Source: http://circ.ahajournals.org/cgi/content-nw/full/111/23/e394/TBLIB
Echocardiographic Features That Suggest Potential Need for Surgical Intervention
Vegetation
Persistent vegetation after systemic embolization
Anterior mitral leaflet vegetation, particularly with size >10 mm* embolic events during first 2 wk of antimicrobial therapy*
Increase in vegetation size despite appropriate antimicrobial http://circ.ahajournals.org/math/dagger.gif
Valvular dysfunction
Acute aortic or mitral insufficiency with signs of ventricular http://circ.ahajournals.org/math/dagger.gif
Heart failure unresponsive to medical http://circ.ahajournals.org/math/dagger.gif
Valve perforation or http://circ.ahajournals.org/math/dagger.gif
Perivalvular extension
Valvular dehiscence, rupture, or http://circ.ahajournals.org/math/dagger.gif
New heart http://circ.ahajournals.org/math/dagger.gif
Large abscess or extension of abscess despite appropriate antimicrobial http://circ.ahajournals.org/math/dagger.gif
See text for more complete discussion of indications for surgery based on vegetation characterizations.
Surgery may be required because of risk of embolization.
Surgery may be required because of heart failure or failure of medical therapy.
Echocardiography should not be the primary modality used to detect or monitor heart block.
Source: http://circ.ahajournals.org/cgi/content-nw/full/111/23/e394/TBLIB
V. Nursing Care
According to the work of Estlow (1998) in the work entitled: Prevention of Infective Endocarditis in the Pediatric Congenital Heart Population. "Nursing's role and responsibility is to convey the appropriate…...
mlaReferences
Endocartis: What is Endocartitis? Online availble at http://www.heartpoint.com/endocarditis.html .
Ferrieri, P. MD, et al. (2005) Infective Carditis - From the Committee on Rheumatic
Fever, Endocaritis and Kawasaki Disease of the American Heart Association Council on Cardiovascular Disease in the Young. AHA Journal 105 (17):
2115. (2002) Online available at http://circ.ahajournals.org/cgi/reprint/105/17/2115 .
Endocarditis, a heart condition, "is an infection of the inner lining of the heart," the inner lining being the endocardium (Mayo Clinic Staff). According to the Mayo Clinic, the condition "typically occurs when bacteria or other germs from another part of [one's] body....spread through the bloodstream and attach to damaged areas in [the] heart" (Mayo Clinic Staff, 2011). Endocarditis has the ability to damage or completely destroy the heart when left untreated and can also lead to life-threatening complications; there are treatments that include antibiotics and, in sometimes more severe cases, surgery (Mayo Clinic Staff, 2011). To truly understand the heart condition, it would be useful to evaluate some causes, symptoms, risk factors, explore some clinical trials on the condition, and ultimately, treatments for the condition and prevention methods.
Foremost, the causes, symptoms and risk factors of endocarditis are important to explore in detail to better understand the heart condition. Endocarditis,…...
mlaBibliography
Levy, Daniel. (2010, May 7). Infectious endocarditis. Retrieved from http://health.nytimes.com/health/guides/disease/infectious-endocarditis/overview.html
Mayo Clinic Staff, Initials. (2011, August 11). Endocarditis. Retrieved from http://www.mayoclinic.com/health/endocarditis/DS00409
U.S Department of Health and Human Services, Initials. (n.d.). What causes endocarditis?. Retrieved from http://www.nhlbi.nih.gov/health/dci/Diseases/endo/endo_causes.html
Quality Development in Advanced Practice field knowledge in nursing: Proposal on Enhancing the dental health of children suffering Congenital Heart Disease
One of the most prevalent development abnormalities found in children is heart disease, and it occurs in about 8-10 in every 1, 000 births. Dental supervision of children with congenital heart problems calls for special care, due to their increased susceptibility to contagious endocarditis, which is associated with bacteremia caused by persistent dental processes. Additionally, these patients always have developmental enamel abnormalities that raises caries risk, and always have deprived oral health. This latter condition may be said to be due to cardiac health problems, whose care and attention may lead to the under-estimation of oral health and inadequate consideration. Additionally, continual administration of liquid drugs containing sucrose as sweetener may cause caries and gingivitis cases in children (Andersson et al. 2013a). Dental ailment may cause dental extractions in young…...
mlaReferences
Andersson, A-C., Elg, M., Perseius, K-I. & Idvall, E. (2013a) Evaluating a questionnaire to measure improvements initiatives in Swedish healthcare. BMC Health Services Research, 13(48)
Andersson, A-C., Idvall, E., Perseius, K-I. & Elg, M. (2013b) Sustainable Outcomes of an Improvement Program: Do Financial Incentives Matter? Total Quality Management & Business Excellence
Balmer, R., Booras, G. & Parsons, J. (2010). The oral health of children considered very high risk for infective endocarditis. Int J Paediatr Dent. 20(3):173-8
Frankl, S.N., Shiere, F.R., Fogels, H.R. (1962). Should the parent remain with the child in the dental operatory? J Dent Child.29:150-163.
Clicking on the links reveals that some of the topics provide more information and information in different formats than others. For example, the Aging Driver topic lists the following clickable PDF files:
Tips for Safe Driving, How to Help the Older Driver, Getting by Without Driving, Am I a Safe Driver?, and Successful Aging Tips.
Other topics, such as Health Disparities, do not provide information directly but only link the user to external resources and other databases. This might discourage many users, especially those unfamiliar with online research hoping to find printable information with a minimum of further searching online. Meanwhile, another topic, Breastfeeding, does provide easily accessible information that includes illustrative diagrams along with the text-based information, as depicted below.
How should I hold my baby while breastfeeding?
You can hold your baby in a number of ways. Your baby shouldn't have to turn his or her head or strain his or her…...
Vancomycin should be given for at least 60 minutes. The initial dosage for pediatrics with renal impairment is not less than 15 mg/kg per day or 15 times the GF in mL/min. Premature infants should have longer dosing intervals. PO administration should be 40 mg/kg/day in 3-4 divided doses for 7-10 days. The maximum is 2,000 mg/day, which may be diluted in 1 oz of water or administered through an NG tube (PD).
Contraindications
Vancomycin is contraindicated to patients with hypersensitivity to vancomycin (Drug.com, 2012). Commercially prepared frozen Vancomycyn Hydrochloride injections in 5% dextrose may also be contraindicated to those with known allergic reaction to corn or corn products (Drug.com).
Drug-Drug Interactions
The patient should inform the doctor or pharmacist of all prescription and non-prescription or herbal products currently used (Medicine Net, 2012; Levinson, 2012). Aminoglycosides, amphotericin B, other antibiotics, and live bacterial vaccines are special mentions. If treatment requires anesthesia, the doctor…...
mlaReference: PDR Network LLC.
Retrieved on April 20, 2012 from http://www.pdr.net/drugpages/concisemonograph.aspx?concise=688
Treatment to Patients
The main objective of providing treatment to patients is to relieve symptoms along with decreasing the progression of the disease as well as the mortality or morbidity. However, in some cases, this objective is not fully achieved, especially in the case of the patients who are admitted to the ICU with some serious and almost always a terminal stage of the disease. For example, when old patients are admitted in the ICU, their immunity is extremely low and this is the perfect time for the opportunistic infections to make matters worse for these patients. There are many infections that are specifically associated with patients admitted in the hospitals. Pseudomonas Aurigeonosa is a micro-organism that is well documented to cause bacterial pneumonia and bacteremia in the patients who are terminally ill and are receiving treatment in the hospital setting. Since most of the patients in the ICU are…...
mlaBibliography:
Beekmann, SE;Diekema, DJ; Chapin, KC;Doern, GV (2003) Effects of rapid detection of bloodstream infections on length of hospitalization and hospital charges.J ClinMicrobiol, 41:3119-3125.
Boussekey, N, Leroy, O, Georges, H, Devos, P, d'Escrivan, T, Guery, B (2005).Diagnostic and prognostic values of admission procalcitonin levels in community-acquired pneumonia in an intensive care unit.Infection, 33:257-263.
Charles, PE, Dalle, F, Aho, S, Quenot, JP, Doise, JM, Aube, H, Olsson, NO, Blettery, B: Serum procalcitonin measurement contribution to the early diagnosis of candidemia in critically ill patients. Intensive Care Med, 32:1577-1583.
Digiovine, B; Chenoweth, C; Watts, C; Higgins, M (1999)The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J. RespirCrit Care Med, 160:976-981.
This became more so with the advancement of molecular iology Tests. Subsequently a group of clinicians met in Ghent elgium and came up with the current diagnostic criteria known as the Ghent Nosology. (De Paepe et al. 1996) Similar to the erlin Nosology the Ghent criteria was based on clinical findings in the various organ systems as well as the nature of family history and relationships, a major criteria was classified as which has a high diagnostic specificity because it was less frequent in other conditions and in the general population. A point of divergence from the erlin Nosology was the conversion of minor criteria in the skeletal system into major criteria. For one to be diagnosed with Marfan's the patient must have a first degree relative diagnosed with the disease in addition two systems must be involved with one having a major sign. In the absence of a…...
mlaBibliography
Beighton, P., de Paepe, a., Danks, D., Finidori, G., Gedde-Dahl, T., Goodman, R., Hall, J.G., Hollister, D.W., Horton, W., McKusick, V.A., Opitz, J.M., Pope, F.M., Pyeritz, R.E., Rimoin, D.L., Sillence, D., Spranger, J.W., Thompson, E., Tsipouras, P., Viljoen, D., Winship, I., Young, I (1988). International nosology of heritable disorders of connective tissue. Am. J. Med. Genet. 29: 581-594,
Borger F (1914): Uber zwei Falle von Arachnodaktylie. Zschr Kinderheilk 12: 161 -1-84.
Baer RW, Taussig HB, Oppenheimer EH (1943): Congenital aneurysmal dilatation of the aorta associated with arachnodactyly. Bull Johns Hopkins Hosp 72:309-33 1.
De Paepe, a., Devereux, R.B., Dietz, H.C., Hennekam, R.C.M., Pyeritz, R.E.( 1996) Revised diagnostic criteria for the Marfan syndrome. Am. J. Med. Genet. 62: 417-426
Another caution that exists for people suffering from lupus is to exercise caution before and after receiving dental treatment. Lupus patients could develop serious heart infections from the streptococci that might be released into their bloodstream during routine dental procedures, even bi-annual teeth cleanings (Blau and Schultz, 174). The infection can travel to the heart when the patient has certain other manifestations of lupus, and, if the patient has developed a condition called verrucous endocarditis, then it can be deadly if the streptococci infect the heart (Blau and Schultz, 174). Therefore it is strongly recommended that prior to and following dental procedures and cleanings that lupus patients receive antiobiotics that can help them to be prepared to defend their body against the streptococci (Blau and Schultz, 174-175).
The antibiotic -- usually amoxicillin, or another member of the penicillin family, or erythromycin in cases of penicillin allergy -- is taken an hour…...
mlaWorks Cited
http://www.questiaschool.com/PM.qst?a=o&d=91348305
Blau, Sheldon Paul, and Dodi Schultz. Living with Lupus: All the Knowledge You Need to Help Yourself. Cambridge, MA: Perseus Books, 1993. Questia. 21 Nov. 2008 http://www.questia.com/PM.qst?a=o&d=91348486 .
De Rossi, Scott S. DMD, and Glick, Michael, DMD. Lupus Erythematosus: Considerations for Dentistry. Journal American Dental Association, vol 129, March, 1998, 330-339.
A www.questiaschool.com/PM.qst?a=o&d=111488560
One possible explanation for the differences observed in the studies could be that the strengths of the chlorhexidine solution were different. It could also be that over time more effective techniques have been developed in the application of the solution, as the results do appear to improve over time.
There are limitations to the methodology of the study which are centered on the use of secondary data for analysis. The use of secondary data allows a wider range of data to be gathered from across the U.S. than would be practical from primary data collection which is the reason for the choice in this study. However this puts the control of several variables beyond the researcher. The results of the techniques may have been affected by the application of different individuals, departments and hospitals, all of whom may vary techniques and other factors influencing the success of these techniques. The…...
mlaReferences
Adams, D., Quavum, M., Worthington, T., Lambert, P., & Elliott, T. (2005). Evaluation of a 2% chlorhexidine gluconate in 70% isopropyl alcohol skin disinfectant. Journal of Hospital Infections, 61 (4), 287-290.
Brungs, S., & Render, M. (2006). Using Evidence-Based Practice to Reduce Central line Infections. Clinical Journal of Oncology Nursing, 10 (6), 723-725.
CDC. (2002). Guidelines for Prevention of Intravascular Catheter-Related Infections. Morbidity and Mortality Weekly Report; Recommendations and Reports, 51 (RR-10), 1-34.
CDC Mission. (n.d.). Retrieved February 6, 2006, from CDC Web site: http://www.cdc.gov/about/mission.htm
prokaryotes consist of millions of genetically distinct unicellular organisms. A procaryotic cell has five essential structural components: a genome (DNA), ribosomes, cell membrane, cell wall, and some sort of surface layer which may or may not be an inherent part of the wall (1). Functional aspects of procaryotic cells are related directly to the structure and organization of the macromolecules in their cell make-up, i.e., DNA, RNA, phospholipids, proteins and polysaccharides. Diversity within the primary structure of these molecules accounts for the diversity that exists among procaryotes (1). Identifiable groups of prokaryotes are assembled based on easily observed phenotypic characteristics such as Gram stain, morphology (rods, cocci, etc.), motility, structural features (e.g. spores, filaments, sheaths, appendages, etc.), and on distinguishing physiological features (e.g. anoxygenic photosynthesis, anaerobiasis, methanogenesis, lithotrophy, etc.). Prokaryotes are commonly known as bacteria, and it is estimated that bacteria have been around for at least 3.5 billion…...
mlaBIBLIOGRAPHY
1. Bergey's Manual of Systematic Bacteriology (2nd Edition). 1989. Williams, S.T., Sharpe, M.E., Holt J.G. Lippincott Williams & Wilkins
2. Breiman RF, Butler JC, Tenover FC, Elliott JA, Facklam RR. (1994). Emergence of drug-resistant pneumococcal infections in the United States. JAMA. 1994 Jun 15;271(23):1831-5.
3. Center for Disease Control and Prevention. Antibiotic/Antimicrobial resistance. http://www.cdc.gov/drugresistance/actionplan/html/
4. Jones RN, Pfaller MA (1998). Bacterial resistance: a worldwide problem. Diagn Microbiol Infect Dis. Jun;31(2):379-88.
Acupuncture is an ancient practice of the East with a long history, which has been incorporated into modern Western use, and has been met with mixed reviews by the public and scientific communities.
The History of Acupuncture
The Origins of Acupuncture
Early tools and methods
Early texts
Evolution of Acupuncture
Moxabustion
F. Development of schools and comprehensive Texts
Eastern Medicine Meets the Modern West
Medical Missionaries to China
Adoption of Western Practice
The Decline of Acupuncture
Communist Support for Acupuncture
Regrowth and new methods
Acupuncture in Use Today
FDA Approved Needles
Growing Popularity
Universities and Physicians
New variations on Acupuncture
E. Why Western Medicine Fails
Arguments Against Acupuncture
A. The skeptics
. Risks
C. How to avoid Risks
Scientific Proof and Conclusion
A. Studies have varying conclusions
. Remains widely used by prestigious medical institutions and private practitioners
C. Acupuncture makes people feel better, therefore it works
Acupuncture
Although there is a great deal of controversy surrounding alternative forms of healing today, many forms of natural or complimentary medical treatments seem to be more popular today than any time…...
mlaBibliography
Carroll, Robert Todd. "Acupuncture." The Skeptic's Dictionary. 2003. http://www.skepdic.com/acupunc.html
Dold, Catherine. "Needles & Nerves - Evidence of the Effectiveness of Acupuncture." Discover. September 1998.
Ellis, Andrew, Wiseman, Nigel, and Boss, Ken. Fundamentals of Chinese Acupuncture. Boston: Paradigm Publications, 1991.
Findlay, Steven; Podlosky, Doug; and Silberner, Joanne. "Acupuncture." U.S. News & World Report. 23 September 1991.
Tetralogy of Fallot: Literature eview
Tetralogy of Fallot is a congenital heart defect associated with systemic cyanosis, accounting for approximately 5 to 6% of all cases of congenital heart disease and is characterized by; ventricular septal defect, aortic override, pulmonary stenosis and right ventricular hypertrophy. It is the most common cause of blue baby syndrome with children diagnosed developing Tet spells. Sudden increases in cyanosis followed by syncope characterize Tet spells and may result in hypoxic brain injury and death. Environmental and genetic disorders are other causes of TOF; always associated with chromosome 22 deletions and DiGeorge syndrome and occurs slightly more often in males than in females. If left untreated, Tetralogy of Fallot rapidly results in progressive right ventricular hypertrophy due to the increased resistance on the right ventricle. This progresses to dilated cardiomyopathy which begins in the right heart chambers often leading to left heart failure. Actuarial survival for…...
mlaReferences
Digilio, M.C., Casey, B., Toscano, A., Calabro, R., Pacileo, G., Marasini, M., et al. (2001). Complete Transposition of the Great Arteries: Patterns of Congenital Heart Disease in Familial Precurrence. Journal of the American Heart Association, 2809-2814.
Gelson, E., Gatzoulis, M., Lupton, M., Steer, P., & Johnson, M. (2008). Tetralogy of Fallot: Maternal and Neonatal Outcomes. British Journal of Obstetrics and Gynaecology, 398-402.
Jing-bin, H., Ying-long, L., Pei-wu, S., Xiao-dong, L., Ming, D., & Xiang-ming, F. (2010). Molecular Mechanisms of Congenital Heart Disease. Cardiovascular Pathology, 183-193.
Marshall, J. (2007). Caring for the Child with a Cardiovascular Condition. Maternal-Child Nursing Care, 853-884.
Psuedomonas Aeruginosa
Pseudomonas aeruginosa
Epidemiology
The Gram-negative, motile, rod-shaped bacterium Pseudomonas aeruginosa is an opportunistic killer that takes advantage of people suffering from medical problems (Van Delden and Iglewski, 1998).For this reason, P. aeruginosa is one of the most common nosocomial infection that occurs in hospitals. P. aeruginosa is responsible for causing 16% of pneumonia cases, 12% of urinary tract infections, 10% of bloodstream infections, and 8% of surgical infections due to hospital care. Patients who are immune-compromised are also susceptible to P. aeruginosa infections, such as patients undergoing chemotherapy, suffering from HIV / AIDS, recovering in burn units, and suffering from cystic fibrosis. With death rates ranging from 30 to 60% for these patients, P. aeruginosa is considered to be a significant threat to patient health.
Ecology
P. aeruginosa can switch between a free-swimming planktonic form and colonies enclosed within slime-protected biofilms attached to surfaces (Baltch and Smith, 1994, p. 1). The planktonic form…...
mlaReferences
Baltch, A.L. And Smith, R.P. (Eds.). (1994). Pseudomonoas aeruginosa Infections and Treatment. New York, NY: Marcel Dekker, Inc.
Botzenhart, Konrad and Doring, Gerd. (1993). Ecology and Epidemiology of Pseudomonas aeruginosa. In M. Campa, M. Bendinelli, H. Friedman (Eds.), Pseudomonas aeruginosa as an Opportunistic Pathogen (pp. 1-18). New York, NY: Plenum Press.
Hawkey, Peter M. And Kerr, Kevin G. (2004). Laboratory investigation of health care-associated infection. In P. Hawkey and D. Lewis (Eds.), Medical Bacteriology: A Practical Approach (pp. 331-354). Oxford, UK: Oxford University Press.
Hurley, Matthew N., Camara, Miguel, and Smyth, Alan R. (2012). Novel approaches to the treatment of Pseudomonas aeruginosa infections in cystic fibrosis. European Respiratory Journal, published online ahead of print, 1-19. Retrieved 23 July 2012 from http://erj.ersjournals.com/content/early/2012/06/27/09031936.00042012.long .
Women and AIDS in New York City:
Hidden Cases, Hidden Problems
Ask most people what group of people you think of when you think of AIDS, and most people will name gay men. While it's undeniable that the AIDS epidemic was first noticed among gay men, AIDS has become an equal opportunity illness, and currently women represent the fastest growing sector of people with HIV / AIDS in the United States. This fact is true in New York City as well.
The growth in the rate of HIV / AIDS among women in New York City is a growing concern for a variety of reasons. Worse than the increase in infection among women is the death rate. Although overall, the death rate from AIDS has dropped significantly, the death rate for women with AIDS is significantly higher than that of men.
How widespread is the problem?
A look at recent history begins to show how…...
mlaBibliography
Author not available. Fall, 1998. "The Children Left Behind. Harvard AIDS Institute. Accessed via the Internet 10/13/02. http://www.hsph.harvard.edu/hai
Author not available. "It Helps To Know." Brooklyn AIDS Task Force, Inc. Accessed via the Internet 10/13/02. http://www.batf.net/ .
Cadman, Jill. Spring 1998. "Strategies for Interrupting Mother-to-Child Transmission." CRIA Update: Vol. 7, No. 2. Accessed via the Internet 10/13/02. http://www.criany.org/treatment/treatment_edu_springupdate1998.html
Center for Disease Control. "CDC: National Center for HIV, STD and TB Prevention." Divisions of HIV / AIDS Prevention." Accessed via the Internet 10/13/02. http://www.cdcnpin.org/topic/stats.htm .
drives under the influence of alcohol, it is a criminal offense abbreviated as driving under the influence (DUI). However alcohol is but one of the many substances that can interfere with one's driving capability. DUI charges can also be pressed against individuals who are driving under the influence of other kinds of drugs, including illegal drugs and even prescription medication. Taking drugs and driving at the same time, whether the drugs are just prescription muscle relaxers or medicinal marijuana is illegal and a DUI offense. The argument that one took drugs because of doctor's orders is not a defense to DUI charges. Various drugs have different effects on drivers. The drugs that impair concentration, judgment, alertness and/or motor skills are regarded as dangerous and in several cases even more dangerous than alcohol. Driving while having a blood alcohol concentration (BAC) of more than 0.08% or higher is illegal in…...
mlaReferences
African-Americans, Substance Abuse and Spirituality - Minority Nurse. (2013, March 29). Retrieved from http://minoritynurse.com/african-americans-substance-abuse-and-spirituality/
Cohagan, A., Worthington, R., & Krause, R. (2013, July 3). Alcohol and Substance Abuse Evaluation . Retrieved from http://emedicine.medscape.com/article/805084-overview#aw2aab6b3
FindLaw. (n.d.). Driving Under the Influence of Drugs - FindLaw. Retrieved from drugs.htmlhttp://dui.findlaw.com/dui-charges/driving-under-the-influence-of -
MedlinePlus. (n.d.). Steroids: MedlinePlus. Retrieved from http://www.nlm.nih.gov/medlineplus/steroids.html
Our semester plans gives you unlimited, unrestricted access to our entire library of resources —writing tools, guides, example essays, tutorials, class notes, and more.
Get Started Now