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By: H. Ilja, M.S., Ph.D.
Program Director, Center for Allied Health Nursing Education
Objects that contain magnets (eg blood pressure medication list buy benicar 10 mg mastercard, the earpiece of a standard phone; large stereo speakers; magnet therapy products such as mattresses pulse pressure ati buy 10 mg benicar with visa, jewelry arrhythmia vs tachycardia cheap 40 mg benicar mastercard, and wraps) should not be near the generator for longer than a few seconds arrhythmia guidelines discount benicar online amex. Patients are advised to use digital cellular phones on the side opposite the pacemaker generator. Patients should be cautioned to avoid such situations or to simply move farther away from the area if they experience dizziness or a feeling of rapid or irregular heartbeats (palpitations). If such tools are used, precautionary steps such as limiting the welding current to a 60- to 130-ampere range or using electric rather than gasoline-powered chain saws are advised. The metal of the pacemaker generator may trigger some store and airport security alarms, but these alarm systems will not interfere with the pacemaker function. However, the handheld screening devices used in airports may interfere with the pacemaker. Patients should be advised to request a hand search instead of the handheld screening device. Patients also should be instructed to wear or carry medical identification to alert personnel to the presence of the pacemaker. Pacemaker Surveillance Pacemaker clinics have been established to monitor patients and to test pulse generators for impending pacemaker battery failure. Several other factors, such as lead fracture, muscle inhibition, and insulation disruption, are assessed depending on the type of pacemaker and the equipment available. The pacemaker rate and other data concerning pacemaker function are obtained and evaluated by a cardiologist. This simplifies the diagnosis of a failing generator, reassures the patient, and improves management when the patient is physically remote from pacemaker testing facilities. The ap- pearance or increasing frequency of dysrhythmia is observed and reported to the physician. The incision site where the pulse generator was implanted (or the entry site for the pacing electrode, if the pacemaker is a temporary transvenous pacemaker) is observed for bleeding, hematoma formation, or infection, which may be evidenced by swelling, unusual tenderness, unusual drainage, and increased heat. The patient with a temporary pacemaker is also assessed for electrical interference and the development of microshock. Improperly grounded equipment can generate leakage of current capable of producing ventricular fibrillation. Exposed wires must be carefully covered with nonconductive material to prevent accidental ventricular fibrillation from stray currents. The nurse, working with a biomedical engineer or electrician, should make certain that the patient is in an electrically safe environment. Patients, especially those receiving a permanent pacemaker, should be assessed for anxiety. In addition, for those receiving permanent pacemakers, the level of knowledge and learning needs of the patient and the family and the history of adherence to the therapeutic regimen should be identified. Planning and Goals the major goals for the patient may include absence of infection, adherence to a self-care program, effective coping, and maintenance of pacemaker function. The nurse reassures the patient that the responses are normal, then assists the patient to identify realistic goals (eg, develop interest in another activity) and to develop a plan to attain those goals. The nurse may also teach the patient easy-to-use stress reduction techniques (eg, deep-breathing exercises) to facilitate coping. Education (Chart 27-3) may assist a patient to cope with changes that occur with pacemaker treatment. At different times during the healing process, the patient may feel angry, depressed, fearful, anxious, or a combination of these emotions. Although each patient uses individual coping strategies (eg, humor, prayer, communication with a significant other) to manage emotional distress, some strategies may work better than others. Signs that may indicate ineffective coping include social isolation, increased or prolonged irritability or depression, and difficulty in relationships. Nurses often need to include home caregivers in the teaching and provide printed materials for use by the patient and caregiver. Teaching may include the importance of periodic pacemaker monitoring, promoting safety, avoiding infection, and sources of electromagnetic interference (see Chart 27-3). Has white blood cell count within normal range (5,000 to 10,000/mm3) Chapter 27 Management of Patients With Dysrhythmias and Conduction Problems 705 Chart 27-3 Home Care Checklist the Patient With a Pacemaker At the completion of the home care instruction, the patient or caregiver will be able to: Monitor pacemaker function. Electromagnetic interference: Describe the importance of the following: Avoid large magnetic fields such as those surrounding magnetic resonance imaging, large motors, arc welding, electrical substations. Avoid leaning directly over devices, or ensure that contact is brief; place cellular phone on opposite side of generator.
Mark 5 v 11 12: "And the demons begged Him heart attack 45 years old purchase benicar 10mg with amex, saying blood pressure medication zestoretic purchase benicar 10mg amex, Send us to the hogs heart attack low generic 20 mg benicar free shipping, that we may go into them! And the unclean spirits came out of the man and entered into the hogs; and the herd blood pressure quiz nursing cheap benicar online mastercard, numbering about 2000 rushed headlong down the steep slope into the sea and were drowned in the sea. When it is cast out, the human is at peace and the spirit is in torment because it now has no place to fulfil its fallen nature in creation. But first you need to go before God with deep and heartfelt repentance for the sin that allowed the virus to cause the sickness. I also do not yet have all the answers when it comes to the entrance points or spiritual roots behind them. They can damage tissue which then results in an inflammatory reaction cells harboring viruses are damaged by their presence. The hepatitis A and E virus and Rota virus are spread by contamination of food and « 602 » Specific Diseases water with sewage. However it is only when your immune system is weakened by fear, anxiety and stress that these viruses are able to cause infection and sickness. Rhinovirus causes the common cold where you have inflammation of the lining of the nose. The Rhinovirus which causes the common cold is often given the entrance point to cause sickness through the sin of not properly taking care of your body i. This puts your body into a stress state thereby weakening your immune system which gives the virus an opportunity to cause sickness. Your body is also put into a toxic state of stress resulting in a compromised immune system through strife and/or a thought life dominated by fear, anxiety and stress. Other examples of viruses that cause tissue damage are the coxsackie A and B virus, echovirus and other enteroviruses that cause viral meningitis. Meningitis is inflammation of the membranes surrounding the brain and spinal cord it can be caused by viruses as well as bacteria. Another example of tissue damage caused by viruses is encephalitis which is infection and inflammation of the brain. The entrance point for all the viruses mentioned in point 1 is a weakened or damaged immune system because of fear, anxiety and stress. Viruses can cause tissue damage over a long period of time and can lead to degenerative disorders of the nerves. An example of this is the polio virus, which enters the body through the gut and goes to destroy the nerves in the brain and spinal cord. The virus is able to enter the body through the gut as a result of a damaged immune system due to fear, anxiety and stress. The virus causes damage to the cell directly and as a result of an immunological response which is explained in point 5 below. Some viruses have the ability to transform normal cell into cancerous cells that multiply uncontrollably, forming cancerous tumors that spread all over the body. These viruses can also be given an entrance point through the use of contaminated needles used by drug addicts and people who get tattoos. There is also the unfortunate situation of people getting these viruses from blood transfusions but this is rare now that blood is screened for these viruses before it is given to a patient. This enables the viral infections to become dormant for a while (they usually hide in the nerve roots), and then under certain circumstances to be reactivated and flare up again. Early in childhood it causes chicken pox and then later in adult life it flares up again as Shingles. Shingles most commonly manifests as a vesicular rash on the chest or upper part of the back or in the cornea of the eye with pain in the area of the rash. Less commonly it can cause paralysis of the face, loss of taste on one side of the tongue and ulcers on the cheeks (Ramsay Hunt syndrome) or bladder and bowel dysfunction. It flares up again because of weakening of the immune system due to the high levels of stress hormones in stage 2 and 3 of stress (stage 2 and 3 of stress is explained in the chapter on page 178). There is a second component to shingles which is self-rejection and selfhatred - this is an autoimmune reaction which is explained in point 5 below. The rash in chicken pox and shingles is due to excessive secretion of histamine and persistent nerve stimulation and irritation which are reactions that occur as part stage 2 and 3 of stress. Many dormant viruses are often released again in conjunction with fear, anxiety and stress, which weakens the immune system. Another virus that lies dormant in the nerves and then flares up again is the herpes simplex virus.
Untreated pericardial effusion and cardiac tamponade lead to circulatory collapse and cardiac arrest arteria fibularis discount benicar 20 mg without a prescription. In malignant effusions arteria revista benicar 20 mg for sale, pericardiocentesis provides only temporary relief; fluid usually reaccumulates arrhythmia dance company purchase benicar pills in toronto. Windows or openings in the pericardium can be created surgically as a palliative measure to drain fluid into the pleural space blood pressure difference in arms buy benicar canada. Catheters may also be placed in the pericardial space and sclerosing agents (such as tetracycline, talc, bleomycin, 5-fluorouracil, or thiotepa) injected to prevent fluid from reaccumulating. Medical Chemotherapy, biologic response modifier therapy, radiation therapy, or surgery is used to treat the underlying cancer. Clots are deposited in the microvasculature, placing the patient at great risk for impaired circulation, tissue hypoxia, and necrosis. In addition, fibrinolysis occurs, breaking down clots and increasing the circulating levels of anticoagulant substances, thereby placing the patient at risk for hemorrhage. The release of intracellular contents from the tumor cells, leads to electrolyte imbalances-hyperkalemia, Clinical Clinical manifestations depend on the extent of metabolic abnormalities. Medical Fluid intake range limited to 500 to 1,000 mL/day to increase the serum sodium level and decrease fluid overload. When neurologic symptoms are severe, parenteral sodium replacement and diuretic therapy are indicated. Electrolyte levels are monitored carefully to detect secondary magnesium, potassium, and calcium imbalances. If water excess continues despite treatment, pharmacologic intervention (urea and furosemide) may be indicated. Medical To prevent renal failure and restore electrolyte balance, aggressive fluid hydration is initiated 48 hours before and after the initiation of cytotoxic therapy to increase urine volume and eliminate uric acid and electrolytes. Critical Thinking Exercises You are seeing a married couple in their 70s in the clinic for blood pressure checks. How would you respond if your suggestions for cancer screening are met with the answer that they are too old to worry about cancer? What special considerations are there if the woman has a physical disability that requires her to use a wheelchair? A 54-year-old woman with bone metastases secondary to breast cancer has been admitted to the hospital with a diagnosis of hypercalcemia. Describe the underlying cause of hypercalcemia and the medical and nursing management strategies that are anticipated. What patient monitoring would be essential before and after treatment of hypercalcemia? One of your home care patients, a 42-year-old executive of a major corporation, has a nonresectable malignant brain tumor for which she is receiving radiation therapy. She is being discharged from the hospital and will continue therapy as an outpatient. She is also concerned about her ability to carry out her executive responsibilities. What assessment by the nurse is indicated at this point, and what actions would be warranted by the nurse to help the patient and her husband deal with their concerns? A 70-year-old man with advanced cancer living at home with his wife has been experiencing increasingly severe pain for which an oral opioid analgesic has recently been prescribed. How would you modify your teaching if the patient and his wife understand little English? Tamoxifen for prevention of breast cancer: Report of the National Surgical Adjuvant Breast and Bowel Project P-1 study. Intraoperative lymphatic mapping and sentinel lymph node dissection in breast cancer. A research review of current treatment for radiation-induced oral mucositis in patients with head and neck cancer. Oral mucositis and the clinical and economic outcomes of hematopoietic stem-cell transplantation. American Cancer Society guidelines for the early detection of cancer: Update of early detection guidelines for prostate, colorectal and endometrial cancers. Use of complementary med- Agency for Health Care Policy and Research, Public Health Service, Department of Health and Human Services. Agency for Health Care Policy and Research, Public Health Service, Department of Health and Human Services.
Sometimes a person dies because the multiple sclerosis gets so severe that even the muscles needed for breathing do not work or there is severe damage to the nerves in the brain and spinal cord blood pressure chart please purchase benicar overnight delivery. There is no disease that is incurable with God when His conditions for healing are met blood pressure goes up when standing discount benicar 20mg line. As you read in the chapter on autoimmune diseases arrhythmia management institute of south florida order benicar 20mg with visa, when you are attacking yourself spiritually with thoughts of self-hatred blood pressure newborn order benicar, self-rejection, self-condemnation, self disapproval, guilt and condemnation, your brain will eventually convert that into a physical reaction and your body begins to attack and destroy itself physically. You see, the father is responsible for the spiritual welfare of the family (see Ephesians 5 v 22 25). When you learn to love yourself, your new thinking patterns will be converted into a physical reaction, which this time is healthy. Your immune system will recover and begin functioning as God originally designed it to , and will no longer attack and destroy its own body tissue. In the Name of Jesus you need to command the immune system to stop attacking the nerves and operating in the gift of miracles you need to speak new nerves into being. Insomnia (Inability to Sleep) nsomnia is our perception of poor quality of sleep because we have difficulty falling asleep, we wake up frequently during the night, we wake up too early or we feel un-refreshed after sleep. When we are deprived of sleep, we cannot function properly and our health deteriorates. Lack of sleep causes tiredness, difficulty in concentrating, lack of energy, irritability, muscle pain (fibromyalgia) and predisposes us to infections by weakening our immune system. There are many medical conditions that can cause insomnia, especially those that cause pain for example arthritis or problems with breathing such as asthma, heart failure and sleep apnea. When the spiritual roots behind those diseases are dealt with, the disease along with insomnia will fall away. A disturbance in the sleep-wake cycle commonly develops with jet lag and in shift workers or somebody who has a continually Insomnia is a disrupted sleep/wake schedule. This is not abnormal, and with the practice recognized fear, anxiety of good sleep hygiene (explained on the following page), it should normalize after a short period of time. There are also several drugs that have insomnia as a side effect such as appetite suppressants, Ritalin, steroids, drugs used to treat asthma and some drugs that are used to treat high blood pressure. If you are taking chronic medication have a look at the package insert or speak to your local pharmacist to find out if insomnia is a possible side effect. Apart from the above scenarios, insomnia is a recognized fear, anxiety and stress disorder. When there is fear, anxiety and stress in your thought life, the hypothalamus responds to this emotional and spiritual conflict by stimulating an area in your brain called your reticular activating system that wakes you up. This is why stressful life events such as tragedy, breaches in relationships, strife, abuse, victimization, unrest, worrying about the future, fears and so on are enough to keep you awake at night. After the initial stressful event that causes the insomnia, some people become pre-occupied with lack of sleep where they fear trying to get to sleep, expect to have difficulty sleeping and worry about it. Fear I « 442 » Specific Diseases of not being able to sleep will only compound the problem and cause the vicious cycle to perpetuate. You may not be at peace with God, simply because you are not obeying Him you are not doing what He has called you to do. You may not be at peace with yourself because you have conflict with yourself over an issue. How many "could have", "would have", "should have", "if only" statements have you made today? When you think like this you waste precious time building up a toxic thought that releases chemicals that put your body into a toxic state of stress which will inhibit the way in which you function. They think that God must be so disappointed and angry with them for all their failures and shortcomings. I purposely said how much time is wasted because that is precisely what that kind of thinking is a waste of time. Every time the devil brings a condemning thought to your mind, quote Romans 8 v 1 to him and tell him to take his condemnation and "Hit the road Jack! You need to stop hitting yourself over the head with something that God has forgiven and forgotten (Hebrews 10 v 17). This does not mean that you are perfect and will never mess up again, it just means that you can go on with your life without being weighed down with a constant burden of guilt and condemnation for what happened in the past.
Because of decreased perfusion to the kidneys and liver blood pressure chart during the day buy benicar paypal, serum concentrations of antibiotic agents that are normally cleared by these organs may increase and produce toxic effects blood pressure medication video buy benicar 10mg without a prescription. If the patient complains of pain in the calf heart attack symptoms in women generic benicar 20 mg with mastercard, the sign is positive and suggestive of deep vein thrombosis blood pressure medication lotrel purchase discount benicar line. Administering heparin or low-molecular-weight heparin (Lovenox) as prescribed, applying elastic compression stockings, or initiating pneumatic compression of the legs may prevent thrombus formation. Performing passive range of motion of the immobile extremities helps promote circulation. Patients who have experienced a spinal cord injury may not report pain caused by internal injuries. Therefore, in the immediate postinjury period, the nurse must monitor the patient closely for signs of internal bleeding that could lead to hypovolemic shock. This process requires that the patient has previously been exposed to the substance. An antigenantibody reaction provokes mast cells to release potent vasoactive substances, such as histamine or bradykinin, that cause widespread vasodilation and capillary permeability. Because anaphylactic shock occurs in patients already exposed to an antigen who have developed antibodies to it, it can often be prevented. Therefore, patients with known allergies need to understand the consequences of subsequent exposure to the antigen and should wear medical identification that lists their sensitivities. This could prevent inadvertent administration of a medication that would lead to anaphylactic shock. Additionally, the patient and family need instruction about emergency use of medications to treat anaphylaxis. This can be caused by spinal cord injury, spinal anesthesia, or nervous system damage. It can also result from the depressant action of medications or lack of glucose (eg, insulin reaction or shock). Neurogenic shock may have a prolonged course (spinal cord injury) or a short one (syncope or fainting). It is characterized by dry, warm skin rather than the cool, moist skin seen in hypovolemic shock. Another characteristic is bradycardia, rather than the tachycardia that characterizes other forms of shock. Medical Management Treatment of neurogenic shock involves restoring sympathetic tone either through the stabilization of a spinal cord injury or, in the instance of spinal anesthesia, by positioning the patient properly. Further discussion of managing the patient with a spinal cord injury is presented in Chapter 63. Medical Management Treatment of anaphylactic shock requires removing the causative antigen (eg, discontinuing an antibiotic agent), administering medications that restore vascular tone, and providing emergency support of basic life functions. Diphenhydramine (Benadryl) is administered to reverse the effects of histamine, thereby reducing capillary permeability. Nebulized medications, such as albuterol (Proventil), may be given to reverse histamine-induced bronchospasm. If cardiac arrest and respiratory arrest are imminent or have occurred, cardiopulmonary resuscitation is performed. Intravenous lines are inserted to provide access for administering fluids and medications. Nursing Management It is important to elevate and maintain the head of the bed at least 30 degrees to prevent neurogenic shock when a patient is receiving spinal or epidural anesthesia. Elevation of the head of the bed helps to prevent the spread of the anesthetic agent up the spinal cord. In suspected spinal cord injury, neurogenic shock may be prevented by carefully immobilizing the patient to prevent further damage to the spinal cord. Nursing interventions are directed toward supporting cardiovascular and neurologic function until the usually transient episode of neurogenic shock resolves. Applying elastic compression stockings and elevating the foot of the bed may minimize pooling of blood in the legs. When new allergies are identified, the nurse advises the patient to wear or carry identification that names the specific allergen or antigen. Patients who have a penicillin allergy may also develop an allergy to similar medications. For example, they may react to cefazolin sodium (Ancef) because it has a similar antimicrobial action of attaching to the penicillin-binding proteins found on the walls of infectious organisms.
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