cold or infection) will increase the likelihood of a spontaneous nosebleed. Anticoagulant medication and disorders of blood clotting can promote and prolong bleeding. Spontaneous epistaxis is more common in the elderly as the nasal mucosa (lining) becomes dry and thin and blood pressure tends to be higher. The elderly are also more prone to prolonged nose bleeds as their blood vessels are less able to constrict and control the bleeding.


E. Nursing Measures in Epistaxis Cases

1. Place patient in an upright position, leaning forward to reduce venous pressure
2. Avoiding the patient to talk and let to breathe through his mouth
3. Tell the Patient to firmly grasp and pinch his entire nose between the thumb and fingers for at least 10 minutes
4. Compress the soft outer portion of the nose against the midline septum for about 5-10 minutes continuously
5. Keep the head of the bed elevated 30 to 45 degrees for the next 4 hours.
6. Tell to the patient not to blow his/her nose for several hours and to avoid lifting objects or bending at the waist for the next 24 hours.
7. If symptoms persist assist the physician, They will do or order some of following treatments: application of topical anesthetic vasoconstrictor solution, such as a 4% lidocaine and topical epinephrine; topical chemical cauterization with silver nitrate; nasal tampon insertion; or insertion of up to 36 to 72 inches (90 to 180 cm) of ½ inch petroleum gauze packing into the nostril.
8. Care of the gauze packing pack inside the nose and be remove after 24 hours
9. Psychological support to the patient specially if packing is applied as he feels uncomfortable

Image of Netcell Epistaxis Pack and Epistaxis Catheter

F. Nursing Diagnoses

Nursing dianoses on the patient with Epistaxis :

• Risk for Deficient Fluid Volume (If excessive blood loss happened)
• Risk for Ineffective Breathing Pattern or Ineffective Airway Clearance (especially in children, they are going to be scared, so Fear is also another nursing diagnosis to consider).

In case bleeding does not stop after 20 minutes, Medical team will think about suspect posterior nasal epistaxis. A relatively serious condition that may require intervention by an otolaryngologist. Treatment may include placement of a double-lumen posterior epistaxis balloon catheter and packing.

Nose bleeding occurs after an injury to the head, this may suggest a skull fracture and x-rays should be taken, the nose may be broken (for example, it is misshapen after a blow or injury).

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Spina Bifida

What is Spina bifida?

Spina bifida is a birth defect in central nervous system. It occurs as a result from neural tube failure to close during embryonic development. The term spina bifida comes from Latin and literally means "split" or "open" spine.

Spina bifida commonly occurs at the end of the first month of pregnancy when the two sides of the embryo's spine fail to join together, leaving an open area. In some cases, the spinal cord or other membranes may push through this opening in the back. The condition usually is detected before a baby is born and treated right away.


Type of Spina Bifida :

1. Spina Bifida Occulta :
Posterior vertebral arches fail to close in the lumbosacral area. Spinal cord remains intact and usually is not visible. Meninges are not exposed on the skin surface and neurological deficit are not usually present. In other word, Most children with this type of defect never have any health problems, and the spinal cord is often unaffected.

2. Spina Bifida Cystica/Manifesta:
The vertebra and neural tube close incomplete resulting in a saclike protrusion in the lumbar or sacral area. The defect includes meningocele, myelomeningocele, lipomeningocel, and lipomeningomyelocele.

Spina Bifida Cystica - Meningocele

The protrusion involves meninges and a saclike cyst that contains CSF in the midline of the back. Spinal cord is not involved and neurological deficits are usually not present.

Spina Bifida Cystica - Myelomeningocel

The protrusion involves meninges, CSF, nerve roots, and spinal cord. The sac is covered by a thin membrane that is prone to leakage or rupture. Neurological deficit are evident.


Signs and Symptoms of Spina Bifida :

Those patients were diagnosed as Spina Bifida, mostly they have sign and symptom bellow :

• Visible spinal defect
• Flaccid paralysis of the legs
• Hip and joint deformities
• Altered bladder and bowel function
• Specific signs and symptoms depend on the spinal cord involvement

Nursing Intervention of Spina Bifida :

• Assess the sac and measure the lesion
• Assess neurological system
• Assess and monitor for increasing ICP
• Measure head circumferences
• Protect the sac, cover with a sterile, moist (normal saline), nonadherent dressing and change the dressing every 2-4 hours
• Place patient in prone position and head to one side
• Use antiseptic technique
• Assess and monitor the sac for redness, clear or purulent drainage, abrasions, irritation, and signs of infection
• Assess for hip and joint deformities
• Administer medication: antibiotics, anticholinergics, and laxatives as prescribed

Treatment of Spina Bifida :

Currently, there is no cure for spina bifida, but there are a number of treatments available to help manage the disease and prevent complications. Initial goals of treatment include reducing neurological damage to your child, minimizing complications such as infections and helping your family learn about and cope with the disorder.

Children with the mildest form of the disease, spina bifida occulta, usually do not require treatment (and often not for meningocele.). The key priorities in the treatment of myelomeningocele are to prevent infection from developing through the exposed nerves and tissue of the defect on the spine and to protect the exposed nerves and structures from additional trauma.

Treatment of the severe form of spina bifida myelomeningocele depends on the specific problems caused by the spinal defect and may include surgery, physical therapy, and the use of braces and other aids.

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External Radiation Therapy

All cancer patients, About 60% are treated with some form of external radiation therapy (radiotherapy). This treatment delivers X-rays or gamma-rays directly to the cancer place. Radiotherapy effects are local because only the area being treated experiences direct effects.

Radiation doses are based on the type, stage, and location of the tumor as well as on the patient's size, condition and overall treatment goals. Radiation doses are given in increments, usually three to five times a week, until the total dose is reached. The goals of radiation therapy include cure, in which the cancer is completely destroyed and not expected to recur; control, in which the cancer doesn't progress or regress but is expected to progress at some later time; or palliation, in which radiation is given to relieve symptoms caused by the cancer (such as bone pain, bleeding, and headache).

External beam radiation therapy is delivered by machines that aim a concentrated beam of high-energy particles (photons and gamma rays) at the target site. There are two types of radiotherapy machines; units containing cobalt or cesium as radioactive sources for gamma rays, and linear accelerators that use electricity to produce X-rays.

Linear accelerators produce high energy with great penetrating ability. Some (known as orthovoltage machines) produce less powerful electron beams that may be used for superficial tumors.

Radiation therapy may be augmented by chemotherapy, brachytherapy (radiation implant therapy), or surgery, as needed.

Equipment for Radiotherapy Procedure

Radiation therapy machine need for film badge or pocket dosimeter.

Implementation of Radiotherapy Procedure

1. Explain the treatment to the patient and his family.
Review the treatment goals, and discuss the range of potential adverse effects as well as interventions to minimize them. Also discuss possible long-term complications and treatment issues. Educate the patient and his family about local cancer services.

2. Make sure the radiation oncology department has obtained informed consent.

3. Review the patient's clinical record for recent laboratory and imaging results, and alert the radiation oncology staff to any abnormalities or other pertinent results (such as myelosuppression, paraneoplastic syndromes, oncologic emergencies, and tumor progression).

4. Transport the patient to the radiation oncology department.

5. The patient begins by undergoing simulation (treatment planning), in which the target area is mapped out on his body using a machine similar to the radiation therapy machine. Then the target area is tattooed or marked in ink on his body to ensure accurate treatments.

6. The physician and radiation oncologist determine the duration and frequency of treatments, depending on the patient's body size, size of portal, extent and location of cancer, and treatment goals.

7. The patient is positioned on the treatment table beneath the machine. Treatments last from a few seconds to a few minutes. Reassure the patient that he won't feel anything and won't be radioactive. After treatment is complete, the patient may return home or to his room.

Special considerations

1. Explain to the patient that the full benefit of radiation treatments may not occur until several weeks or months after treatments begin. Instruct him to report long-term adverse effects.

2. Emphasize the importance of keeping follow-up appointments with the physician.

3. Refer the patient to a support group, such as a local chapter of the American Cancer Society.

Home care after Radiotherapy done

Instruct the patient and his family about proper skin care and management of possible adverse effects.

Complications of Radiotherapy

Adverse effects arise gradually and diminish gradually after treatments. They may be acute, subacute (accumulating as treatment progresses), chronic (following treatment), or long-term (arising months to years after treatment). Adverse effects are localized to the area of treatment, and their severity depends on the total radiation dose, underlying organ sensitivity, and the patient's overall condition.

Common acute and subacute adverse effects can include altered skin integrity, altered GI and genitourinary function, altered fertility and sexual function, altered bone marrow production, fatigue, and alopecia.

Chronic and long-term complications or adverse effects may include radiation pneumonitis, neuropathy, skin and muscle atrophy, telangiectasia, fistulas, altered endocrine function, and secondary cancers.

Other complications of treatment include headache, alopecia, xerostomia, dysphagia, stomatitis, altered skin integrity (wet or dry desquamation), nausea, vomiting, heartburn, diarrhea, cystitis, and fatigue.

Documentation of Radiotherapy Procedure

Record radiation precautions taken during treatment; interventions used and their effectiveness; grading of adverse effects; teaching given to the patient and his family and their responses to it; the patient's tolerance of isolation procedures and the family's compliance with procedures; discharge plans and teaching; and referrals to local cancer services, if any.

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Management of Acute Hypersensitivity Reactions

Type I Hypersensitivity reactions are immunologic responses to a foreign antigen to which a patient has been previously sensitized (immediate hypersensitivity or anaphylaxis). Anaphylactoid reactions are not immunologically mediated; however, symptoms and treatment are similar.

Process of Acute Hypersensitivity Reactions

Signs and symptoms of Acute Hypersensitivity Reactions :

Acute hypersensitivity reactions typically begin within 1 to 30 minutes of exposure to the offending antigen. Tingling sensations and a generalized flush may proceed to a fullness in the throat, chest tightness, or a “feeling of impending doom.” Urticaria and sweating are most common sign and symtomp of acute hypersensitivity reactions. Severe reactions include life-threatening involvement of the airway and cardiovascular system.

Acute Hypersensitivity Reactions: Urticaria

Acute Hypersensitivity Reactions: Allergic area

Treatment of Acute Hypersensitivity Reactions :

When this case is happened , an appropriate and immediate treatment is imperative. The following general measures are commonly employed to the patient who has acute hypersensitivity reactions :

• Administered of Epinephrine.
  Epinephrine Sub Cutaneouse (SC) Injection : 1:1000, 0.2 to 0.5 mg (0.2 to 0.5 ml) is primary treatment. In children, administer 0.01 mg/kg or 0.1 mg. Doses may be repeated every 5 to 15 minutes if needed. A succession of small doses is more effective and less dangerous than a single large dose. Additionally, 0.1 mg may be introduced into an injection site where the offending drug was administered. If appropriate, the use of a tourniquet above the site of injection of the causative agent may slow its absorption and distribution. However, remove or loosen the tourniquet every 10 to 15 minutes to maintain circulation.
  
  Epinephrine Intravenouse (IV) Injection as general indicated in the presence of hypotension is often recommended in a 1:10,000 dilution, 0.3 to 0.5 mg over 5 minutes; repeat every 15 minutes, if necessary. In children, inject 0.1 to 0.2 mg or 0.01 mg/kg/dose over 5 minutes; repeat every 30 minutes.
  
  A conservative IV epinephrine protocol includes 0.1 mg of a 1:100,000 dilution (0.1 mg of a 1:1000 dilution mixed in 10 ml normal saline) given over 5 to 10 minutes. If an IV infusion is necessary, administer at a rate of 1 to 4 mcg/min. In children, infuse 0.1 to 1.5 (maximum) mcg/kg/min.
  
  Giving epinephrine 1:10,000 through an endotracheal tube is a possible way, if no other parenteral access is available, directly into the bronchial tree. It is rapidly absorbed there from the capillary bed of the lung.


• Check for Airway.
  Ensure a patent airway via endotracheal intubation or cricothyrotomy (ie, inferior laryngotomy, used prior to tracheotomy) and administer oxygen. Severe respiratory difficulty may respond to IV aminophylline or to other bronchodilators.


• Check for Blood Pressure.
  Hypotension in acute hypersensitivity reactions is should be recumbent with feet elevated. Depending upon the severity, consider the following measures :
  
  - Establish a patent IV catheter in a suitable vein.
  - Administer IV fluids (eg, Normal Saline, Lactated Ringer's).
  - Administer plasma expanders.
  - Administer cardioactive agents (see group and individual monographs). Commonly recommended agents include dopamine, dobutamine, norepinephrine, and phenylephrine.


• Adjunctive therapy.
  Adjunctive therapy does not alter acute reactions, but may modify an ongoing or slow-onset process and shorten the course of the reaction.
  
  - Antihistamines : Diphenhydramine 50 to 100 mg IM or IV, continued orally at 5 mg/kg/day or 50 mg every 6 hours for 1 to 2 days. For children, give 5 mg/kg/day, maximum 300 mg/day. Chlorpheniramine Adults, 10 to 20 mg; children, 5 to 10 mg IM or slowly IV. Hydroxyzine 10 to 25 mg orally or 25 to 50 mg IM 3 to 4 times daily.
  
  - Corticosteroids : Eg, hydrocortisone IV 100 to 1000 mg or equivalent, followed by 7 mg/kg/day IV or oral for 1 to 2 days. The role of corticosteroids is controversial.
  
  - H2 antagonists : Cimetidine Children, 25 to 30 mg/kg/day IV in 6 divided doses; Adults, 300 mg every 6 hours. Ranitidine 50 mg IV over 3 to 5 minutes. May be of value in addition to H1 antihistamines, although this opinion is not universally shared.

Source :
Books@Ovid - Facts and Comparisons
A to Z Drug Facts by David S. Tatro.

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Rheumatic Heart Disease

Rheumatic heart disease (RHD) is a condition in which permanent damage to heart valves is caused by rheumatic fever. Rheumatic fever begins with a strep throat from streptococcal (STREP'to-KOK'al) infection. As many as 39% of patients with acute rheumatic fever may develop varying degrees of pancarditis with associated valve insufficiency, heart failure, pericarditis, and even death.

With chronic rheumatic heart disease, patients develop valve stenosis with varying degrees of regurgitation, atrial dilation, arrhythmias, and ventricular dysfunction. Chronic rheumatic heart disease remains the leading cause of mitral valve stenosis and valve replacement in adults in many countries including in Indonesia.

What are the symptoms of rheumatic heart disease?

The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. When symptoms do appear, they may depend on the extent and location of the heart damage. The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. When symptoms do appear, they may depend on the extent and location of the heart damage.

• Fever.
• Weight loss.
• Fatigue.
• Stomach pains.
• Joint inflammation - including swelling, tenderness, and redness over multiple joints. The joints affected are usually the larger joints in the knees or ankles. The inflammation "moves" from one joint to another over several days.
• Small nodules or hard, round bumps under the skin.
• A change in your child's neuromuscular movements (this is usually noted by a change in your child's handwriting and may also include jerky movements).
• Rash (a pink rash with odd edges that is usually seen on the trunk of the body or arms and legs).

How to treat of rheumatic heart disease :

Medical therapy is directed toward eliminating the group A streptococcal pharyngitis (if still present), suppressing inflammation from the autoimmune response, and providing supportive treatment for congestive heart failure. But the specific treatment for rheumatic heart disease will be determined by your physician based on:

1. your overall health and medical history
2. extent of the disease
3. your tolerance for specific medications, procedures, or therapies
4. expectations for the course of the disease
5. your opinion or preference

Since rheumatic fever is the cause of rheumatic heart disease, the best treatment is to prevent rheumatic fever from occurring. Oral penicillin V remains the drug of choice for treatment of group A streptococcal pharyngitis. When oral penicillin is not feasible or dependable, a single dose of intramuscular benzathine penicillin G is therapeutic. For patients who are allergic to penicillin, administer erythromycin or a first-generation cephalosporin.

Other options include clarithromycin for 10 days, azithromycin for 5 days, or a narrow-spectrum (first-generation) cephalosporin for 10 days. To reduce inflammation, aspirin, steroids, or non-steroidal medications may be given. Surgery may be necessary to repair or replace the damaged valve.

Can Rheumatic Heart Disease be Prevented?

The best way to prevent rheumatic heart disease is to seek immediate medical attention to a strep throat and not let it progress to rheumatic fever. The Nurses also have a role in prevention, primarily in screening school-aged children for sore throats that may be caused by Group A streptococci(especially Group A β Hemolytic Streptococcus pyogenes).

Persons who have previously contracted rheumatic fever are often given continuous (daily or monthly) antibiotic treatments, possibly for life, to prevent future attacks of rheumatic fever and lower the risk of heart damage.

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Loss, Grief and End-of-Life Care

People are complex, biopsychosocial beings. When they become ill, undergo diagnosis for altered health states, experience a loss, or progress into the end stage of life, their responses are the result of the complex interaction of biopsychosocial changes that occur. Because we live in a culture marked by dramatically different responses to the experiences of loss and grief, nurses often feel inadequate in planning interventions to facilitate grief management and the healing process.

A. Loss

The concept of loss can be defined in several ways. The following definitions have been selected to familiarize the student with the concept of loss:

1. Change in status of a significant object
2. Any change in an individual's situation that reduces the probability of achieving implicit or explicit goals
3. An actual or potential situation in which a valued object, person, or other aspect is inaccessible or changed so that it is no longer perceived as valuable
4. A condition whereby an individual experiences deprivation of, or complete lack of, something that was previously present

Everyone has experienced some type of major loss at one time or another. Clients with psychiatric disorders, such as depression or anxiety, commonly describe the loss of a spouse, relative, friend, job, pet, home, or personal item.

Types of Loss ;

A loss may occur suddenly (eg, death of a child due to an auto accident) or gradually (eg, loss of a leg due to the progression of peripheral vascular disease). It may be predictable or occur unexpectedly. Loss has been referred to as actual (the loss has occurred or is occurring), perceived (the loss is recognized only by the client and usually involves an ideal or fantasy), anticipatory (the client is aware that a loss will occur), temporary, or permanent.

For example, a 65-year-old married woman with the history of end stage renal disease is told by her physician that she has approximately 12 months to live. She may experience several losses that affect not only her, but also her husband and family members, as her illness gradually progresses. The losses may include a predictable decline in her physical condition, a perceived alteration in her relationship with her husband and family, and a permanent role change within the family unit as she anticipates the progression of her illness and actual loss of life.

Whether the loss is traumatic or temperate to the client and her family depends on their past experience with loss; the value the family members place on the loss of their mother/wife; and the cultural, psychosocial, economic, and family supports that are available to each of them. Box 6-1 describes losses identified by student nurses during their clinical experiences.

Examples of Losses Identified by Student Nurses

1. Loss of spouse, friend, and companion. The client was a 67-year-old woman admitted to the psychiatric hospital for treatment of depression following the death of her husband. During a group discussion that focused on losses, the client stated that she had been married for 47 years and had never been alone. She described her deceased husband as her best friend and constant companion. The client told the student and group that she felt better after expressing her feelings about her losses.


2. Loss of physiologic function, social role, and independence because of kidney failure. A 49-year-old woman was admitted to the hospital for improper functioning of a shunt in her left forearm. She was depressed and asked that no visitors be permitted in her private room. She shared feelings of loneliness, helplessness, and hopelessness with the student nurse as she described the impact of kidney failure and frequent dialysis treatment on her lifestyle. Once an outgoing, independent person, she was housebound because of her physical condition and presented what her kidneys were doing to her.

B. Grief

Grief is a normal, appropriate emotional response to an external and consciously recognized loss. It is usually time-limited and subsides gradually. Staudacher (1987, p. 4) refers to grief as a “stranger who has come to stay in both the heart and mind.â€‌ Mourning is a term used to describe an individual's outward expression of grief regarding the loss of a love object or person.

The individual experiences emotional detachment from the object or person, eventually allowing the individual to find other interests and enjoyments. Some individuals experience a process of grief known as bereavement (eg, feelings of sadness, insomnia, poor appetite, deprivation, and desolation). The grieving person may seek professional help for relief of symptoms if they interfere with activities of daily living and do not subside within a few months of the loss.

The grief process is all-consuming, having a physical, social, spiritual, and psychological impact on an individual that may impair daily functioning. Feelings vary in intensity, tasks do not necessarily follow a particular pattern, and the time spent in the grieving process varies considerably from weeks to years (Schultz & Videbeck, 2002).

Five Stages of Grief Identified by Kubler-Ross

1. Denial: During this stage the person displays a disbelief in the prognosis of inevitable death. This stage serves as a temporary escape from reality. Fewer than 1% of all dying clients remain in this stage. Typical responses include: No, it can't be true, It isn't possible, and No, not me. Denial usually subsides when the client realizes that someone will help him or her to express feelings while facing reality.


2. Anger: Why me? Why now? and it's not fair! are a few of the comments commonly expressed during this stage. The client may appear difficult, demanding, and ungrateful during this stage.


3. Bargaining: Statements such as; If I promise to take my medication, will I get better? or If I get better, I'II never miss church again? are examples of attempts at bargaining to prolong one's life. The dying client acknowledges his or her fate but is not quite ready to die at this time. The client is ready to take care of unfinished business, such as writing a will, deeding a house over to a spouse or child, or making funeral arrangements as he or she begins to anticipate various losses, including death.


4. Depression: This stage is also a very difficult period for the family and physician because they feel helpless watching the depressed client mourn present and future losses. The dying patient is about to lose not just one loved person but everyone he has ever loved and everything that has been meaningful to him. (Kubler-Ross, 1971, p. 58).


5. Acceptance: At this stage the client has achieved an inner and outer peace due to a personal victory over fear: “I'm ready to die. I have said all the goodbyes and have completed unfinished business. During this stage, the client may want only one or two significant people to sit quietly by the client's side, touching and comforting him or her.

Several authors have described grief as a process that includes various stages, characteristic feelings, experiences, and tasks. Staudacher (1987) states there are three major stages of grief: shock, disorganization, and reorganization.

Westberg (1979) describes ten stages of grief work, beginning with the stage of shock and progressing through the stages of expressing emotion, depression and loneliness, physical symptoms of distress, panic, guilt feelings, anger and resentment, resistance, hope, and concluding with the stage of affirming reality.

Kubler-Ross (1969) identifies five stages of the grieving process including denial, anger, bargaining, depression, and acceptance; however, progression through these stages does not necessarily occur in any specific order. Her basic premise has evolved as a result of her work with dying persons.


C. End-of-Life Care

End-of-life care refers to the nursing care given during the final weeks of life when death is imminent. The American culture is marked by dramatically different responses to the experience of death. On one hand, death is denied or compartmentalized with the use of medical technology that prolongs the dying process and isolates the dying person from loved ones.

On the other hand, death is embraced as a frantic escape from apparently meaningless suffering through means such as physician-assisted suicide. Both require compassionate responses rooted in good medical practice and personal religious beliefs.

The Patient Self-Determination Act (PSDA), passed in 1990, states that every competent individual has the right to make decisions about his or her health care and is encouraged to make known in advance directives (AD; legal documents specifying care) end-of-life preferences, in case the individual is unable to speak on his or her own behalf (Allen, 2002; Robinson & Kennedy-Schwarz, 2001).

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Drugs as Medicine to Treatment of Disease

Antihistamines: Antihistamines are used for symptomatic relief from allergic rhinitis (hay fever) including runny nose, sneezing, itching of the nose or throat, and itchy and watery eyes. The anticholinergic effects of antihistamines may cause a thickening of bronchial secretions; therefore, these agents may be counterproductive in respiratory conditions characterized by congestion. Antihistamines may cause drowsiness.

Xanthines: Xanthines, primarily theophylline, relieve bronchial spasm by direct action on the bronchial smooth muscle in bronchospastic conditions such as asthma and chronic bronchitis. Some xanthine-containing combination products are available over-the-counter, but asthmatic patients should use them only under physician supervision.

Sympathomimetics: Sympathomimetics are used for their vasoconstrictor/decongestant or bronchodilator effects.

Decongestants: Decongestants are used for temporary relief of nasal congestion due to colds or allergy. Given orally, they are less effective than topical nasal decongestants and have a potential for systemic side effects. Frequent or prolonged topical use may lead to local irritation and rebound congestion.

Bronchodilators: Ephedrine is common in these combinations; however, it stimulates cardiac (b1) receptors. Bronchodilation is weaker than with the catecholamines: a-adrenergic effects may decrease congestion of mucous membranes. Other b-active agents are effective bronchodilators, but pseudoephedrine is not.

Analgesics: Analgesics (eg, acetaminophen, aspirin, ibuprofen, sodium salicylate) are frequently included for symptoms of headache, fever, muscle aches, and pain.

Anticholinergics: Anticholinergics are included for their drying effects on mucous secretions. This action may be beneficial in acute rhinorrhea; however, drying of respiratory secretions may lead to obstruction. Traditionally, anticholinergics have been avoided in patients with asthma or chronic obstructive pulmonary disease (COPD); however, some patients respond well to these agents. Caution is still advised in this group. An anticholinergic for oral inhalation is available as a bronchodilator for maintenance of bronchospasm associated with COPD, including chronic bronchitis and emphysema.

Papaverine HCl: Papaverine HCl relaxes the smooth muscle of the bronchial tree and tractus duodenum, this drug mostly use for the diarrhea patients.

Barbiturates: Barbiturates are included for their sedative effects as “correctives” in combination with xanthines or sympathomimetics, which may cause CNS stimulation. The sedative efficacy of low doses (eg, 8 mg phenobarbital) is questionable.

Caffeine: Caffeine is included in some combinations for CNS stimulation to counteract antihistamine depression and to enhance concomitant analgesics.

Barbiturates, prochlorperazine, hydroxyzine, meprobamate, chlordiazepoxide: These components are used as sedatives and antianxiety agents.

Ergotamine tartrate: Ergotamine tartrate provides inhibition of the sympathetic nervous system.

Kaolin: Kaolin is used for its adsorbent properties.

Narcotic analgesics: Codeine, hydrocodone bitartrate, dihydrocodeine bitartrate, opium, oxycodone HCl, oxycodone terephthalate, meperidine HCl, propoxyphene HCl, propoxyphene napsylate.

Nonnarcotic analgesics: Acetaminophen, salicylates, salicylamide. Caffeine, a traditional component of many analgesic formulations, may be beneficial to certain vascular headaches.

Magnesium-aluminum hydroxides and calcium carbonate: Magnesium-aluminum hydroxides and calcium carbonate are used as buffers.

Barbiturates, acetylcarbromal, carbromal, and bromisovalum: Barbiturates, acetylcarbromal, carbromal, and bromisovalum are used for their sedative effects.

Promethazine HCl: Promethazine HCl (a phenothiazine derivative with antihistamine properties) is used for its sedative effect.

Belladonna alkaloids: Belladonna alkaloids are used as an antispasmodic.

Barbiturates, meprobamate, and antihistamines: Barbiturates, meprobamate, and antihistamines are used for their sedative effects.

Antacids: Antacids are used to minimize gastric upset from salicylates.

Caffeine: Caffeine, a traditional component of many analgesic formulations, may be beneficial in treating certain vascular headaches.

Belladonna: Belladonna alkaloids are used as antispasmodics, the medicine which popular for the colic abdominal patients.

Pamabrom: Pamabrom is used as a diuretic.

Cinnamedrine: Cinnamedrine, a sympathomimetic amine claimed to have a relaxant effect in the uterus, is used in products for premenstrual syndrome. Its real value has not been established.

Aminobenzoate: Aminobenzoate retards the conjugation of salicylic acid and prolongs the action of salicylates.

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Breast Cancer Disease

Breast cancer is a malignant tumor that has developed from cells of the breast. Breast cancer is fairly common. In men, breast cancer is very rare. Breast cancer is not exclusively a disease of women, however. Breast cancer is the most lethal form of cancer for women in the world. Breast cancer is the leading cause of death for women between the ages of 35 and 55. In Arizona and Canada, breast cancer is the leading form of cancer among women. The highest recorded incidence of male breast cancer is in parts of Brazil, Colombia, Hungary, and Singapore, though it is not clear why. The Breast cancer is the most frequently diagnosed cancer (other than skin cancer) in women.

Cause of Breast Cancer

The cause of breast cancer is unknown. The most deadly feature of breast cancer is when it disperses from the breast, causing tumours to develop in other parts of the body. Breast cancer is life-threatening because it spreads to vital organs. A family history of breast cancer is one of the few identified and most consistent determinants of breast cancer risk. The relationship between alcohol consumption and the risk of breast cancer is currently the focus of much research (Alcohol can cause breast cancer by increasing levels of the hormone oestrogen). The relationship between race, ethnicity, and breast cancer is complex. Many rumor and suggest that the leading cause of breast cancer is the use of deodorants and antiperspirants. Radiation as a cause of breast cancer. Postmenopausal Hormone Therapy Cause Breast Cancer.

Bumping, bruising, pinching, or touching the breast does not cause breast cancer. While it is questionable that additional awareness of breast cancer is useful, in the case of domestic violence, more coverage would be helpful. In fact, breast cancer is still a rare occurrence in young women. Breast cancer is also far more common in post-menopausal women and the risk continues to increase with rising age.

Researchers now understand that breast cancer is not one disease, but many different diseases. Many people with Paget's disease of the nipple also have a breast cancer somewhere else in the same breast. Proliferative breast disease (PBD) is a significant risk factor for the development of breast cancer and appears to be a precursor lesion. Current use of hormone-replacement therapy (HRT) increases the incidence of breast cancer.

Type of Breast Cancer

There are 3 types of breast cancer;

1. Ductal carcinoma in situ, is an early breast cancer in the milk ducts. It can be detected by mammograms and is normally easy to cure.
2. Lobular carcinoma in situ, this is not considered to be breast cancer but a pre-cancerous condition. They just have an increased risk of breast cancer, so they are given frequent checkups.
3. Invasive lobular carcinoma, is a breast cancer that starts in the lobules and has spread. It's may difficult to diagnose because they do not always form a lump or show up on mammograms.

The most common type of breast cancer is ductal cancer. Breast cancer is now classified into six distinct subtypes based on unique molecular characteristics (gene-expression) and prognostic significance. system most often used to describe the extent of breast cancer is the TNM staging system. The earliest stage of breast cancer is called ductal carcinoma in situ (DCIS).

Sign and Symptom of Breast Cancer

Symptoms may not always be severe, but can cause a lot of discomfort. If a woman has any breast symptoms it is very important that she consult her doctor so that the cause of these symptoms can be found. Bellow are some sign and symptom that you may put attention to check your self to the dokter :

- A new lump in the breast
- A lump that has changed
- change in the size or shape of the breast
- Pain in the breast or nipple that does not go away
- Skin anywhere on the breast that is flaky, red, or swollen
- A nipple that is very tender or that suddenly turns inward
- Fluid coming from the nipple when not nursing a baby

Treatment for Breast Cancer

In th Breast cancer is identified by type, and the type will be a determining factor in treatment. When breast cancer is diagnosed, tests will be done to find out if the cancer has spread from the breast to other parts of the body. Calcium deficiency may cause breast cancer spread, David Douglas said on his Book which released 10/19/2007. Drug for Advanced Breast Cancer Is Also Found Effective in Early Treatment.

Research new approach, chemotherapy would be mostly for the 30 percent of women whose not fueled by estrogen. Women with a fibrocystic disease should continue to do breast self-examination. Until now, the adjuvant therapy for breast cancer is a complex one. Aromatase inhibitors as adjuvant endocrine therapy for post-menopausal women with hormone receptor-positive early breast cancer. Adjuvant therapy after surgery for breast cancer has provided significant benefits to patients at risk of relapse.

Post Breast Therapy Pain Syndrome (PBTPS) remains an underreported-yet often debilitating-consequence of breast cancer therapy. Treatments are improving all the time, and new drugs are on the horizon waiting to be implemented into the adjuvant therapy of breast cancer.

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Pneumococcal's Vaccine (Prevnar)

Pneumococcal disease are infections caused by the bacteria Streptococcus pneumoniae, which also known as pneumococcus. The most common types of infections caused by this bacteria are include middle ear infections, pneumonia, blood stream infections (bacteremia), sinus infections, and meningitis. Pneumococcal diseases is a very serious illness in young children which can cause brain damage. In rare cases, Pneumococcal diseases can cause of death.


Young children are much more likely than older children and adults to get pneumococcal disease. Children under 2, children in group child care, and children who have certain illnesses (for example sickle cell disease, HIV infection, chronic heart or lung conditions) are at higher risk than other children to get pneumococcal disease.

US Food and Drug Administration (FDA) as an agency of the United States Department of Health and Human Services, on February 17, 2000 approved the first vaccine to prevent invasive pneumococcal diseases (IPD) in infants and toddlers. This vaccine is Pneumococcal 7-valent Conjugate Vaccine (Diphtheria CRM197Protein) and marketed as Prevnar by a unit of Wyeth-Ayerst Laboratories, a Division of American Home Products Corporation in Philadelphia, Pennsylvania.

Prevnar is the first multivalent conjugate pneumococcal vaccine for children under the age of two. The vaccine has composition (Ingredients) such as Streptococcus pneumoniae, diphtheria CRM protein, casamino acids, yeast extract, ammonium sulphate, aluminium.

The vaccine should be given to all infants <> At 2, 4, and 6 months of age, followed by a booster dose at 12-15 months of age ;

Children who are unvaccinated and are 7 to 11 months of age should be given a total of 3 doses (2 months apart)

Children age 12 to 23 months should be given a total of 2 doses at least two months apart

Most children who are 24 months of age or older only need one dose of the vaccine

The Advisory Committee on Immunization Practices (ACIP) also recommends this vaccine be given to children age 24 to 59 months at highest risk of infection, including those with certain illness (sickle cell anemia, HIV infection, chronic lung or heart disease).

Important Safety Information
In clinical trials (n=18,168), the most frequently reported adverse events included injection site reactions, fever (>=38ْ C/100.4ْ F), irritability, drowsiness, restless sleep, decreased appetite, vomiting, diarrhea and rash.

Risks are associated with all vaccines, including PREVNAR. Hypersensitivity to any vaccine component including diphtheria toxoid, Thrombocytopenia or any coagulation disorder, Adults - especially pregnant and lactating women , are a contraindication to its use. PREVNAR does not provide 100% protection against vaccine serotypes or protect against nonvaccine serotypes.

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Hypokalemic Periodic Paralysis

Hypokalemic Periodic Paralysis (HypoKPP) is a congenital disorder that occurs within certain families and causes intermittent episodes of muscle weakness or paralysis, It can be inherited but occasionally this condition caused by genetic mutations (CACNA1S and SCN4A) in a voltage-gated calcium channel. The CACNA1S and SCN4A genes provide instructions for making proteins that play an essential role in muscles used for movement (skeletal muscles).

Sporadic cases of Hypokalemic Periodic Paralysis have also been reported, a temporary inability to move muscles in the arms and legs. Attacks can occur without warning or can be triggered by factors such as rest after exercise, a viral illness, or certain medications. The attacks can occur from daily to yearly and may last for a few hours or for several days.

Symptom of Hypokalemic Periodic Paralysis

Symptoms of Hypokalemic Periodic Paralysis are usually refers to various symptoms known to a patient, and the doctor will get sign of Hypokalemic Periodic Paralysis after they do some test or examination to the patient.

Most common symptom of Hypokalemic Periodic Paralysis are :
- Normal muscle strength between attacks
- Positive Babinski's reflex
- Eyelid spasms between episodes
- Normal alertness during attacks
- Episodic muscle weakness or paralysis.
Patient will mention some weakness on his body located at the shoulders, hips, involves the arms and legs. Its Occurs intermittently and commonly occurs on awakening. The patient may be triggered by rest after exercise, by exposure to cold, by heavy, high-carbohydrate, high-salt meals or alcohol consumption.

Diagnosis for Hypokalemic Periodic Paralysis

Hypokalemic Periodic Paralysis usually begin in adolescence, but they can occur before age 10. To diagnose this case, the doctors are needs specific examination such as patient history and confirmed by appropriate evaluation of serum electrolytes during attacks, with the CMAP amplitude test (Exercise EMG)(30), evaluation of the response to provocative testing or by DNA analysis.

When period of paralysis happened mostly potassium levels are low, a physical examination shows nothing abnormal but muscle reflexes may be decreased or absent and muscles go limp rather than staying stiff. On this period also when ECG or heart tracing done, the result may show an abnormal. Include of muscle biopsy to the patient with Hypokalemic Periodic Paralysis may show abnormalities.

Treatment of Hypokalemic Periodic Paralysis

There is no cure for periodic paralyses, The goals of treatment are relief of acute symptoms like myotonia and prevention of further attacks. Patient who diagnose by the doctor as Hypokalemic Periodic Paralysis may they will get advice to avoid carbohydrate-rich meals and do the strenuous exercise. The doctor may prescribed some medicine such as acetazolamide or another carbonic anhydrase inhibitor, may help prevent attacks of weakness.

To the Patients with hypokalemic periodic paralysis, administering potassium may stop an attack and also giving some glucose or other carbohydrates (sugars) may reduce the severity. Potassium is generally taken by mouth, but in a case of severe muscle weakness, the patient would need to receive it intravenously in a hospital. Intravenous calcium or diuretics such as furosemide may be needed to stop sudden attacks. Patients with Hypokalemic Periodic Paralysis they should take a low-carbohydrate diet and avoidance of alcohol may be recommended.

By taking acetazolamide periodically, its high risk to the patient for potential Kidney stones. Some of complication during phase of paralysis came, patients with hypokalemic periodic paralysis may risk for difficulty breathing, speaking, or swallowing even all of this are rare cases. The other complication that may happen to the patient hypokalemic periodic paralysis is progressive muscle weakness.

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Acquired Immunodeficiency Syndrome

Acquired Immunodeficiency Syndrome (AIDS) is defined as the most severe form of a continuum of illnesses associated with human immunodeficiency virus (HIV) infection. HIV belong to a group of viruses known as retroviruses, These virus carry their genetic material in the form of ribonucleic acid (RNA) rather than deoxyribonucleic acid (DNA).

Infection with HIV occurs when it enters the host CD4 (T) cell and causes this this cell to replicate viral RNA and viral proteins, which in turn invade other CD4 cells. The stage of HIV disease is based in clinical history, physical examination, laboratory evidence of immune dysfunction, sign and symptoms, and infection and malignancies. The stage of primary infection is acute and spans the time from infection to antibody development.

Three categories of infected states have been denoted are :

HIV asymtomatic (CDC catehory A; more than 500 CD4+ T lymphocytes/mm3)

HIV symptomatic (CDC category B; 200-499 CD4+ T lymphocytes/mm3)

AIDS (CDC category C; fewer than 200 CD4+ T lymphocytes/mm3

1. Risk Factors in HIV Infection
HIV is transmitted through bodily fluids by high-risk behaviors such as heterosexual intercourse with an HIV-infected partner, injection drug use and male homosexual relations. Also at risk are people who received transfusions of blood or blood products contaminated with HIV, Children born in mothers with HIV infections, breast-fed infant of HIV infected mothers and health care workers exposed to needle-stick injury associated with an infected patient.

2. Clinical Manifestations
Symptoms are widespread and may affect any organ system. Manifestations range from mild abnormalities in immune response without overt sign and symptoms to profound immunosupression, life-threatening infection, malignancy, and the direct effect of HIV on body tissues.

Respiratory System

- Shortness of breath, dyspnea, cough, chest pain, and fever are associated with opportunistic infections, including Pneumocyties carinii pneumonia (PCP), the most common infection, and Mycobacterium avium complex (MAC) or Mycobacterium avium intracellular (MAI) which is leading bacterial infection in AIDS patients.
- HIV-associated tuberculosis occurs early in the course of HIV infection, often preceding a diagnosis of AIDS. If diagnosed early, HIV-associated tuberculosis responds well to antituberculosis therapy.

Gastrointestinal System

Loss of appetite, nausea and vomiting, oral and esophageal candidiasis and chronic diarrhea.

Wasting Syndrome

Multyfactorial protein-energy malnutrition, Profound involuntary weight loss exceeding 10% of base line body weight, Chronic diarrhea, chronic weakness and documented intermittent or constant fever with no concurrent illness, Anorexia, Gastrointestinal malabsorption and for some patients a hypermetabolic state.

Neurological complications

- System central (memory deficits, headache, lack of concentration, progressive confusion, psycomotor slowing, apathy and ataxia).
- System Peripheral (pain and numbness in the extremities, weakness, diminished deep tendon reflexes, orthostatic hypotention and impotence.
- Central and peripheral neuropathies, including vascular myelophaty (spastic paraparesis, ataxia and incontinence).
Other neurologic disorder include Toxoplasma gondii, CMV and Mycobacterium tuberculosis infection with symptoms ranging from confusion to blindness, aphasia, paresis and dead.

Integumentary

- Kaposi's sarcoma (KS), herpes simplex and herpes zoster viruses and various form of dermatitis associated with painful vesicles.
- Folliculities, associated with dry flacking skin or atopic dermatities (eczema or psoriasis).

Reproductive System (Female)

- Persistent recurrent vaginal candidiasis may be the first sign of HIV infection.
- Ulcerative sexuallytransmitted diseases such as chancroid, syphillis and herpes are more severe in women with HIV.
- Venereal warts and cervical cancer/cervical intraepithelial neoplasia (CIN) may be noted.
- Women with HIV have a higher incidence of pelvic inflammatory disease (PID) and menstrual abnormalities.

3. Assessment and Diagnostic Methodes
Confirmation of HIV antibodies is done using enzyme immunoassay (EIA; formerly enzyme-linked immunosorbent assay [ELISA]), Western blot assay and viral load tests such as target amplification methods.

4. Medical Management
Currently there is no cure for HIV or AIDS, although researchers continue to work on developing a vaccine. Treatment decisions for an individual patient are based on three factors : HIV RNA (viral load), CD4 T-cell counts and the clinical condition of patient.

The goal of treatment are maximal and durable suppression of viral load, restoration and/or preservation of immunologic function, improvement of quality of life and reduction of HIV-related morbidity and mortality. To determine and evaluate the treatment plan, viral load testing is recommended at diagnosis and then every 3 to 4 months there after in the untreated person. CD4+ T cell counts should be measured at diagnosis and generally every 3 to 6 months thereafter.

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Medical Malpractice

What is Medical Malpractice? Medical Malpractice is a term used for a specific type of negligence on the medical profession. It refers to the negligence of a specially trained or educated person in the performance of his or her job.

Medical malpractice (medical mistake or medical error also called medical negligence) is an act or omission of the best possible medical treatment available by a health care professional in the care of an individual which causes injury or harm to the patient.

The professional medical staff must have had a professional duty toward the person receiving the care, also accurate medical interventions care plan to reduce case of medical malpractice. For example, the Nurse was performing the professional activities of a Nurse for the patient needing the care (in either a paid or volunteer capacity). Additionally, the harm that occurred to this patient or to the property must be based on a failure to act as a prudent professional and in occordance with professional standards in the situation.

Doctors profession also often make a mistake such as failure in diagnosing a disease or a physician who has made the correct diagnosis, may thereafter commit malpractice by failing to properly treat the disease process. Medical malpractice or physician error (negligence) also may responsible for thousands and thousands of cerebral palsy cases.

Medical malpractice may happened during labor and/or delivery, the medical team may make a mistaken such as excessive use of vacuum extraction, fail to follow the necessary steps to ensure a safe delivery and failure to perform a timely cesarean section may result in damage to the motor centers in the brain. So the child was diagnose as cerebral palsy because of medical malpractice case or called medical negligence.

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Discrimination in Nursing

Just simple stuff about discrimination in Nursing. Discrimination in Nursing may accur regarding racial or ethnic background, gender or sex, sexual orientation and age.

1. Racial/Ethnic Discrimination
Racial and ethnic discrimination remain problem in society as a whole and unfortunately, health care system are not immune to these problem. Although there are indications that nurses have moved into greater acceptance of all individuals in advance of some other portions of society, concerns about discrimination remain.

Historically, the American Association of Colored Graduate nurse united with the American Nurses Association (ANA) in 1952, before the general civil rights movement in the United State. There have always prominent nurses of color, such as the past president of the ANA, Beverly Malone, and the current president of the National League for Nursing, Rhetaugh Dumas, and the current president of Sigma Theta Tau, May Wykle, who are all African-American women who have been leaders for all Nursing throughout their long and distinguished careers. They are just three of the many ethnic/racial minority nurses who have made significant contributions to Nursing.

However, the number of minorities in nursing does not reflect the number of minorities in the general populations. Spratley et al (2000) reported that 12,3% of nurses represent minority groups. This contrasts with a general population that has 17% racial/ethnic minorities (U.S. Census Bureau, 1999). This different may stem from many causes, but is of concern because a workforce that reflects the population is more likely to meet the health care needs of that population in a culturally sensitive manner.

Some of the root causes of the lower participation of minorities in nursing have to do with access to education, support for high career goals, economic status, the image of nursing, institutionalize racism, and other general social problems.

A survey minority nurses published by the ANA indicated that many believe that they have been adversely affected by discrimination in nursing profession. Some concerns cited were the perception that others questioned their capabilities and that they were passed over for promotions. To combat this issue, several organizations for ethnic nurses have joined together to create the National Coalition of Ethnic Minority Nurses Associations (Bessent, 2002).

Nurses are challenged to examine this situation and be a part of solution. All of us need to recognize and welcome diversity in the nursing profession. We need to acknowledge that a diversity of views and life experiences will enrich nursing as a profession and support excellent in patient care. When we see discrimination occurring, whether in education or in the workplace, we each need to speak up as agents for change. The National Student Nurses' Association (NSNA) has supported a program called Breakthrough to Nursing, in which nursing student mentor minority individuals in nursing education. These and similar efforts help nursing to move forward as a profession that welcome and provides opportunities for all.

2. Discrimination Against Men
Men in nursing also have expressed concern about sex discrimination. Their concern is not monetary, but is related to being allowed to practice in all areas of nursing and being accepted within the profession.

Anti-male sexism of nurses in the united state was brought to the forefront by the research of Kus (1985), who pointed out that society stereotypes men just as feminists have criticized that it stereotypes women. He made strong case for the importance of nurses examining the stereotypes they hold about men. Stereotypes narrow our thinking and interfere with people being able to develop to their fullest potential. It is important for women in nursing to examine their own behavior and identify whether they have been guilty of perpetuating outmoded stereotypes of the nurse and supporting a type of discrimination toward men that they would fight to eliminate for women.

In some facilities or areas, men are not allowed to care for women clients, or if they are allowed to care for women, restrictions are placed on them in terms of obtaining consent for care from each client. those who support the limitations on the practice of men in nursing state that it is a matter of providing for the modesty and privacy of female clients. This position was upheld by a court decision in favor of a hospital that refused to assign a men to a nursing position in labor and delivery (Arkansas judge..,"1981). The argument was made that the client did not have free choice of a nurse, but rather was assigned a nurse for care and therefore the restrictions were appropriate.

In article in the American Nurse, Ketter (1994) presented the situation of men who have felt discrimination in the workplace based on their gender. One of these men has filed three complaints with Equal Employment Opportunities Commision (EEOC) regarding discrimination in employment in obstetric/gynecologic setting in the 3 years he has been in nursing. His care is expected to end up in federal court.

In interview, Luther Chrisman, PhD, RN, discussed the discrimination that he encountered throughout a long and prestigious career in nursing. His career began with his graduation from a diploma program in 1993 and extended through doctoral studies and a joint position as dean of Rush University and vice-president of nursing for Rush-Presbyterian-St. Luke's Medical Center in Chicago. He identified over acts that excluded him from positions and covert acts that tried to undermine his influence. He identified this as being in issue of power and control just as is sex discrimination against women(Sullivan, 2002).

Those who oppose limitations on the practice of men in nursing state that, as a professional, a nurse (whether a man or women) should always consider the privacy and modesty of client of either gender. This can be done without excluding anyone from providing care in a any area. By careful assessment, the nurse can determine the true needs of the client and plan for appropriate avenues to deliver that care. Furthermore, the point has been made that men physicians have not excluded from any branch of medicine and this has not created problems.

The client does not always choose physicians, either. House staff are assigned, referral are made to specialty physician, and many group plans designate a physician to provide care. Female nurses care for male clients in all situations. This has been accepted because women are see in a nurturing, mothering role that the public associates with nursing.

The American Assembly for Men in Nursing provides a forum for the concerns of men in nursing and those who are concerned about the problems of sex discrimination. This organization seeks to educate people and oppose any limitations on opportunities available for men.

Source : Nursing in Today's World (eighth edition, by Lippincott Williams & Wilkins)

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Management of Shock

Shock is a serious medical condition where the tissue perfusion is insufficient to meet demand for oxygen and nutrients because the body is not getting enough blood flow. This can damage multiple organs and can get worse very rapidly. This hypoperfusional state is a life-threatening medical emergency and one of the leading causes of death for critically ill people.

Major classes of shock include :
1. Hypovolemic Shock (caused by inadequate blood volume)
Hypovolemic shock is an emergency condition in which severe blood and fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.

Blood loss can be due to bleeding from cuts or other injury or internal bleeding such as gastrointestinal tract bleeding. The amount of blood in your body may drop when you lose too many other body fluids, which can happen with diarrhea, vomiting, burns, and other conditions.

Management of Shock
Symptom are :

• Anxiety, restlessness, altered mental state due to decreased cerebral perfusion and subsequent hypoxia.


• Hypotension due to decrease in circulatory volume.


• A rapid, weak, thready pulse due to decreased blood flow combined with tachycardia.


• Cool, clammy skin due to vasoconstriction and stimulation of vasoconstriction.


• Rapid and deep respirations due to sympathetic nervous system stimulation and acidosis.


• Hypothermia due to decreased perfusion and evaporation of sweat.


• Thirst and dry mouth, due to fluid depletion.


• Fatigue due to inadequate oxygenation.


• Cold and mottled skin (cutis marmorata), especially extremities, due to insufficient perfusion of the skin.

Therapy are include :

• Maintain or increase intravascular volume, In hypovolaemic shock, caused by bleeding, it is necessary to immediately control the bleeding and restore the victim's blood volume by giving infusions of balanced salt solutions. Blood transfusions are necessary for loss of large amounts of blood (e.g. greater than 20% of blood volume), but can be avoided in smaller and slower losses. Hypovolaemia due to burns, diarrhoea, vomiting, etc. is treated with infusions of electrolyte solutions that balance the nature of the fluid lost.


• Decrease any future fluid loss via I.V fluid regimen


• Give supplementary O2 therapy to commence replacement of fluids via the intravenous route.

2. Cardiogenic shock (associated with heart problems)
Cardiogenic shock is a disease state where the heart is damaged enough that it is unable to supply sufficient blood to the body. Most common causes are :
a). acute myocardial infarction
b). dilated cardiomyopathy, This is a serious disease in which the heart muscle becomes inflamed (enlarged and stretched) and doesn't work as well as it should.
c). acute myocarditis
d). arrhythmias

Symptoms are :
similar to hypovolaemic shock but in addition:

• Distended jugular veins due to increased jugular venous pressure.


• Absent pulse due to tachyarrhythmia.

Therapy are include :
The main goals of the treatment of cardiogenic shock are the re-establishment of circulation to the myocardium, minimising heart muscle damage and improving the heart's effectiveness as a pump.

• Oxygen (O2) therapy to reduces the workload of the heart by reducing tissue demands for blood flow.


• Administration of cardiac drugs


• Increase heart’s pumping action through medication such as Dopamine, dobutamine, epinephrine, norepinephrine, amrinone

3. Septic shock (associated with infections)
Septic shock is a serious condition that occurs when an overwhelming infection leads to low blood pressure and low blood flow. The brain, heart, kidneys, and liver may not work properly or may fail.

Most common of this case may it’s happened to the patients with Meningococcemia, Waterhouse-Friderichsen syndrome, DIC (disseminated intravascular coagulation), Multiple organ dysfunction syndrome (MODS), Acute Respiratory Distress Syndrome (ARDS).

Symtomps are :
similar to hypovolaemic shock except in the first stages:

• Pyrexia and fever, or hyperthermia, due to overwhelming bacterial infection.


• Vasodilation and increased cardiac output due to sepsis.

Therapy are include :

• Restore intravascular volume via I.V fluid


• Give supplemental O2 therapy


• Identify and control source of infection


• Administer antibiotic


• Remove risk factor for infection

4. Neurogenic shock (caused by damage to the nervous system)
Neurogenic shock is shock caused by the sudden loss of the sympathetic nervous system signals to the smooth muscle in vessel walls. This can result from severe central nervous system (brain and spinal cord) damage. With the sudden loss of background sympathetic stimulation, the vessels suddenly relax resulting in a sudden decrease in peripheral vascular resistance and decreased blood pressure.

Signs and symptoms:
similar to hypovolaemic shock except in the skin's characteristics. In neurogenic shock, the skin is warm and dry.

Therapy are include :

• Large volumes of fluid may be needed to restore normal hemodynamics


• Vasopressors (Norepinephrine)


• Atropine (speeds up heart rate and Cardiac Output)

5. Anaphylactic Shock (caused by allergic reaction)
Anaphylaxis is an severe, whole-body allergic reaction. After an initial exposure to a substance like bee sting toxin, the person's immune system becomes sensitized to that allergen. On a subsequent exposure, an allergic reaction occurs. This reaction is sudden, severe, and involves the whole body.

Common causes include insect bites/stings, horse serum (used in some vaccines), food allergies, and drug allergies.

Symptoms of anaphylaxis are related to the action of Immunoglobulin E and other anaphylatoxins, which act to release histamine and other mediator substances from mast cells (degranulation). In addition to other effects, histamine induces vasodilation of arterioles and constriction of bronchioles in the lungs, also known as bronchospasm (constriction of the airways).

Symptoms can include the following :
Polyuria, respiratory distress, hypotension (low blood pressure), encephalitis, fainting, unconsciousness, urticaria (hives), flushed appearance, angioedema (swelling of the lips, face, neck and throat), tears (due to angioedema and stress), vomiting, itching, diarrhea, abdominal pain, anxiety, impending sense of doom.

Therapy are include :

• Identify and remove causative antigen


• Administer counter-mediators such as anti-histamine


• Oxygen therapy and I.V fluid replacement

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Lung Cancer

Lung Cancer is one of killer disease. Lung cancer is the uncontrolled growth of abnormal cells in one or both of the lungs, usually in the cells lining air passages. Lumps of cancer cells (tumors) then form and disrupt the lung, making it difficult to function properly.

Types of Lung cancer are :

1. Non-small cell lung cancer (NSCLC)
This types are are grouped together because their prognosis and management are roughly identical. Non-small cell lung cancer accounts for about 80 percent of lung cancers with subtypes :

Epidermold carcinoma (also called squamous cell carcinoma) forms in the lining of the bronchial tubes. This kind is the most prevalent type of lung cancer in men.

Adenocarcinoma is found in the mucus glands of the lungs, the most common subtype of NSCLC. This is the most common type of lung cancer in women and among people who have not smoked.

Bronchioalveolar carcinoma is subtype of adenocarcinoma, forms near the lungs’ air sacs. bronchioloalveolar carcinoma is more common in female never-smokers, and may have different responses to treatment.

Large-cell undifferentiated carcinomas, form near the surface of the lungs.

2. Small cell lung cancer (SCLC)
Small cell lung cancer accounts for 20 percent of all lung cancers. Although the cells are small, but they grows rapidly becoming quite large.

Sign and Symptom of Lung Cancer :

Signs and symptoms of lung cancer may take years to appear and may not appear until the disease reaches an advanced stage. Symptoms of lung cancer are varied dependent upon where and how wide-spread the tumor is. Symptoms that suggest lung cancer include:
- dyspnea (shortness of breath)
- hemoptysis (coughing up blood)
- chronic coughing or change in regular coughing pattern
- wheezing
- chest pain or pain in the abdomen
- cachexia (weight loss), fatigue and loss of appetite
- dysphonia (hoarse voice)
- clubbing of the fingernails (uncommon)
- difficulty swallowing

Lung cancer is most common cause by Carcinogens such as those in tobacco smoke, Radiation exposure, Genetic susceptibility, Viral infection.


Lung Cancer Treatment :

Treatment for lung cancer depends on the cancer's type and how far it has spread, also look at the patient's performance status. Common treatments for lung cancer are include surgery, chemotherapy, and radiation therapy.

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Diabetes Mellitus (DM)

What is Diabetes Mellitus? Diabetes Mellitus (DM) is chronic metabolic disorder in which the body does not produce enough insulin or deficiency of insulin. Insulin is a hormone produced in the pancreas, and it is needed to turn sugar and other food into energy.

Type of Diabetus Mellitus :
- Type 1 Diabetes Mellitus
Type 1 on diabetes mellitus called as insulin-dependent diabetes mellitus [IDDM] or juvenile-onset diabetes, is characterized by loss of the insulin-producing beta cells of the islets of Langerhans of the pancreas leading to a deficiency of insulin. Type 1 diabetes usually occurs in children and young adults in which without daily injections of insulin, people with type 1 diabetes won’t survive.

Till now, type 1 diabetes can be treated only with insulin therapy and this treatment must be continued indefinitely. People with diabetes mellitus Type 1 are needed careful monitoring of blood glucose levels using blood testing monitors. Children with significant dehydration, persistent vomiting, serious intercurrent illness, require inpatient management and intravenous rehydration.

- Type 2 Diabetes Mellitus
Diabetes mellitus type 2 called as non–insulin-dependent diabetes mellitus [NIDDM] or adult-onset diabetes, this case due to a combination of defective insulin secretion and insulin resistance or reduced insulin sensitivity (defective responsiveness of tissues to insulin) as heterogeneous disorder, which almost certainly involves the insulin receptor in cell membranes.

Diabetes mellitus type 2 is the most common form of diabetes mellitus and is highly associated with a family history of diabetes, older age, obesity and lack of exercise. Diabetes mellitus type 2 appears most often in middle-aged adults.

In some countries, 20% or more of new patients with diabetes in childhood and adolescence have NIDDM, a change associated with increased rates of obesity. Another case is may have inherited disorders of insulin release leading to maturity onset diabetes of the young (MODY).

Diabetes mellitus type 2 usually treated by attempts to change physical activity (generally an increase is desired) such as exercise, the diet as well as to decrease carbohydrate intake, and weight loss. Then the next treatment for diabetes mellitus type 2 is oral antidiabetic drugs (if necessary).


Certain diseases and drugs can affect the way the body uses insulin and can lead to type 2 diabetes. Diabetes can occur temporarily during pregnancy and also may occur in people with excess production of growth hormone (acromegaly) and in people with certain hormone-secreting tumors. Patient with pancreatitis and other diseases that directly damage the pancreas can lead to diabetes mellitus.

Sign and Symptom of Diabetes Mellitus :
Patients with Diabetes Mellitus has possible systemic signs and symptoms include polyuria (increased frequency of urination), polydipsia (increased thirst), polyphagia (increased appetite), glycosuria, weakness, weight loss, neuropathy, and nephropathy, blurred vision, cuts and bruises that are slow to heal.

The early symptoms of diabetes mellitus are related to the direct effects of high blood sugar levels. Normally, blood glucose levels for fasting (at least eight hours but not more than 16 hours) is 4 to 7MMol/L and less than 10MMol/L two hours after meals.

Acute complications on the diabetes mellitus patients may occur Diabetic ketoacidosis , Nonketotic hyperosmolar coma , Hypoglycemia , and Diabetic coma. Chronic complications may appear as Vascular disease (microvascular disease in which due to damage to small blood vessels and Macrovascular disease, due to damage to the arteries).

Others related cases of Diabetes Mellitus are : Diabetic retinopathy, Diabetic neuropathy, Diabetic nephropathy.

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Nursing Care Plan for MCI

Nursing care plan to the patients with Myocardial Infarction. Patients who suffer Myocardial Infarction they have many symptom include chest pain, shortness of breath, nausea, vomiting, palpitations, sweating, and anxiety or a feeling of impending doom. In physical examination to the patient with Myocardial Infarction cases appear some of general symptom like comfortable, or restless and in severe distress with an increased respiratory rate.

The Nurse in medical care to take an action as nursing intervention they will collecting data and priority nursing care plane according to the patients condition. This is some nursing care plan (NCP) for patients with Myocardial Infarction related to patient condition :



1. Nursing care plan for chest discomfort (pain) due to an inbalance Oxygen (O2) demand supply.
- Asses the severity, location & duration of pain (report)
- Administer O2 with semi-fowler's position
- Obtain a 12 lead ECG during pain
- Monitor vital signs
- Administer Nitroglycerine & Narcotic analgesics as ordered
- Administer & Monitor Thrombolytic therapy
- Ensure rest & sleep, provide a comfortable environment
- Monitor patient's response to drug therapy

2. Nursing care plan for potential Arrhythmias related to decrease cardiac output.
- Monitor cardiac rate, rythm & conduction (report any change)
- Observe vital signs, ECG, urine output, skin temp & colour
- Administer prophylactic anti-arrhythmic & other drugs as ordered
- Administer IV fluids
- Promote physical & mental rest & comfort
- Monitor laboratorium result
- Keep anti-dysrhythmic drugs & defibrillator ready

3. Nursing care plan for respiratory difficulties (dyspnoea) due to decrease CO
- Asses for any dyspnoea, abnormal breath sound (report)
- Ensure propped up position, rest & comfort
- Administer O2 & drugs as ordered
- Psycological support, give liquid diet

4. Nursing care plan for anxiety & fear of death
- Encourage patient & family to express fear or anxiety by interest, listening, caring
- Explain the procedures being done on him
- Psycological & spiritual support
- Administer morphine or other anti-anxiety drug

5. Nursing care plan for activity intolerance related to limitations imposed by Myocardial Infarction
- Explain to the patient if he need Bed rest to decrease O2 consumption
- give liquid diet & stool softners to avoid constipation
- help for personal hygienic activity
- Watch for dyspnoea, chest pain during activity
- Administer O2 as needed

6. Nursing care plan for potential for complications of thrombolytic therapy
- Watch for sign & symptom of bleeding, arrhythmias ect
- Fix cannula for IV medication & blood collection
- Protect patient from any injury
- Monitor bleeding time & coagulation profile
- Keep anti-coagulant antidote ready (protamine sulphate ect)
- Monitor vital signs

7. Nursing care plan for discharge medications, follow up & Health teachings
- Explain the name, purpose & side effect of each medicine
- Ask for regular follow up & continuing medications at home
- Teach about management of chest pain at home
- Teach how to take Nitroglycerine
- Explain diet to avoid large meals, rest after meals
- Ask to seak immediate medical aid if chest pain not relieved after taking GTN and rest.

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Myocardial Infarction (Heart Attack)

Myocardial Infarction (MI) occurs when the blood supply to part of the heart is cut off, Without prompt treatment, this can lead to damage to the affected part of the heart.

Acute Myocardial Infarction sometimes called a heart attack or a coronary thrombosis, It's result when severe prolonged myocardial ischemia cause death & necrosis of the hearth muscle. MI ussually follows the sudden occlusion of coronary artery & abrupt cessation of blood & Oxygen (O2) flow to the hearth muscle resulting in localized necrotic area in myocardium.


The most common site for Myocardial Infarction is the anterior wall of the left ventricle, another site are posterior and inferior wall of the left ventricle. More then half the deaths case of MI occur during the first and second hours before hospitalized, and Majority of hospital deaths occur during the first 24 hours discharged's patient.

1. Risk Factor for Myocardial Infarction

Unavoidable factor such as age, sex (male more then female), heredity (family history of atherosclorosis).

Major (controllable) such as cigarette smoking, hypertension, hyperlipoproteinemia and diabetes Mellitus.

Contributing factors such as obesity, physical activity, emotional stress, excess alcohol use, sometime also effect from oral contraceptives (estrogen).

2. Symptoms of Myocardial Infarction
Patient with Myocardial Infarction has severe chest pain as main symptom, pain may also spread up into your jaw, and down your left arm, or down both arms. Patient may also sweat, feel sick, and feel faint. The pain may be similar to angina, but it is usually more severe and lasts longer. (Angina usually goes off after a few minutes. Myocardial Infarction pain usually lasts more than 15 minutes - sometimes several hours.)


3. Complications of Myocardial Infarction
Complications of Myocardial Infarction include Arrhythmias (abnormal heart rhythms or heartbeat), ischemic shock, pulmonary embolic, cardiac failure, pulmonary edema, reccurrent Myocardial Infarction, cardiac rupture.

4. Rehabilitation for Patient Myocardial Infarction
On this stage the goals is how to give health education to the patient with Myocardial Infarction cases by assist the patient to achieve and maintain optimum helath & a productive life within the limitations.

Develop a programe of progressive physical activity

Give learning guidelines to patient & significant others

Help patient to accept the limitations imposed by illness

Aid patient in adujusting to changes in occupational goals

Modification of risk factors such as :

- control hypertension, hyperglycemia, hyperlipidemia
- changing dietary habits, maintain optimum body weight
- stop smoking, quit alqohol consumption
- regular exercise, avoid strenuous activity
- resuming work after 6 -8 weeks (change to less hard work)
- sexual life after 6 -8 weeks
- follow up medications & regular check ups.
- managing chest pain at home.

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Intravenous Therapy

A. Indications Of Intravenous Therapy:
1. Establish or maintain a fluid or electrolyte balance
2. Administer continuous or intermittent medication
3. Administer intravenous anesthetics
4. Administer fluid to keep vein open (KVO)
5. Administer blood or blood components
6. Administer bolus medication
7. Maintain or correct a patient's nutritional state
8. Administer diagnostic reagents
9. Monitor hemodynamic functions

B. Intravenous Devices :
1. Steel Needles, Example; Butterfly catheter. Mostly used to deliver small quantities of medicines, to deliver fluids via the scalp veins in infants, and sometimes to draw blood samples.

2. Over the Needle Catheters, Example; peripheral IV catheter. This is the kind of catheter you will primarily be using. Catheters (and needles) are sized by their diameter, which is called the gauge. Obviously, the greater the diameter, the more amounts of fluid can be delivered.


C. Intravenous Fluids :
IV fluids are usually an intervention to provide volume replacement, administer medications, including electrolytes, monitor cardiac functions. For example, a patient comes into the ED with gastroenteritis and is dehydrated from vomiting and diarrhea.

There are three main types of fluids:
1. Isotonic fluids, close to the same osmolarity as serum. They stay inside the intravascular compartment, thus expanding it. This fluid can be helpful in hypotensive or hypovolemic patients and alsoc an be harmful. There is a risk of fluid overloading, especially in patients with CHF and hypertension such as Lactated Ringer's (LR), NS (normal saline, or 0.9% saline in water).

2. Hypotonic fluids, it's less osmolarity than serum. This fluid dilutes the serum, which decreases serum osmolarity. Hypotonic fluids is helpful when cells are dehydrated such as a dialysis patient on diuretic therapy, also be used for hyperglycemic conditions like diabetic ketoacidosis, in which high serum glucose levels draw fluid out of the cells and into the vascular and interstitial compartments.

Can be dangerous to use because of the sudden fluid shift from the intravascular space to the cells. This can cause cardiovascular collapse and increased intracranial pressure (ICP) in some patients. Example: .45% NaCl, 2.5% dextrose.

3. Hypertonic fluids, have a higher osmolarity than serum. Pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment. Can help stabilize blood pressure, increase urine output, and reduce edema.

Rarely used in the prehospital setting, care must be taken with their use. Dangerous in the setting of cell dehydration. Examples: D5% .45% NaCl, D5% LR, D5% NS, blood products, and albumin.

Flow Rates :
You will often need to calculate IV flow rates. The administration sets come in two basic sizes:
- Microdrip sets, Allow 60 drops (gtts) / mL through a small needle into the drip chamber (Good for medication administration or pediatric fluid delivery).
- Macrodrip sets, Allow 10 to 15 drops / mL into the drip chamber (Great for rapid fluid delivery. Also used for routine fluid delivery).
- Fluid may be ordered at a KVO rate. This means to Keep the Vein Open, or run in fluids very slowly, enough to keep the vein open, but not really deliver much volume.

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Nursing Care Plan (NCP)

Nursing Care Plan (NCP) is a plan that identifies the individual's needs which provides by a nurse with some guide to interventions necessary to meet those needs and which encompasses all phases of the nurse's process.

Care planning is an essential part of healthcare, The first step in care planning is accurate and comprehensive assessment. Once the initial assessment is completed, a problem list should be generated.

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Development of Preschoolers Children

Children aged 3 to 6 years can be claasified into 2 developmentally distinct group. 3 to 5 years-old children are considered preschoolers, where as children 5 years and older are part of the school-age. Preschoolers children are undergoing significant social development.


1. Physical and Motor Skills.
This is also time of advancement in motor skills. They have the coordination and balance of an adult. They also developing the muscular strength to perform difficult activities, including jumping rope, swimming, riding bicycles hop and climb.

2. Cognitive and Intellectual Development
Preschooler's vocabulary will expand to at least 2,500 word, and can understand as many as 30,000 words.They can tell elaborat stories with complex sentences of 5 to 8 words. They understand and respect roles. They show interest in reading, including independently looking through books, attempting to write letters and number, and listening attentivelly when others read to them.

3. Dietary Changes
Preschoolers generally have a healthy attitude about eating and will eat as a natural response to hunger. They may still have specific food preferences that can vary on a daily basis. They are receptive and vulnerable to media advertisements for popular foods and snacks that may be good-tasting but of poor nutritional quality, dietary habits that begin in these childhood years can impact health later in life.

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Nursing Intervention

What is Nursing Intervention? Nursing intervention means is an action of Nurse that carried out in handling some patient's health problems based on nursing care plan in accordance with the nurse's diagnosis that was determined beforehand by comprehensive system of nursing's standard method.

Nursing interventions are different between one patient to the other patient depend on case or disease, general practice to all specialty areas. Nursing intervention has clinical tool standardizes and defines the knowledge base for nursing curricula and practice, communicates the nature of nursing, and facilitates the appropriate selection of nursing interventions for nurses, including practicing nurses, nursing students, nursing administrators, and faculty.


To provide standardization of expected nursing interventions, better for the nurses if they have a handbook of Nursing Diagnosis, Nursing Care Plans and Nursing interventions classification.

Many handbook are release to help the nurses as pocket guide to determinant of Nursing Diagnosis, Nursing Care Plans and Nursing interventions.

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Pulmonary Hypertension

Hypertension has definitions abnormally high blood pressure that consistently (more than 6 months) above 140/90, called the Systolic blood pressure for the top number and Diastolic blood pressure is the bottom number. A condition of elevated blood pressure that can lead to kidney disease, heart disease and stroke.

Hypertension can occur without apparent or determinable prior organic changes in the tissues, emotional tensions, possibly because of hereditary tendency, hormonal influence, or faulty nutrition. Also can be associated with demonstrable organic changes (as in nephritis, diabetes, and hyperthyroidism).

This time I will let you know about Pulmonary Hypertension.

Pulmonary Hypertension (PHT) is High blood pressure in the arteries that supply to the lungs and makes the heart work harder. Signs of pulmonary hypertension are getting short of breath with activity, having chest pain, feeling tired, Swelling or edema (ankles, legs and eventually abdomen/ascites) also fainting. Then for the symptoms usually limit a person's ability to exercise and do other activities.


Pulmonary hypertension cause by many thing, sometimes the cause is not known so the disorder is called "primary pulmonary hypertension". But if pulmonary hypertension has a known causes by breathing problems (emphysema and chronic bronchitis) or congestive heart failure, birth defects in the heart, chronic pulmonary thromboembolism and the others, called as secondary pulmonary hypertension.

Primary pulmonary hypertension (PPH) is unknown cause that results in the progressive narrowing of the blood vessels of the lungs, causing high blood pressure and eventually leading to heart failure. This is a rare disease but since 2000 According to the research case of primary pulmonary hypertension experienced the fast increase.

Therapies for pulmonary hypertension are Fluid retention, and adequate diuresis, Oxygen supplementation should be provided to hypoxemic patients, either at rest or with exertion or during sleep. Digoxin is often administered for supraventricular arrhythmias or right ventricular dilatation and other medicine belong to the pulmonary hypertension.

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Down Syndrome or Trisomy 21

Down syndrome or trisomy 21 also called mental retardation is a genetic disorder caused by the presence of an extra 21st chromosome in humans. It is described by a British doctor John Langdon Down in 1866.

Pathophysiology : The extra chromosome 21 affects almost every organ system in the body and then make results in a wide spectrum of phenotypic consequences. Down syndrome decreases prenatal viability, increases prenatal and postnatal morbidity. So far, Affected children have delayed physical growth, maturation, bone development, and dental eruption.


Down syndrome Patients have decreased buffering of physiologic reactions, resulting in hypersensitivity to pilocarpine also abnormal responses on sensory-evoked electroencephalographic tracings. Children with leukemic Down syndrome most of them have hyperreactivity to methotrexate.

Physical :

Growth: Short stature and obesity occurs during adolescence.

Behavior: Natural spontaneity, genuine warmth, cheerful, gentleness, patience, and tolerance are characteristics. A few patients exhibit anxiety and stubbornness.

Nose: Hypoplastic nasal bone and flat nasal bridge are typical characteristics.

Mouth and teeth: An open mouth with a tendency of tongue protrusion, a fissured and furrowed tongue, mouth breathing with drooling, a chapped lower lip, angular cheilitis, partial anodontia (50%), tooth agenesis, malformed teeth, delayed tooth eruption, microdontia (35-50%) in both the primary and secondary dentition, hypoplastic and hypocalcified teeth, malocclusion, taurodontism (0.54-5.6%), and increased periodontal destruction are noted.

Abdomen: Diastasis recti and umbilical hernia occur.

Medical Care :

Genetic counseling, If the couple has a child with trisomy 21, the risk of recurrence is about 1%. The risk does not appear to be increased in siblings of affected individuals.

Vaccination and medication

Medical care and monitoring for the adolescent with Down syndrome.

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Alcohol Treatment

What is Alcohol Treatment?

Many medical problems that cause individuals to seek or require medical treatment are related to drug or alcohol abuse. When screening programs identify medical patients who may have alcohol or drug problems, the concern shown by healthcare providers, even during brief encounters or interventions, can provide patients with significant motivation for engaging in the assessment and treatment process.

If you want to stop abusing drugs and alcohol you must have options. Inpatient Residential, Day-Treatment, Outpatient and Alternatives exist and for every individual, there is a way to get sober and stay sober. Private and non-profit agencies in the the world that offer various levels of alcoholism and drug abuse rehabilitation and treatment services.

Many people who are struggling with addiction may appear very successful, affluent and productive to the outside world, however internally they often feel extremely distraught, tortured and fearful of their future after they get perfect alcohol's treatment.

These are four most common types of Alkohol treatment programs; outpatient methadone, outpatient drug-free, long-term residential , and short-term inpatient.

1. Outpatient methadone programs administer the medication methadone to reduce cravings for heroin and block its effects. Counseling, vocational skills development, and case management to help patients access support services are used to gradually stabilize the patients functioning. Some patients stay on methadone for long periods, while others move from methadone to abstinence.

2. Long-term residential programs offer around-the-clock, drug-free treatment in a residential community of counselors and fellow recovering addicts. Patients generally stay in these programs several months or up to a year or more. Some of these programs are referred to as therapeutic communities.

3. Outpatient drug-free programs use a wide range of approaches including problem-solving groups, specialized therapies such as insight-oriented psychotherapy, cognitive-behavioral therapy, and 12-step programs. As with long-term residential treatment programs, patients may stay in these programs for months or longer.

4. Short-term inpatient programs keep patients up to 30 days. Most of these programs focus on medical stabilization, abstinence, and lifestyle changes. Staff members are primarily medical professionals and trained counselors. Once primarily for alcohol abuse treatment, these programs expanded into drug abuse treatment in the 1980s.

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PERITONEAL MESOTHELIOMA CANCER

Mesothelioma is a serious cancer found in the mesothelium (cancer of the mesothelium), a protective sac that covers most of the body’s internal organs including the lungs (called pleura mesothelioma), heart (called pericardium mesothelioma) and abdominal (called peritoneal mesothelioma) organs. Particle cells of the mesothelium become cancerous and grow out of control as mesothelioma cancer most cause by exposure to mineral Asbestos.


Mesothelioma is a very aggressive form of cancer, comes from inhaling the particles of dust as the asbestos degrades; eating away at the lining of your lungs and developing into a deadly cancer. This form of cancer affects people of every race equally, does people who have been diagnosed with mesothelioma has increased significantly in the past 30 years.

Mesothelioma, Between 70-80% of people diagnosed with mesothelioma have been exposed to asbestos, usually in the workplace so more common in men, with a male-to-female ratio of 3:1. They worked in factories, at shipyards, in mines, for the US military, as engineers, as pipefitters, as steel workers, as auto mechanics, and in so many other professions.

Mesothelioma's Diagnosis is the process of ascertaining a disease by its symptoms, signs, and the results of a variety of diagnostic tests.

Sign and Symptom Mesothelioma

Peritoneal Mesothelioma, signs and symptoms usually do not appear until 30+ years after exposure to asbestos. Patients who have peritoneal mesothelioma generally experience abdominal pain, fever, loss of appetite, nausea and abdominal swelling, often in addition to the symptoms of pleural mesothelioma like persistent cough, breathing becomes more restricted and severe chest pain develops. These symptoms are the result of tumors that press against the abdominal wall. In advanced cases of peritoneal mesothelioma, a patient may also develop bowel obstruction or further breathing obstruction due to tumor expansion.

Peritoneal Mesothelioma

Test Diagnosis for Mesothelioma

Peritoneal Mesothelioma's suspects will get order a chest x-ray, CAT Scan, or Magnetic Resonance Imaging (MRI). If mesothelioma is present, imaging tests may show thick, nodular masses on the pleural surface. Other is may choose to perform a needle biopsy to collect a sample of tissue, 40% needle biopsy is accurate.

Mesothelioma with an open biopsy's method is the most accurate diagnostic because a larger tissue sample can be obtained.Cytology testing of the pleural fluid has little value and therefore is not commonly used as a means for diagnosing mesothelioma.

Treatment Peritoneal Mesothelioma

Three traditional kinds of treatment exist for patients with malignant mesothelioma: surgery which removes the cancerous masses from the body, chemotherapy which uses a variety of potent drugs to kill the cancer, and radiation therapy which uses high doses of x-rays to kill the cancer cells and multimodality treatment which involves a combination of all 3 standard strategies (ie, surgery, chemotherapy, radiation).

Alimta (Pemetrexed) Mesothelioma Treatment

The U.S. Food and Drug Administration and Eli Lilly Company announced that Alimta (pemetrexed) would be made available to patients with malignant pleural mesothelioma, It was on July 2002. Alimta is a new antifolate, a type of drug that targets the folic acid metabolic pathway, inhibiting the availability of certain B complex vitamins to fight mesothelioma infections.

The findings: Tumors shrank in 41 percent of patients on Alimta (pemetrexed) in combination cisplatin, a more common chemotherapy treatment. Cisplatin resulted reduced to tumors in 17 percent of patients receiving it. Patients on the Alimta (pemetrexed) cisplatin combination lived nearly three months longer than those on cisplatin alone.


Mesothelioma in related link :

About Peritoneal Mesothelioma
Mesothelioma: Questions and Answers
Mesothelioma from lungdiseases site
Peritoneal Mesothelioma
Peritoneal Mesothelioma Center
Peritoneal Mesothelioma Treatment

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THALASSEMIA ALPHA AND BETA

Thalassemia is one of genetic blood diseases which vary widely in severity. Patient with Thalassemia disease are not able to make enough hemoglobin, which causes severe anemia. Hemoglobin is found in red blood cells and carries oxygen to all parts of the body.

When there is not enough hemoglobin in the red blood cells, oxygen cannot get to all parts of the body. Organs then become starved for oxygen and are unable to function properly.


Hemoglobin contains two different kinds of protein chains named alpha and beta chains. Any deficiency in these chains causes abnormalities in the formation, size, and shape of red blood cells.

People whose hemoglobin does not produce enough alpha protein have alpha thalassemia. It is commonly found in Africa, the Middle East, India, Southeast Asia, southern China, and occasionally the Mediterranean region.

People whose hemoglobin does not produce enough beta protein have beta thalassemia. It is found in people of Mediterranean descent, such as Italians and Greeks, and is also found in the Arabian Peninsula, Iran, Africa, Southeast Asia and southern China.

Thalassemia is always inherited, passed on from parents to children through their genes. A child cannot develop the disease unless both parents carry the thalassemia gene.

The individual with alpha thalassemia will experience no significant health problems except a possible slight anemia which cannot be treated with iron.

The beta thalassemia syndromes are much more diverse than the alpha thalassemia syndromes due to the diversity of the mutations that produce the defects in the beta globin gene. Unlike the deletions that constitute most of the alpha thalassemia syndromes, beta thalassemias are caused by mutations on chromosome 11 that affect all aspects of beta globin production: transcription, translation, and the stability of the beta globin product. Most hematologists feel there are three general categories of beta thalassemia: beta thalassemia trait, beta thalassemia intermedia and beta thalassemia major.

Patients with Beta-Thalassemia Intermedia have varying effects from the disease - mild anemia might be their only symptom or they might require regular blood transfusions.

The most common complaint is fatigue or shortness of breath, heart palpitations (due to the anemia, and mild jaundice, which is caused by the destruction of abnormal red blood cells that result from the disease), bone abnormalities( Because the bone marrow is working overtime to make more red blood cells to counteract the anemia, children can experience enlargement of their cheek bones, foreheads, and other bones).

Beta thalassemia major was first described by a Detroit pediatrician, Thomas Cooley, in 1925. The child born with thalassemia major has two genes for beta thalassemia and no normal beta-chain gene. The child is homozygous for beta thalassemia. This causes a striking deficiency in beta chain production and in the production of Hb A. Thalassemia major is, therefore, a serious disease.

Anemia begins to develop within the first months after birth. It becomes progressively more and more severe. The infant fails to thrive (to grow normally) and often has problems feeding (due to easy fatigue from lack of oxygen, with the profound anemia), bouts of fever (due to infections to which the severe anemia predisposes the child) and diarrhea and other intestinal problems.

Treatment for Thalassemia :

Patients with thalassemia minor usually do not require any specific treatment. Treatment for patients with thalassemia major includes chronic transfusion therapy, iron chelation, splenectomy or removal of the spleen (rarely require splenectomy, although the development of bilirubin stones frequently leads to cholecystectomy), and Bone Marrow or Stem Cell Transplants also other name was called allogeneic hematopoietic transplantation (this is curative in some patients with thalassemia major).

Other Treatments :

People with severe thalassemia are more likely to get infections that can worsen their anemia. They should get an annual flu shot and the pneumonia vaccine to help prevent infections.

Folic acid is a B vitamin that helps build red blood cells. People with thalassemia should take folic acid supplements.

Researchers are also studying other treatments, such as gene therapy and fetal hemoglobin.

Diet for Patient Thalassemia :

Drinking tea may help to reduce iron absorption through the intestinal tract, Vitamin C may improve iron excretion in patients receiving iron chelation. Anecdotal reports suggest that large doses of vitamin C can cause fatal arrhythmias when administered without concomitant infusion of deferoxamine.

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Pulmonary Tuberculosis

X-ray, Tuberculosis is an infectious disease that causes inflammation, the formation of tubercules and other growths within tissue, and can cause tissue death.
These chest X-rays show advanced pulmonary tuberculosis. There are multiple light areas (opacities) of varying size that run together (coalesce).

Arrows indicate the location of cavities within these light areas. The X-ray on the left clearly shows that the opacities are located in the upper area of the lungs toward the back. The appearance is typical for chronic pulmonary tuberculosis but may also occur with chronic pulmonary histiocytosis and chronic pulmonary coccidioidomycosis. Pulmonary tuberculosis is making a comeback with new resistant strains that are difficult to treat. Pulmonary tuberculosis is the most common form of the disease, but other organs can be infected.

Another X-ray on this bellow shows a single lesion (pulmonary nodule) in the upper right lung (seen as a light area on the left side of the picture). The nodule has distinct borders (well-defined) and is uniform in density. Tuberculosis (TB) and other diseases can cause this type of lesion.



Typical signs of tuberculosis are:

- chronic or persistent cough and sputum production. If the disease is at an advanced stage the sputum will contain blood.

- fatigue.

- lack of appetite.

- weight loss.

- fever.

- night sweats.

Tuberculosis can mimic many forms of disease and must always be considered if no firm diagnosis has been made.

Other non-tuberculous mycobacteria found in soil and water can cause disease in susceptible patients with a history of cystic fibrosis, chronic lung damage, alcoholism and immunosuppression (suppression of immune responses by a disease or drugs). These atypical mycobacteria can be present as colonising organisms without necessarily causing disease.
Tuberculosis Treatment

Because administration of a single drug often leads to the development of a bacterial population resistant to that drug, effective regimens for the treatment of TB must contain multiple drugs to which the organisms are susceptible. When two or more drugs are used simultaneously, each helps prevent the emergence of tubercle bacilli resistant to the others. However, when the in vitro susceptibility of a patient's isolate is not known, which is generally the case at the beginning of therapy, selecting two agents to which the patient's isolate is likely to be susceptible can be difficult, and improper selection of drugs may subsequently result in the development of additional drug-resistant organisms.

Hence, tuberculosis is usually treated with four different antimicrobial agents The course of drug therapy usually lasts from 6-9 months. The most commonly used drugs are rifampin (RIF) isoniazid (INH), pyrazinamide (PZA ) and ethambutol (EMB) or streptomycin (SM). When adherence with the regimen is assured, this four-drug regimen is highly effective . Based on the prevalence and characteristics of drug-resistant organisms, at least 95% of patients will receive an adequate regimen (at least two drugs to which their organisms are susceptible) if this four-drug regimen is used at the beginning of therapy (CDC, unpublished data). Furthermore, a patient who is treated with the four-drug regimen, but who defaults therapy, is more likely to be cured and not relapse when compared with a patient treated for the same length of time with a three-drug regimen.

Picture are showing to you about some of TB case's X-ray

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Leukaemia Treatment

Leukaemia is a cancer of the white blood cells, which are produced by the bone marrow. There are two main types: lymphocytic leukaemia (arising from a type of white blood cell called a lymphocyte) and myeloid leukaemia (arising from an immature type of white blood cell called a myeloid stem cell).

The bone marrow produces two main types of white blood cells: granulocytes and lymphocytes. These work together to fight infection in the body. The fully developed white blood cells circulate around the body in the blood.Many patients with chronic leukemias are asymptomatic. Other leukemias present with splenomegaly, fever, weight loss, malaise, frequent infections, bleeding, thrombosis, or lymphadenopathy. Some chronic leukemias enter a blast phase where the clinical manifestations are similar to the acute leukemias.

Chronic myelogenous leukemia (CML) is characterized by an uncontrolled proliferation of granulocytes. Usually an accompanying proliferation of erythroid cells and megakaryocytes is present. Many patients are asymptomatic but may present with splenomegaly, weight loss, malaise, bleeding, or thrombosis.

Chronic lymphocytic leukemia (CLL) represents a monoclonal expansion of lymphocytes. In 95% of cases, CLL is a predominantly malignant clonal disorder of B lymphocytes. The remainder is secondary to a T-cell clone. The neoplastic cell is a hypoproliferative, immunologically incompetent small lymphocyte. There is primary involvement of the bone marrow and secondary release into the peripheral blood. The recirculating lymphocytes selectively infiltrate the lymph nodes, the spleen, and the liver. The majority of patients are asymptomatic at diagnosis. As the disease progresses, lymphadenopathy, splenomegaly, and hepatomegaly develop. A secondary immune deficiency with hypogammaglobulinemia exists.

Acute lymphocytic leukemia (ALL) is a malignant clonal disorder of the bone marrow lymphopoietic precursor cells. In ALL progressive medullary and extramedullary accumulation of lymphoblasts are present that lack the potential for differentiation and maturation. An inhibition of the normal development of hematopoietic cell elements occurs. The clinical presentation is dominated by progressive weakness and fatigue secondary to anemia, infection secondary to leukopenia, and bleeding secondary to thrombocytopenia. When 50% of the bone marrow is replaced then peripheral blood cytopenias are observed.

Acute myelogenous leukemia (AML) is a group of neoplastic disorders of the hematopoietic precursor cells of the bone marrow. AML is subdivided by the French-American-British system into 6 categories depending on the morphology. AML is not a disorder of rapidly proliferating neoplastic cells. The time for one cell division is prolonged with respect to that of normal bone marrow blast cells. A failure of maturation of the neoplastic cell clone exists. The bone marrow is gradually replaced by blast cells. Therefore, the most important complications are progressive anemia, leukopenia, and thrombocytopenia. Chemotherapy is a treatment of an illness or disease with a chemical substance, e.g. in the treatment of cancer.

Treatment for Leukaemia :
1. Chemotherapy
The first treatment for all types of leukaemia is usually Chemotherapy (treatment of an illness or disease with a chemical substance, e.g. in the treatment of cancer). This is a powerful drug treatment that kills the leukaemia cells. Chemotherapy drugs can be given in the form of tablets or injected directly into a Veins (Intravenous or IV).

Sometimes they are injected directly into the fluid around the brain and spinal cord, to destroy any cells that are in the nervous system. How you receive the drugs depends on whether your leukaemia is chronic or acute, and what stage of treatment you are at. The first stage of chemotherapy is called induction. It consists of several sessions each lasting a few days, with rest periods of several weeks in between. Induction is a period of intensive therapy and usually manages to kill most of the cancerous cells.

Induction is usually followed by one or two further cycles of treatment. This is the intensification or consolidation stage, and aims to increase the chances of a cure by continuing to destroy leukaemia cells. In both induction and consolidation, chemotherapy drugs are usually injected directly into a vein.

Finally, there is a stage of maintenance therapy. This is less intensive and the drugs are given as tablets. It can continue for another two years and is designed to kill any remaining leukaemia cells. Steroid drugs are sometimes given at the same time as chemotherapy, to help destroy the leukaemia cells.

2. Bone marrow transplant
Bone marrow is the soft, spongy tissue in the centre of bones that produces blood cells. Bone marrow transplant is also used to treat leukaemia. It can be used in conjunction with chemotherapy to greatly improve the patient’s chances of recovery. It provides the patient with a new set of parent-forming cells(cells that are at an early stage of development, so they still have the ability to turn into any type of cell in the bodystem cells, we called as stem cells ) that can produce healthy new red and white blood cells.

Before a transplant takes place, the patient’s abnormal bone marrow is destroyed through total body radiation, in combination with the drug cyclophosphamide. Bone marrow transplant requires a matched donor (whose cells are compatible with the Leukaemia patient) to donate some of their stem cells. Matched donors may be found among close relatives such as brothers or sisters, or can be from an unrelated donor.

In certain forms of leukaemia it is even possible to take marrow from a person in remission, store it, expose the person to heavy radiation and then replace the original sample to start up the marrow function again. The transplant involves sucking marrow out of the pelvis or breastbone of the donor and injecting it into one of the recipient’s veins. The bloodstream carries the marrow cells to the recipient’s bone marrow, where they settle and begin to produce new cell lines (clones) Certain treatments for leukaemia can have an effect on your fertility (your ability to have children).

Leukaemia's drugs have more effect on fertility than others; radiation prior to bone marrow transplant is very likely to cause infertility, but patients treated with certain chemotherapy drugs will still be able to have children. If you may want to have children in the future, you should discuss options with your hospital consultant prior to treatment, because it is sometimes possible to remove sperm or eggs from your body and store them for future use.

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