The pancreas, which is located in the curve of the duodenum, is a flat organ measuring between 12.5cm-15cm. It is a composite gland – both an exocrine and an endocrine gland: Exocrine acini secrete digestive enzymes into the duodenum, while the Islets of Langerhans help with carbohydrate metabolism.
Retrieved from https://en.wikipedia.org/wiki/Pancreas on 7th March 2022
Pancreas Blood Supply
The Splenic Artery supplies the pancreas with blood, while venous return is completed through small veins within the Splenic Vein.
Retrieved from https://epos.myesr.org/posterimage/esr/ecr2014/120564/mediagallery/539242?deliveroriginal=1 on 7th March 2022
Pancreas Nerve Supply
The Autonomic Nervous System (ANS) innervates the pancreas. Parasympathetic Vagal Fibres stimulate exocrine secretion, while Sympathetic Vasoconstrictor Impulses travel through nerves derived from spinal cord segments T6-T10 which pass through blood vessels within the pancreas. This reflects why pancreatic pain frequently radiates these nerve pathways.
Retrieved from https://clinicalgate.com/thorax-2/ on 7th March 2022
The Endocrine Portion
The Islets of Langerhans contain 4 types of cells:
Alpha Cells – make up 15% of the pancreatic islet cells; secrete Glucagon
Beta Cells – make up 80% of the pancreatic islet cells; secrete Insulin
Delta Cells – make up 5% of the pancreatic islet cells; secrete Somatostatin
F Cells – secrete Pancreatic Polypeptide
Retrieved from https://slideplayer.com/slide/7426531/ on 7th March 2022
Glucagon INCREASES blood glucose level
Insulin DECREASES blood glucose level
Somatostatin INHIBITS insulin and glucagon, acting as a regulator
Pancreatic Polypeptide INHIBITS somatostatin secretion, gallbladder contraction, and digestive enzyme secretion (Pancreatic Polypeptide is secreted near the end of the digestive system)
Glucagon
The main function of glucagon is that of increasing blood glucose level. This is carried out through the following process:
Glucagon increases glycogen conversion into glucose within the liver (glycogenolysis) AND increases nutrient (amino acids, glycerol and lactic acid) conversion into glucose within the liver (gluconeogenesis)
Liver releases glucose into the blood, causing an increase in blood sugar level
Blood sugar level controls secretion of glucagon through a negative feedback mechanism
lysis = breaking down of glycogen
neo = new
genesis = production
Secretion of glucagon is STIMULATED by:
decreased blood glucose level
protein-based foods
exercise
Secretion of glucagon is INHIBITED by:
somatostatin
insulin
Insulin
Islet beta cells produce insulin, which increases protein build-up within the cells. Insulin regulation is controlled by a negative feedback mechanism based on the blood sugar level.
Insulin decreases blood sugar level through the following process:
increases glucose transportation from the blood into the cells
increases glucose conversion into glycogen (glycogenesis)
decreases glycogenolysis and gluconeogenesis
stimulates glucose conversion to fatty acids
stimulates protein synthesis
Secretion of insulin is STIMULATED by:
increased blood glucose level
acetylcholine (released by parasympathetic vagus nerve fibres)
amino acids (arginine and leucine)
growth hormone (GH) (which causes increase in blood sugar level)
ACTH (adrenocorticotropic hormone) (stimulates glucocorticoids secretion leading to hyperglycaemia, indirectly stimulating insulin release)
Somatostatin is secreted by delta cells in the Islets of Langerhans following an increase in blood glucose, fatty acids, and amino acids due to an ingested meal. Somatostatin travels in the blood, slowing down the absorption of nutrients from the GIT, acting as paracrine secretion, diffusing into tissue fluid targeting nearby cells, and inhibiting both insulin and glucagon release from nearby alpha and beta cells.
Somatostatin secretion is INHIBITED by pancreatic polypeptide.
Pancreatic Polypeptide
Pancreatic Polypeptide inhibits secretion of somatostatin, gallbladder contraction, and secretion of pancreatic digestive enzymes.
Secretion of pacreatic polypeptide is STIMULATED by:
protein-containing meals
fasting
exercise
hypoglycaemia
Secretion of pancreatic polypeptide is INHIBITED by:
somatostatin
hyperglycaemia
Did you find the above nursing information useful? Follow us on Facebook and subscribe to receive new blogposts by email as soon as they’re published 🙂
The endocrine system is made up of hormone-producing glands within the body which facilitate communication between cells. Glands that make up the endocrine system include the hypothalamus, pituitary gland, and pineal gland, all of which can be found within the brain; the thyroid and parathyroid glands which can be found in the neck; the thymus which is situated between the lungs; the adrenals, which sit on the kidneys; the pancreas, which is found behind the stomach; and the ovaries (women) or testes (men) which are in the pelvic region.
Retrieved from https://www.blendspace.com/lessons/tv-3ufAxEQI3pQ/group-3-307-313-331-endocrine-system on 3rd March 2022
Within the endocrine system, an endocrine gland or tissue releases an amount of hormone, which amount is determined by the body’s need for that hormone. Through sensing and signalling systems, hormone-producing cells receive information and regulate hormone release amount and duration. Released hormones are carried by the blood to target cells, which contain receptors that bind the hormone, leading to the desired effect. This effect is then recognised by secretory cells through a feedback signal. Once the required hormonal effect is fully accomplished, the hormones are either removed by the liver or the kidneys, or else degraded by the target cells.
Hormonal secretion is regulated by negative feedback control so homeostasis within the body is maintained.
The Hypothalamus
The hypothalamus, which is located below the thalamus, acts as a link between the nervous system and the endocrine system. It receives inputs from various parts of the brain, and sensory signals from internal organs and the retina. Changes are triggered in the hypothalamic activity due to pain, stress, and other emotional factors. The hypothalamus controls the autonomic nervous system and regulates various bodily factors such as temperature, hunger and thirst, sexual behaviour, and defensive reactions.
Retrieved from https://kids.frontiersin.org/articles/10.3389/frym.2021.534184 on 3rd March 2022
Within the hypothalamus are clusters of specialised neurons – neurosecretory cells, which synthesise the hypothalamic hormones in their cell body. The hormones are transported inside vesicles by axonal transport.
Hypothalamus-Released Hormones
The hypothalamus is an important endocrine gland that produces hormones which, after being released into the blood, travel in the portal veins to a secondary capillary bed found in the anterior lobe of the pituitary, where their effects are produced. Hormones released in this way include:
Thyrotropin-releasing hormone(TRH) – related to thyroid gland growth and function
Gonadotropin-releasing hormone (GnRH) – related to the reproductive system
Growth hormone-releasing hormone (GHRH) – related to growth
Corticotropin-releasing hormone (CRH) – related to hormone secretion
Somatostatin – related to the growth hormone
Dopamine – acts as a neurotransmitter
Hormones which travel in the neurons to the posterior lobe of the pituitary before being released into circulation include:
Antidiuretic Hormone (ADH) / Vasopressin – promotes regulation of the amount of water within the body
Oxytocin – involved in childbirth and breastfeeding
The Pituitary Gland
The pituitary gland, which measures just about 1.3cm in diameter, is located in the cella turcica of the sphenoid bone. It is attached to the hypothalamus via the infundibulum – a stalklike structure. Pituitary gland hormones regulate body activities. The pituitary gland is divided into two lobes: the anterior lobe and the posterior lobe.
The pituitary gland anterior lobe accounts to around 80% of the pituitary gland. It is involved in growth regulation, metabolism, and reproduction, through its produced hormones. Hormone production happens through stimulation or inhibition by chemical messages originating from the hypothalamus. Thus, hypothalamic hormones act as a link between the nervous system and the endocrine system. They reach the anterior pituitary through the Hypophyseal Portal System.
The pituitary gland posterior lobe is involved in hormone transmission. Hormones originating from neurons within the region of the hypothalamus are secreted directly into peripheral circulation.
The lobes are divided by the pars intermedia – a relatively avascular zone.
Retrieved from https://www.nature.com/articles/nrdp201692 on 5th March 2022
The 5 Types of Glandular Cells
Somatotroph Cells – produce GH (growth hormone) which is responsible for general body growth
Lactotroph Cells – synthesise PRL (prolactin) which promotes milk production by the mammary glands
Corticolipothroph Cells – synthesise ACTH (adrenocorticotropic hormone) which stimulates hormone secretion, and MSH (melanocyte-stimulating hormone) which is responsible for skin pigmentation
Thyrothroph Cells – produce TSH (thyroid-stimulating hormone), which controls the thyroid gland
Gonadotroph Cells – produce FSH (follicle-stimulating hormone), which stimulates egg and sperm production in the ovaries and testes, and LH (luteinizing hormone), which stimulates other sexual and reproductive activities.
Retrieved from http://www.pharmacy180.com/article/pituitary-gland-3595/ on 5th March 2022
Growth Hormone (GH)
is released through two regulating factors from the hypothalamus, namely GHRF (growth hormone releasing factor) and GHIF (growth hormone inhibiting factor) or Somatostatin
causes cells to grow and multiply by increasing the rate at which amino acids enter the cells to be built up into proteins
acts on the skeleton and the skeletal muscles firstly by increasing their growth rate, and then maintaining their size when growth is attained
increases the rate of protein synthesis a.k.a. protein anabolism
promotes fat catabolism by causing cells to change from burning carbohydrates to burning fats to produce energy
accelerates rate at which glycogen stored within the liver converts into glucose and releases itself into the blood
converts other factors into growth-promoting substances – somatomedins and insulin-like growth factors (IGF), both of which are similar to insulin yet more potent than insulin
Growth Hormone Secretion Stimuli and Inhibition…
Retrieved from https://basicmedicalkey.com/normal-endocrine-function/ on 5th March 2022
Prolactin (PRL)
requires priming of the mammary glands through oestrogens, progesterone, corticosteroids, growth hormone, thyroxine, and insulin
initiates and maintains milk secretion by the mammary glands (amount of milk is determined by oxytocin)
has an inhibitory and an excitatory negative control system
level rises during pregnancy, falls right after delivery, and rises again during breastfeeding, which is why in the 1st two days following birth, mothers do not produce milk but colostrum
NOTE: women on oral contraceptives may experience lack of milk production due to their hormonal effect.
Melanocyte-Stimulating Hormone (MSH)
increases skin pigmentation through the stimulation of melanin granules dispersion in melanocytes
secretion is stimulated by the melanocyte-stimulating hormone releasing factor (MRF), or inhibited by the melanocyte-stimulating hormone inhibiting factor (MIF)
lack causes the skin to look pallid
excess causes the skin to look dark
Thyroid-stimulating factor (TSH)
stimulates the synthesis and secretion of hormonal production within the thyroid gland
secretion is controlled by the thyrotropin releasing factor (TRF), which is released based on thyroxine blood level, metabolic rate of the body, and other factors through a negative feedback system
Adrenocorticotropic Hormone (ACTH)
controls the production and secretion of some adrenal cortex hormones
is secreted by the hypothalamic regulating factor called corticotropin releasing factor (CRF), which is released depending on stimuli and hormones through a negative feedback system
Follicle-Stimulating Hormone (FSH)
in females initiates the development of an ova every month, and stimulates cells within the ovaries to secrete oestrogens
in males stimulates the testes to produce sperm
secretion depends on the hypothalamic regulating factor gonadotropin releasing factor (GnRF), which is released in response to oestrogens in females, and to testosterone in males through a negative feedback system
Luteinizing Hormone (LH)
along with oestrogens, in females it stimulates the release of an ovum within the ovary, prepares the uterus for the implantation of the fertilised ovum, stimulates the formation of the corpus luteum in the ovary to secrete progesterone, and prepares the mammary glands for milk secretion
in males it stimulates the interstitial endocrinocytes in the testes to develop and secrete testosterone
secretion is controlled by GnRF, which works through a negative feedback system
Pituitary Gland Posterior Lobe
The posterior lobe of the pituitary gland a.k.a. neurohypophysis, does not synthesise hormones. It releases hormones to the circulation via the posterior hypophyseal veins to be distributed to target cells in other tissues. The cell bodies of the neurosecretory cells produce Oxytocin (OT) and Antidiuretic Hormone (ADH) / Vasopressin.
Oxytocin (OT)
is released in high amounts just before birth
stimulates contraction of smooth muscle cells in the pregnant uterus
stimulates the contractile cells around the mammary gland ducts
affects milk ejection
works through a positive feedback cycle which is broken following birthing
is inhibited by progesterone, but can work in conjunction to oestrogens
Antidiuretic hormone (ADH)
affects urine volume; it causes the kidneys to excrete water from fresh urine and return it to the bloodstream, reducing urine volume
absence causes an increase in urine output
raises blood pressure by constricting arterioles
secretion varies based on the body’s needs
causes a decrease in sweat
Retrieved from https://slideplayer.com/slide/10623655/ on 6th March 2022
Did you find the above nursing information useful? Follow us on Facebook and subscribe to receive new blogposts by email as soon as they’re published 🙂
According to the World Health Organisation, suicide is responsible for approximately 2200 deaths per day, which amount to 800,000 deaths per year, or 1 death per 40 seconds (WHO, 2016). In addition, with every successful attempt there are many more attempted suicides. The highest suicide rate can be attributed to the elderly.
4/5ths of individuals who die from suicide have attempted to do it at least once before.
Whilst attempts are three times more often performed by women, men are three times more likely than men to complete it.
Some researchers claim that people with low levels of serotonin are up to ten times more likely to commit suicide than those with normal serotonin levels.
Other researchers claim that 25% of drivers who die in car accidents actually cause them subconsciously, hence the term ‘autocides’, meaning suicides in which individuals crash their cars with the aim of ending their lives.
Psychiatric In-Patient Suicide
Up to 0.4% of suicides take place in a mental health hospital.
Psychiatric inpatients are at particular risk for suicide. Studies show that the inpatients who are most at risk for suicide are those with affective disorders and schizophrenia. Precautions should be taken to reduce the risk of inpatient suicide, and following a suicide, the impact on the individual’s family as well as the other inpatients and staff should be considered.
Level 1 supervision is highly intrusive, but can also be therapeutic. Level 3 supervision is more related to care eg. to prevent falls, not just related to mental health. Based on past observations however, even constant supervision can fail at stopping or avoiding suicide.
Retrieved from http://blog.needymeds.org/2018/09/12/suicide-prevention-awarness/ on 22nd January 2022
Retrieved from https://www.facebook.com/NCSBNLearningExt/posts/10157330874509113:0 on 22nd January 2022
Suicide Nursing Assessment
Suicide nursing assessment depth depends on the setting, ability and willingness of the person to provide information about previous and current mental health state, and availability of further information from other healthcare professionals in relation to the same person.
The SAFE-T card pictured below lists key risks and protective factors to be considered while evaluating the person’s suicide risk level. It provides guidance in conducting a comprehensive assessment and triage, risk estimation, and development of treatment plans and interventions based on the person’s mental health state.
Retrieved from https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432 on 22nd January 2022
Suicide enquiry should ideally include questioning about thoughts, plans, behaviours and intent in relation to suicide:
Intent: how the person plans to carry out the act, whether the person believes the attempt will be lethal or injuring, and for what reason/s does the person think he should die
NOTE: In Malta, teenagers from 14 years up can ask for treatment even if parents refuse to accept that their child needs treatment, and this is possible thanks to the Mental Health Act.
Retrieved from https://slideplayer.com/slide/13630104/ on 22nd January 2022
Protective Factors
Protective factors that may help the person during contemplation phase include:
ability to cope with stress
religious/spiritual beliefs
tolerance to frustration
responsibilities eg. children and pets
positive therapeutic relationships with healthcare professionals who can provide guidance and help
social support eg. support groups or family help
Documentation
Documentation should include assessed risk level and the rationale behind the level assigned. It should contain interventions to reduce risk as well as plans for follow-up treatment. Psychotherapy, medication, treatment setting contact with others, and consultation with other past or present healthcare providers should be considered to reduce the possibility of suicide.
Retrieved from https://alea-research.com/suicide-prevention-the-columbia-protocol/ on 22nd January 2022
Are You Contemplating Suicide?
If you landed on this blogpost and you are contemplating suicide, please know that there are people who do care about you and your well-being. Please seek professional support. You can contact Richmond Foundation on 1770, Kellimni.com and Victim Support Malta.
Did you find the above nursing information useful? Follow us on Facebook and fill in your email address below to receive new blogposts in your inbox as soon as they’re published 🙂
A psychiatric emergency is when an individual experiences an acute disturbance of behaviour, thought or mood. If untreated, a psychiatric emergency may lead the individual to harm self or others. It may happen anywhere in any person, whether diagnosed with a mental health problem or not, and requires intervention by another person (not necessarily by mental health professionals).
A mental health crisis is a situation in which an individual’s actions, feelings, and behaviors can lead them to hurt themselves or others. During a mental health crisis, the individual is at risk of becoming unable to self-care and function in a healthy way within the community.
Psychiatric Emergency Features
A person experiencing a psychiatric emergency exhibits the following 4 behavioural elements:
change and the person’s response towards it
intolerance towards change and towards other persons involved in the situation
reaction of significant others
behavioural change being an instant one
During a psychiatric emergency:
the person appears to be extremely agitated, possibly tearful, and highly distressed
the person may make extreme demands to others
the person may take irrational decisions which seem to be lacking rational judgement
the person may put self in danger, the consequences of which are not obvious to the person at the time
the person may lack the capacity to relate to the surrounding reality
those present during the psychiatric emergency may experience distress and fear, and may act spontaneously in a way that may cause emotional pain or anger following the event
(Ward, 1995)
Psychiatric Emergency Risk Factors
A psychiatric emergency may be triggered by the following psychological responses:
fear
rejection
frustration
intrusion
inferiority
embarassment
grief
reality conflict
psychiatric disturbance
Additionally, a person is more susceptible to experience a psychiatric emergency when:
experiencing an acute psychological disturbance
experiencing a stressful situation
undergoing a detox program
being admitted to a psychiatric facility
recovering from anaesthesia
in an intoxicated state
medication is being changed
unexpected worsening of physical condition occurs eg. infection
witnessing another person’s psychiatric emergency
being discharged
receiving follow-up community care
being cared for in an unfamiliar culture incl. different religious background
Psychiatric Emergency Nursing
Psychiatric emergency nursing may require different types of interventions:
verbal intervention
physical intervention
background management
As a nurse witnessing a PE, aim to:
provide immediate support to help the person regain control over feelings and actions
be flexible by treating the person as an individual with different needs
reduce any possible environmental triggering factors, moving away from the immediate area if required
provide psychiatric first aid to try to reduce the emotional tension being experienced by the person, steering away from the immediate feelings
protect the person experiencing a PE and yourself from physical harm
evaluate the event in both a concurrent and retrospective way to determine the best possible support required by the person
Ask for help or assistance if needed
PE Nursing Care Cycle
Assessment > Intervention > Resolution > Support
Assessment
The person experiencing a PE should be continuously monitored, assessed and re-evaluated. Focus on what the person wants, whether the person (or anyone else) is in danger, what was the behavioural cause, whether any similar situation occurred to the person before and how it was handled, and what it meant for the person if it happened before.
Intervention
Intervention should be provided as mediation between the person experiencing the PE and what is immediately available. Mediate between danger and safety, acting reasonably and quickly in a concise and unambiguous way. Focus on the person’s immediate thoughts and beliefs about self and what is currently causing the issue. Most importantly, act in a calm and confident way.
Safety
Inform your colleagues about the situation
Do not leave the person alone
Stay at arm’s length from a potentially aggressive or an aggressive person
Do not let the person stand between you and an exit point
Approach slowly
Speak slowly and calmly in a ‘matter of fact’ tone, but show that you care
Expect that the person may not even reply to your questions
Be ‘unshockable’
Do not retaliate, do not manhandle, do not belittle, do not respond to personal abuse, and never strike a person even if provoked
If grabbed by your clothing, move towards the person rather than away
If restraining the person is required, do so in a safe manner for all
Always treat the person experiencing a PE with dignity and respect
Resolution
Resolution occurs when the intervention produces a positive effect and the situation becomes no longer critical. In this stage, provide positive reassurance and affirm that it is safe for the person to feel better and relieved. Avoid patronising – keep acting in a kind and calm way without giving away your authority as a nurse. Make sure you reassess the person’s mental state.
Support
During this stage the nurse should re-evaluate the incident’s effects, and encourage the person to reflect on the incident and any possible triggers that could have led to the PE. The nurse should provide emotional support to the person, as well as seek professional support or support from other colleagues.
Did you find the above nursing information useful? Follow us on Facebook and fill in your email address below to receive new blogposts in your inbox as soon as they’re published 🙂
Substance misuse and addictions can be attributed to many reasons other than just an aim of getting high. Studies show that only 20% of individuals who make use of drugs do so with the primary aim of seeking pleasure. Other reasons for substance misuse and addictions include anxiety, depression, anger, boredom, peer pressure, lack of self confidence and lack of self control.
Substance misuse is more probable where there is availability and peer pressure. It is usually obtained either in an illicit way, or else through the chemist (certain drugs such as codeine), shops (such as solvents) and doctors (such as benzodiazepines).
Terminology related To Substance Misuse and Addictions
Acute Intoxication – a transient condition which follows alcohol or psychoactive substance misuse, resulting in disturbances in the individual’s level of consciousness, cognition, perception, judgment, affect or behavior, or other psycho-physiological functions and responses.
Harmful Use – damage incurred by psychoactive substance misuse in the individual as well as the implicated negative effects on the individual’s family and surrounding society eg. at work, in health, etc.
Physiological Dependence – withdrawal symptoms (eg. urgent need for more) and drug tolerance (needing more than before to experience the same ‘high’ effect).
Psychological Dependence – a sense of urgency to take a substance experienced by a drug-dependent individual, even when knowing of its related consequences; social, occupational and recreational activities are usually neglected by an individual with substance psychological dependence. A person with psychological dependence usually becomes addicted to the whole drug-taking process itself – including making sure they’re not being followed.
Diagnosis
Dependence diagnosis requires 3 of the following to be present for at least a year:
increased tolerance to a psychoactive drug
physiological withdrawal symptoms exhibited when drug is reduced or stopped
a sense of urgency to make use of the drug
inability to control substance misuse behaviour
neglecting other social, occupational and recreational activities
increased amount of time required to obtain and make use of the drug, and to recover from its effects
persistent use of drug despite knowing its attributed negative consequences
Experimentation/Recreation Drug Use vs Addiction
A recreational drug user is an individual who has tried the drug, enjoyed its use, may want to re-use it, but does not treat it as a priority.
On the other hand, for a drug addict, the drug becomes the main focus of attention, to a point in which other necessities such as nutrition become unimportant compared to the drug. Addiction is a chronic disorder.
Retrieved from https://greatoaksrecovery.com/cycle-of-addiction/ on 19th January 2022
The Pharmacology of Drugs
Drug pharmacology can be divided into 2 components: desired effects and unwanted effects. Most drug users do not become addicted, dependent or tolerant to the drug. All drugs cause dopamine to be released within the brain‘s nucleus accumbens, which leads to a pleasurable effect. However, it is motivation that may cause cravings for a drug, and drug-seeking behaviour.
Opiates
Opiates such as heroin (illegal), codeine, morphine, and methadone, are analgesic agents which bind to opioid receptors in the central nervous system, causing pain to be reduced or eliminated.
Opiates create a rush sensation of peace followed by CNS depression. Withdrawal symptoms, such as craving, sweating, yawning, diarrhoea, agitation, goose-flesh, abdominal cramping, and flu-like symptoms, can start developing from as early as 24 hours following dose administration.
Retrieved from https://addictionblog.org/infographics/heroin-metabolism-in-the-body-how-heroin-affects-the-brain-infographic/ on 20th January 2022
Retrieved from https://www.colleaga.org/tools/clinical-opiate-withdrawal-scale on 20th January 2022
Opiate Replacement Therapy
Methadone is an opiate receptor agonist which is given as a replacement to heroin and other opioids in the case of addiction. Methadone has a longer half-life when compared with heroin, which means that withdrawal symptoms and cravings are reduced without providing the same euphoric effect that heroin provides, giving opioid users a better chance of weaning off or reducing their dose of opioids.
Buprenorphine is an opiate partial agonist. Together with naloxone, which is an antagonist that blocks the euphoric effect related to opioids, buprenorphine is given in tablet form as Suboxone, with the aim of preventing relapse.
An opioid overdose may cause miosis (pinpoint pupils) and respiratory depression (hypoventilation). Naloxone may be required to rapidly reverse opioid overdose by binding to opioid receptors, thus blocking the effects of the other opioids.
Hallucinogens
Hallucinogens – drugs (such as LSD) which cause dilated pupils, increased temperature, vasoconstriction, and hallucinations (distortions in an individual’s perception of reality), can be found in some plants and mushrooms (or their extracts) or can be man-made.
Hallucinogens do not cause physiological dependence, but rare adverse effects may include flashbacks, psychosis, and seizures.
Ecstasy (MDMA in powder form) can induce hyperactivity, and dehydration which can be fatal.
Flakka is a synthetic drug which has been changing in the past. It is very common, yet very dangerous. Psychosis is a common effect of Flakka.
Magic Mushrooms are similar to LSD with regards to effects.
Stimulants
Amphetamines (stimulant drugs eg. speed) cause euphoria, increased concentration, increased energy, mydriasis (pupil dilation), tachycardia, and hyperreflexia, followed by depression, fatigue and headache.
Cocaine can be sniffed, chewed, or taken through the IV route. Its effects are similar to hypomania, and may include visual and tactile hallucinations. Crack cocaine is a highly addictive form of cocaine with a relatively short ‘high’ effect, which may cause persecutory delusions as a withdrawal symptom.
Retrieved from https://addictionblog.org/infographics/cocaine-metabolism-in-the-body-how-coke-affects-the-brain-infographic/ on 20th January 2022
Cannabis
One of cannabis’s active components is THC, which produces psychological effects such as euphoria, relaxation, an overall well-being sensation, omnipotence and hallucinations. Physiologically, THC causes increased appetite and lowered body temperature.
Cannabis is also associated with depression and schizophrenia. However, to develop schizophrenia, the person using cannabis needs to be at a higher risk of developing it due to factors such as genetic predisposition.
Cannabis may also cause adverse effects such as conjunctival (eye) irritation, decreased sperm production, lung disease, transient psychosis, and apathy. It also causes psychological dependence.
Retrieved from https://addictionblog.org/infographics/marijuana-metabolism-in-the-body-how-marijuana-affects-the-brain-infographic/ on 20th January 2022
Sedatives and Hypnotics
Benzodiazepines such as Ativan and Valium are commonly used addictive drugs which can cause dependence, withdrawal symptoms, and tolerance. They also carry a risk of seizures and respiratory depression. In the hospital setting, Ativan and Valium are two medications that fall under the Dangerous Drug Act (DDAs).
Solvents
Solvents are typically sniffed with the intention of getting high due to the initial euphoria it causes. This however is followed by drowsiness. Chronic solvent sniffing can lead to weight loss, nausea and vomiting, polyneuropathy (widespread malfunction of peripheral nerves), cognitive impairment, and aplastic anaemia (body ceases to produce new blood cells).
Sniffing solvents may cause a red rush around the mouth and nose – this is a good way of detecting sniffing solvent abuse.
Khat
Khat is commonly used by Somali and Yemeni men. It contains cathionone, which is an amphetamine-like stimulant which causes excitement and euphoria. It is typically consumed through chewing.
Alcohol
Alcohol safe drinking limits are 31 units per week in men, 14 units per week in women, with at least 2 drink-free days per week. Whilst rates of alcohol consumption by women and adolescents are increasing rapidly, younger people are more prone to exceed the stipulated safe limits.
Detecting alcohol abuse is important so as to avoid long-term complications and acute withdrawal effects. A good way to detect alcohol abuse is through screening questionnaires such as FAST and CAGE. CAGE is an ideal questionnaire when alcoholism is suspected. Once detected, an alcoholic individual should be referred for counseling.
Retrieved from https://www.researchgate.net/figure/The-Fast-Alcohol-Screening-Test-FAST_tbl2_260423389 on 20th January 2022
Retrieved from http://www.familyvan.org/module-week-9-substance-use on 20th January 2022
Alcoholism-related terminology
Acute Intoxication – a state in which an individual shows signs of slurred speech, impaired coordination, impaired judgement, and labile affect (inappropriate emotion expression). More severe repercussions include hypoglycaemia, stupor and coma.
Acute Withdrawal – following 1-2 days of abstinence, the individual experiences malaise, nausea, autonomic hyperactivity, tremor, labile mood (uncontrollable crying or laughing at an improper time or situation), insomnia, transient (mostly visual) hallucinations, and seizures. In the worst case scenario, delirium tremens, which is a severe withdrawal symptom related only to alcohol withdrawal, may be experienced. This is characterised by altered mental status and sympathetic overdrive that may progress to cardiovascular collapse. Delirium Tremens carries a 15% mortality rate.
Alcohol Dependence – individual experiences cognitive, behavioural and psychological features with compulsion to drink, preoccupation with alcohol, stereotyped drinking pattern, loss in drinking regulation, and tolerance of alcohol intoxicant effect.
Psychotic Disorders – hallucinations with 2nd person threatening voices and at times pathological or morbid jealousy.
Amnesic Syndrome – Korsakoff’s psychosis: a severe, diencephalic amnesia caused by thiamine deficiency, which is typically noted in alcoholic patients with very poor diets.
Alcohol Abuse Residual Problems – residual depression and dementia.
Retrieved from https://addictionblog.org/infographics/alcohol-in-the-body-from-drinking-to-elimination-infographic/ on 20th January 2022
Alcohol Abuse Detection and Screening
collect collateral history
look for signs of alcohol disease eg. jaundice, palmar erythema (a skin condition that makes the palms of your hands turn red), gynaecomastia (a common condition that causes boys’ and men’s breasts to swell and become larger than normal), and spider naevi (swollen spider-like blood vessels on the skin often containing a central red spot and deep reddish extensions)
blood tests should be performed to check for macrocytosis (red blood cells that are larger than normal), high gamma-glutamyltransferase (GGT – indicative of liver disease), and high blood alcohol levels
Complications related to alcoholism are usually encountered in the acute setting. These include:
gastrointestinal complications
haematological complications
cardiovascular complications
wernicke’s encephalopathy (a life-threatening illness caused by thiamine deficiency, which primarily affects the peripheral and central nervous system)
korsakoff’s psychosis
peripheral neuropathy
cerebellar degeneration (a condition in which cerebellar cells a.k.a. neurons, become damaged and progressively weaken in the cerebellum)
erectile dysfunction
social complications
fetal alcohol syndrome (in pregnancy)
Management
motivational interviewing
detoxification (possibly including hospitalisation with administration of benzodiazepines and thiamine)
learning relapse-prevention strategies
referral to self-help groups such as Alcoholics Anonymous
administration of Disulfiram, which causes an unpleasant reaction if the individual consumes alcohol, and Acamprosate, which reduces cravings
public health measures eg. taxation
Retrieved from https://www.verywellmind.com/symptoms-of-alcohol-withdrawal-63791 on 20th January 2022
Synthetic Drugs
Synthetic drugs are manufactured to chemically resemble illicit drugs such as cocaine, LSD, MDMA, or methamphetamines, yet can be purchased legally as the manufacturers continuously change the chemical structure to circumvent drug laws. They are usually not detected in urine tests.
Synthetic Cannabinoids, which are commonly used in Malta, are products that mimic the effect of Cannabis in a more potent way. These can be found as solids or oils. Smoking mixtures with added cannabinoids are mostly sold in metal-foil sachets.
Synthetic Cannabinoids cause psychotic symptoms such as extreme anxiety, confusion, paranoia, and hallucinations.
Other synthetic drug names include:
Spice – synthetic marijuana / cannabinoids
Ecstasy – Molly
Bath Salts – contain one or more synthetic chemicals related to cathinone
Mephedrone – Meow Meow: commonly found in bath salts
Krokodil – cheaper heroin substitute which is a synthetic morphine derivative, commonly used in Russia
NOTE: Psychosis following intoxication can usually be reversed.
The Stages of Change Model
Retrieved from https://researchcor.com/transtheoretical-model-versus-the-health-belief-model/ on 20th January 2022
Did you find the above nursing information useful? Follow us on Facebook and fill in your email address below to receive new blogposts in your inbox as soon as they’re published 🙂
An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
WHO, n.d.
Palliative care is not only available for patients with cancer, but also for patients with no possible recovery, such as patients with end-stage organ failure.
Retrieved from https://online.stanford.edu/courses/som-xche0017-palliative-care-always-capstone on 18th January 2022
What is suffering in palliative care?
A multidimensional and dynamic experience of severe stress that occurs when there is a significant threat to the whole person and regulatory processes (which would normally enable adaptation) are insufficient.
Krikorian & Limonero, 2012
Retrieved from https://ezgif.com/webp-to-jpg/ezgif-7-4e0210900f.webp on 18th January 2022
Promoting Quality of Life in Palliative Nursing Care
Palliative Nursing Care should aim to provide quality of life, which in other words refers to care in all aspects that palliative patients deem necessary for what they perceive quality of life to be. Such aspects include:
emotional needs
autonomy
healthcare
cognitive aspects
physical aspects
social aspects
spiritual aspects
preparatory aspects
A primary assessment aims to point out all current issues as well as potential ones. Palliative Nursing Care should include the following domains when it comes to patient assessment:
symptoms
function
interpersonal
well-being
transcendent
These should be measured through assessment, satisfaction and importance…
Retrieved from https://www.semanticscholar.org/paper/Measuring-quality-of-life-for-patients-with-the-of-Byock-Merriman/db4f292e8c6c3d301fdaf2cb4735a9e72e7ca7b0/figure/1 on 18th January 2022
Palliative Nursing Care Systematic Symptom Assessment
A systematic symptom assessment provides a deeper insight when compared to a primary assessment…
Retrieved from https://www.sciencedirect.com/science/article/pii/S0885392416312131 on 18th January 2022
Retrieved from https://www.tomwademd.net/assessing-your-patients-symptoms-with-the-edmonton-symptom-assessment-scale/ on 18th January 2022
Retrieved from https://www.tomwademd.net/assessing-your-patients-symptoms-with-the-edmonton-symptom-assessment-scale/ on 18th January 2022
Symptomatic Pain Management
Symptomatic Pain Management needs to be applied through the nursing process:
ASSESSMENT of the pain
PLANNING pain management
IMPLEMENTATION of medical and non-medical regimen
EVALUATION of applied pain management and its effectiveness
Retrieved from https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/nursing-documentation-principles/ on 18th January 2022
Detailed information about the pain being experienced by the patient, such as location, intensity, quality, effect, and impact (even including the patient’s own descriptive words about experienced pain), leads to an accurate diagnosis and thus, better pain management strategies.
Pain can be classified as either Neuropathic Pain or Nociceptive Pain. Nociceptive Pain is a combination of Somatic Pain and Visceral Pain…
Retrieved from https://edu.glogster.com/glog/acutechronic-pain/2afxqocdhjg?=glogpedia-source on 18th January 2022
Medical Pain Management Strategies
Retrieved from https://www.researchgate.net/figure/New-adaptation-of-the-analgesic-ladder_fig2_258112804 on 18th January 2022
(‘weak opioids’ include Codeine)
Retrieved from https://www.uspharmacist.com/article/special-considerations-for-opioid-use-in-elderly-patients-with-chronic-pain on 18th January 2022
Non-Medical Pain Management Strategies
Non-medical pain management strategies may help in conjunction with medical pain management methods. Helpful methods may include:
patient inclusion in pain management choices through provision of information, enabling informed consent for intervention choices
Did you find the above nursing information useful? Follow us on Facebook and fill in your email address below to receive new blogposts in your inbox as soon as they’re published 🙂
Cancer treatments can be offered with various aims, depending on which type of cancer, its location, health status, and at what stage and grading it is discovered.
Cancer spreads through lymph nodes. Thus, when cancer is detected, the nearest lymph nodes are checked for signs of cancer, which, if found, would mean that cancer would have started spreading.
Cancer treatments aims include prevention, cure, control (prolonging survival where cure is unattainable), and palliative care (symptom relief), as well as prophylactic care. Active treatment lasts around 8-12 months, however, in some cases, this may take up to 8-10 years.
Cancer treatments include the following options: surgery, chemotherapy, radiotherapy, hormone therapy, targeted therapy, complimentary therapy, bone marrow transplantation, and supportive therapy. Supportive Therapy aims to treat symptoms of cancer through the use of antiemetics, immunotherapy, etc.
The Nurse’s Role in Cancer Treatments
Patient education is a must with regards to patients with cancer. Providing adequate patient education helps minimise risks during cancer treatment. For example, the nurse should teach the patient to avoid areas which are prone to illness if possible, since a patient undergoing certain cancer treatment is considered to be immunocompromised.
A nurse navigator is assigned to patients with cancer, whose role is to look after a patient throughout the whole treatment journey, as well as provide support for both the patient and other family members.
Cancer and its treatment options impact all domains of a patient’s life.
Retrieved from https://www.researchgate.net/figure/Proposed-Model-of-Cancer-Treatment-Decision-Making-Roles-of-the-Nurse_fig2_283429018 on 16th January 2022
Patient Perspective of Quality Care in Cancer Treatments
Retrieved from https://www.semanticscholar.org/paper/Perspectives-of-quality-care-in-cancer-treatment%3A-a-Hess-Pohl/b65299948a68709f74a0ea1ef10a20b9280d59da on 16th January 2022
Cancer Grading and Staging
Retrieved from https://www.radiation-therapy-review.com/Grading_System.html on 16th January 2022
Retrieved from https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/CA.2008.0001 on 16th January 2022
Cancer Treatments Responses
Retrieved from https://askhematologist.com/principles-cancer-therapy/ on 16th January 2022
Surgery
As one of the options for cancer treatments, surgery can be chosen for the following reasons:
prevention
diagnosis and staging
to prevent further growth and spread
to reduce the tumour’s size if size becomes a burden to the individual
to interfere with the tumour’s growth process
to correct defects caused by the tumour
to provide pain relief
Factors for consideration prior to surgery include:
diagnosis
prognosis
risks
health status
impact of recommended surgical procedure
In patients who are predisposed to breast cancer, blood testing is performed to check for BRCA1 and BRCA2 cancer genes. Genetic predisposition carries a risk factor of 10-12% for breast cancer development. If the patient is found positive for BRCA, a prophylactic mastectomy may be recommended.
With regards to pain relief, surgery may be an option too. For example, if a patient has a tumor which is pressing on a neuropathic nerve, removing it surgically would reduce the pain.
Cancer Surgical Treatment Perioperative Nursing Care
patient assessment
provision of health literacy
enabling decision-making and informed consent – patients have a right to refuse treatment
providing and/or enabling physical, functional, psychological, social, and spiritual supportive care
Chemotherapy
In chemotherapy, cytotoxic chemicals are used with the aim of eradicating or controlling cancer.
Types of chemotherapy include:
cytotoxic therapy
systemic treatment
neoadjunvant
adjuvant
chemoradiation
first-order kinetics – kills almost all cancer cells through cycle treatments
primary and secondary tumour resistance
Chemotherapy can be administered via the following routes:
oral
intravenous (continuous and bolus)
intra-arterial
intrapleural
intravesical (through the bladder)
intrathecal/intraventricular (in the subarachnoid space)
intraperitoneal
topical
Retrieved from https://bio.libretexts.org/Courses/Lumen_Learning/Book%3A_Biology_for_Non-Majors_I_(Lumen)/07%3A_Cell_Division/7.05%3A_Cell_Cycle_Checkpoints on 16th January 2022
Retrieved from https://doctorlib.info/pharmacology/medical-pharmacology-therapeutics/52.html on 16th January 2022
When selecting the ideal chemotherapy for a patient, the following considerations are taken into account:
therapy which offers the maximum therapeutic effect and with what is considered as acceptable toxicity levels
assessment of the patient’s physiological and psychosocial status
benefits vs toxicity
in multi-drug regimen, the aim is to kill as many tumour cells as possible, reduce toxicity, and reduce drug resistance possibility
Prior to chemotherapy administration, the patient should be evaluated so as to determine whether he/she is healthy enough to receive chemotherapy treatment.
Histology results provide accurate tumor grading information.
Chemotherapy Side Effects
Chemotherapy side effects include:
myelosuppression – a condition which causes a decrease in bone marrow activity that results in less red blood cells, white blood cells and platelets
neutropaenia – an abnormal low concentration of neutrophils (white blood cells) in the blood; may lead to febrile neutropaenia which is characterised by a fever and other signs indicating infection
thrombocytopaenia – low blood platelet count
anaemia – a deficiency in the number and/or quality of red blood cells
alopecia – hair loss
oral mucositis – tissue swelling in the mouth
fatigue
nausea and vomiting
Retrieved from https://www.healthline.com/health/cancer/effects-on-body on 16th January 2022
Nurse’s Role During Chemotherapy Administration
patient education – enabling informed consent and establishing reachable goals
chemotherapy targets cells that multiply fast, hence why it destroys cancer cells as well as other cells in the body which do the same eg. hair cells (causing alopecia with certain chemotherapies), the lining of the digestive system (causing nausea, vomiting, and diarrhoea)
if patient loses hair following chemotherapy, advise patient that hair will regrow once all chemotherapy sessions are completed, even if the texture and colour may be different
if patient experiences nausea and vomiting, parameters should be taken so as to check for sepsis; antiemetics may be prescribed so as to reduce side effect; tepid-sponging face and neck may also help the patient feel better; prop up patient so as to avoid aspiration in case of vomiting, as this may cause pneumonia; if patient vomits, encourage oral hygiene since gastric contents would contain chemotherapy, which would lead to the oral mucosa to become damaged – encourage to brush teeth, tongue and gums well with toothpaste, mouthwash, and even rinse throughout the day with a solution made out of 1 tsp baking soda in a cup of water – this balances the acidity in the mouth from gastric content, with the alkaline solution used for rinsing
if patient experiences fatigue, encourage to rest, but also encourage bed exercises so as to promote mobility and avoid complications (DVT and pneumonia); reassure patient that once chemotherapy is completed, fatigue lessens; teach patient to identify times during the day in which fatigue is lessened, so as to be able to shower and do other tasks at that time; monitor the patient’s haemoglobin level, as if this is very low, a blood transfusion may be needed
chemotherapy administration & safety – safe handling and disposing of chemotherapy for the benefit of all; spillage protocol; extravasation protocol
prevention of complications
management of side effects
ongoing support
NOTE: Chemotherapy is excreted through bodily fluids including urine. Thus patient should aim to use a different bathroom than other family members, or else clean well after use, since if another person comes in contact with the patient’s bodily fluid, there would be a risk of developing cancer and killing cells (chemotherapy is cytotoxic).
Radiotherapy
Radiotherapy a.k.a. radiation therapy is a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors through the use of Ionising Radiation. This is done either through External Beam Radiotherapy (EBRT) which works through linear accelerators that produce high energy x-rays that can treat deep tumours, or as Internal Radiotherapy / targeted therapy eg. radioisotope therapy, brachytherapy etc).
Retrieved from https://www.researchgate.net/figure/Basic-diagram-of-a-radiotherapy-treatment-workflow_fig2_329362557 on 17th January 2022
Radiotherapy Side Effects
Radiotherapy side effects are usually related to the area being treated for cancer.
Acute side effects usually show up around 10 days following treatment initiation, with its peak effects showing up around 10 days after the full treatment course.
Late side effects usually develop gradually around 6 months following treatment. These side effects are often permanent.
Side Effects of Radiotherapy for Breast Cancer including Axilla
Acute side effects include skin reactions, pain, and fatigue.
Long-term side effects include Brachial Plexopathy (type of peripheral neuropathy in which damage to the brachial plexus is incurred), Lymphoedema (a condition in which build-up of lymph fluid in the body’s soft tissues causes swelling), Lung Fibrosis (damaged and scarred lung tissue), and Bone Necrosis (death of bone tissue).
Skin Reactions to Radiation Therapy
Retrieved from https://www.researchgate.net/figure/RTOG-Scoring-Criteria-for-Acute-Radiation-Skin-Reactions_tbl3_49780739 on 17th January 2022
If skin reactions to radiation therapy are noted:
use a gentle washing technique with mild soap
use an electric shaver when shaving
avoid exposure of affected area to the sun
promote skin hydration using aqueous cream twice daily
avoid using deodorants, perfumes and other irritants
promote adequate hydration
encourage clothing made of natural fibre
Nurse’s Role During Radiotherapy Administration
holistic assessment – take into consideration side effect risks
patient education
aiming to minimise side effects through continuous patient assessment
Hormone Receptors and Hormone Manipulation Therapy
Hormone Manipulation Therapy is a treatment which adds, blocks or removes hormones with the aim of stopping or slowing down cancer cell growth which require hormones to grow.
Side effects of hormone manipulation therapy may include:
hot flushes
sweating
physical changes
low libido
fatigue
nausea
Targeted Therapy
Targeted Therapy refers to the use of drugs or substances which target particular molecules to stop cancer cells from growing and/or spreading. Targeted Therapy doesn’t cause harm to cells other than the ones targeted – cancer cells.
Retrieved from https://www.cell.com/fulltext/S0092-8674(11)00127-9 on 17th January 2022
Immunotherapy
Immunotherapy , which is another type of targeted therapy, stimulates specific components of the immune system and counteracts signals produced by cancer cells that suppress immune responses through checkpoint inhibitors.
Bone Marrow Transplantation
Bone Marrow Transplant (BMT) is a type of cancer (or other diseases) therapy in which cells that are usually found in the bone marrow (eg. stem cells) are filtered and given back to the patient or to another person in need of a bone marrow transplant.
Bone Marrow Transplantation is usually carried out once a patient is in remission. Patient may be sent abroad for this procedure. It is ideal for patients with Leukaemia (the bone marrow is where all blood cells are produced).
Complementary Therapies and Psychological Support for Cancer Patients
Homeopathy
Detoxification/Antioxidant
Nutritional Supplements
Diet
Acupuncture
Aromatherapy
Reflexology
Therapeutic Massage
Reiki / Universal Energy
Counseling
Psychotherapy
Music Therapy
Meditation/Relaxation Techniques
NOTE: Homeopathy isn’t recommended when pharmacological therapy for cancer is involved. Similarly, it is important that a cancer patient mentions all medicines and supplements (even vitamins) that are being ingested.
Did you find the above nursing information useful? Follow us on Facebook and fill in your email address below to receive new blogposts in your inbox as soon as they’re published 🙂
Surgical site infections are the second most common types of healthcare associated infections (HAIs). A surgical site is the incision made by the surgeon during a surgical procedure as well as any manipulated surrounding tissue. Surgical site infections may be caused by intrinsic factors (related to the patient) or extrinsic factors (related to the environment or the equipment used). They develop from 2 to 3 days following surgery or during the wound healing period (up to 3 weeks post-surgery).
Pathogenesis of Surgical Site Infections
SSIs develop through an interaction between microorganisms and host, which is also affected by the surgeon and environment. All surgical wounds have microorganisms, including bacteria, but not all develop a clinical infection, since innate host defenses can be very efficient in eliminating contaminants within the surgical site. If however the concentration of microorganisms in the wound is very high, developing a surgical site infection becomes quite possible.
Retrieved from https://www.researchgate.net/figure/American-Society-of-Anesthesiologists-classification_tbl1_330901325 on 14th January 2022
Increasing Risk for SSI
intact skin> intact mucous membrane> broken skin or mucous membrane> foreign body implant> foreign body from outside to inside of the body
(foreign body implant eg. prosthetic)
Retrieved from https://www.researchgate.net/figure/Classification-of-surgical-site-infections-according-to-CDC-National-Nosocomial_fig1_44670847 on 14th January 2022
Superficial Incisional SSI:
purulent drainage from superficial incision with or without lab confirmation
pain OR swelling OR erythema OR heat at incision site (at least one)
Retrieved from https://www.who.int/infection-prevention/tools/surgical/SSI_student-handbook.pdf on 14th January 2022
Deep Incisional SSI:
abscess involving deep incision found during radiological exam, direct exam or re-operation
deep incision deliberately opened by surgeon when patient has at least one of the following: fever, localised pain, tenderness (unless culture-negative)
purulent drainage found during deep incision but not from organ/space component
teach patient to monitor for SSIs for 90 days post-operation, and give contact details in case a SSI is suspected
Retrieved from https://www.who.int/infection-prevention/tools/surgical/SSI_student-handbook.pdf on 14th January 2022
Organ/Space SSI:
Involves organs or spaces other than the surgical incision site such as:
Organ/Space SSI should also include at least one of the following: purulent drainage, organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space, abscess or other evidence of infection.
Retrieved from https://www.who.int/infection-prevention/tools/surgical/SSI_student-handbook.pdf on 14th January 2022
Wound Healing
Phases of Wound Healing
Retrieved from https://journals.rcni.com/nursing-standard/clinical-management-of-nonhealing-wounds-aop-ns.2018.e10829 on 14th January 2022
Surgical Wound Classification
Retrieved from https://www.semanticscholar.org/paper/The-Impact-of-Preoperative-Hair-Removal-on-Surgical/53d485e036b989f207f9694eebf663be46eae8d8 on 14th January 2022
Post-Discharge Surveillance for Surgical Site Infections
Post-discharge surveillance for surgical site infections are important for early detection of SSIs. Following surgery, the nurse should advise the patient to watch out for signs of SSIs for 30 days post-operation, and give contact details the patient should use in case a SSI is suspected.
Post-discharge SSI surveillance methods include:
medical records review
admission
readmission
patient charts for SSI signs and symptoms
lab, imaging and other diagnostic tests
clinician notes
questionaires
patient surveys (may be performed through phone or mail)
If an SSI is suspected, or if there is no sign of healing, or if there is unexpected wound healing process deterioration, a specimen should be collected as soon as possible, ideally prior to starting antibiotic treatment.
Organisms Causing SSIs
Staphylococcus aureus
Coagulase-negative staphylococci
Gram negative bacilli
Anaerobes
group B streptococci
WHO Guidelines on Surgical Site Infections
Retrieved from https://www.theific.org/wp-content/uploads/2017/10/36.pdf on 14th January 2022
Retrieved from https://www.theific.org/wp-content/uploads/2017/10/36.pdf on 14th January 2022
Retrieved from https://www.theific.org/wp-content/uploads/2017/10/36.pdf on 14th January 2022
Surgical Handrubbing Technique
Retrieved from https://www.journalofhospitalinfection.com/article/S0195-6701(09)00257-6/references on 14th January 2022
Retrieved from https://www.journalofhospitalinfection.com/article/S0195-6701(09)00257-6/fulltext on 14th January 2022
Retrieved from https://www.swissnoso.ch/fileadmin/module/ssi_surveillance/Dokumente_F/7_Presentations/05___E_B-Allegranzi_WHO.pdf on 14th January 2022
Retrieved from https://www.swissnoso.ch/fileadmin/module/ssi_surveillance/Dokumente_F/7_Presentations/05___E_B-Allegranzi_WHO.pdf on 14th January 2022
Retrieved from https://www.swissnoso.ch/fileadmin/module/ssi_surveillance/Dokumente_F/7_Presentations/05___E_B-Allegranzi_WHO.pdf on 14th January 2022
Hyperglycaemia and Surgical Site Infections
Hyperglycaemia is associated with an increased risk of developing surgical site infections, especially in the post-operative period. Early post-operative glycaemic control should reduce the incidence of surgical site infections eg. diabetic protocol.
Pre-operative Hair Removal
Unless the presence of hair at the surgery site may interfere with the surgery itself, hair should not be removed. However, if required, hair should be removed with the use of surgical hair clippers with disposable heads. This should be done on the ward at the latest time possible – NEVER at the theatre due to potential contamination of the sterile field. Shavers should NOT be used since these create micro-abrasions in the skin, increasing the of infection.
Following hair removal, patients need to shower with 4% chlorhexidine solution.
Normothermia
Hypothermia increases the risk of developing a SSI since it causes physiological changes, impairs the immune system, causes subcutaneous vasoconstriction, and tissue hypoxia at the incision site. Additionally, hypothermia increases the risk of bleeding, risk of haematoma, and risk of needing a blood transfusion. Thus, pre-operative and intraoperative normothermia should be targeted – ideal temperature is that of 36°C or more.
MRSA and Surgical Site Infections
MRSA carriage increases the risk of developing a SSI. For this reason, patients are screened prior to surgical procedures such as Coronary Artery Bypass Graft, Aortic Valve Replacement, Total Knee Replacement, Total Hip Replacement, cardiac implants, renal catheter insertions, and central venous catheters.
If MRSA is cultivated, decolonisation treatment in the form of washes and mupirocin nasal ointment is required. The patient is screened three times for MSSA (methicillin-susceptible Staphylococcus aureus) prior to the procedure.
Preoperative Washing
Preoperative bathing or showering should aim to reduce skin bacterial load, leading to a reduction in the development of endogenous surgical site infections.
4% Chlorhexidine Solution for MRSA Colonisation: 4% Chlorhexidine solution is a topical antibiotic commonly used as a skin cleanser prior to surgery due to its protective effects against gram-positive and gram-negative organisms, facultative anaerobes, aerobes, and yeast. This is ideal if MRSA colonisation is present.
2% Chlorhexidine Solution for Prolonged/Deep Surgeries: Skin disinfection with 2% Chlorhexidine is enough in the case of prolonged surgery or deep surgery.
Plain Soap for Minor Surgeries: For other minor surgeries, washing with plain soap is enough.
NOTE: Make sure the patient stays warm prior to being operated upon, since this reduces the chance of developing SSIs.
Prophylactic Use of Antibiotic
CHOICE OF ANTIBIOTIC TREATMENT
Antibiotic treatment choice for prophylactic use should be based on the wound contamination level and efficacy against expected pathogens related to the specific surgery being performed.
TIMING
First dose of prophylactic antibiotic should be given 60-120 minutes prior to surgery being performed, as this ensures bactericidal concentration in serum and tissues from incision until closure. Additional doses may be required for longer surgeries.
DURATION
Unnecessary continuation of antibiotic treatment may contribute to the ever-growing problem of antibiotic resistance.
Retrieved from https://www.who.int/docs/default-source/antibiotic-awareness-week/infographic-ssi-sap011118-bis.pdf on 15th January 2022
Did you find the above nursing information useful? Follow us on Facebook and fill in your email address below to receive new blogposts in your inbox as soon as they’re published 🙂
Infection prevention and control (IPC) is a practical, evidence-based approach which prevents patients and health workers from being harmed by avoidable infection and as a result of antimicrobial resistance.
No one should catch an infection while receiving health care, yet, these infections can spread through outbreaks and many regular care practices, affecting hundreds of millions of people across the world every year.
Retrieved from https://activesocialcare.com/handbook/infection-prevention-and-control/the-chain-of-infection on 12th January 2022
A HAI (hospital acquired infection) occurs:
up to 48 hours after hospital admission
up to 3 days after discharge
up to 30 days after an operation
RESERVOIR:
A microorganism lives and multiplies in what we call ‘reservoirs’: humans (eg. chickenpox, hepatitis B, and HIV), animals (eg. rabies, and salmonella), or inanimate objects (eg. tetanus).
INFECTION SOURCE:
This is the source of infection – a specific infection outbreak or an individual infection. An endogenous infection refers to an infection caused by the patient’s own microflora, while an exogenous infection refers to an infection caused through an environmental source. Zoonosis refers to an infection originating from an animal source.
ENTRY PORTALS:
respiratory tract eg. pneumonia
GI tract eg. Clostridioides difficile or C. difficile
skin breaks (including traumatic and surgical wounds)
blood (through needles and catheters)
All patients are at risk of acquiring a MDRO (multi-drug resistant organism)!
TRANSMISSION ROUTES
direct and indirect contact
air
food
drink
water
insects
Direct or indirect contact include transmission via hands, transmission by inanimate objects, transmission by contact with blood, and transmission through sex…
Transmission via Hands:
Staphylococcus aureus can be spread by staff, either through spreading their own nasal staph to their patients, or spreading staph from one patient to another.
Gram-negative bacteria can be found colonising a patient’s skin, and then transmitted onto staff hands.
Enteric Infections such as shigella and rotavirus (commonly found in children) are faecal-oral spreads transmitted via hands in the community and hospital setting.
Transmission via Inanimate Objects a.k.a. Fomites:
This type of transmission happens passively from one inanimate object to another. Objects include surgical instruments as well as more common objects such as pens, stethoscopes, books, suction catheters, bedpans etc.
Transmission via Sexual Contact:
Sexually transmitted diseases (STDs) are considered to be very fragile and so, they do not usually survive on inanimate objects. STDs include syphilis gonorrhoea, chlamydia, HIV, herpes, etc.
Transmission via Blood:
Transmission by contact with infected blood happens through wounds, menses, human bites, blood products, specimens, contaminated needles (including needle-stick injuries), and during traumatic sexual intercourse.
Endemic Hepatitis B is transmitted during birth from the mother to her baby. Other infections which can pass to the foetus during pregnancy includes rubella, cytomegalovirus and syphilis.
Transmission via Air a.k.a. Airborne Transmission
Transmission via air happens through sneezing, coughing and speaking. Small droplets (<0.1mm) evaporate; Solid droplet nuclei may remain airborne…these may be eventually inhaled. Measles, chickenpox and tuberculosis are spread in this way. Large droplets fall to the ground.
Transmission via Food, Drink, and Water:
Transmission of infection via food, drink and water usually happens in enteric infections via faecal-oral spread.
In food poisoning, bacteria multiply in food prior to ingestion, producing enteric toxin (eg. in staph aureus) or multiply and produce toxin in bowel lumen (eg. in cholera and E.coli). Salmonella happens through infection following ingestion of poorly-cooked food. Brucellosis is an infection resulting from drinking unpasteurised contaminated milk. In water-borne cholera, faecal excretion by-carriers contaminate river water which is then consumed downstream.
Transmission via Insects a.k.a Anthropod-borne Infections:
Anthropod-borne infections are transmitted by blood-sucking insects such as mosquitos (malaria). These parasites have the ability to multiply in their hosts.
Colonisation is the presence of multiplying bacteria with no reaction or symptoms.
Infection is the presence of multiplying bacteria which affects the host’s defenses, causing clinical symptoms.
Bacteria can be transmitted even if no infection is present. This explains why Staphylococcus aureus, which is endemic, can be found outside the hospital, within the community, undetected.
MRSA is resistant to common antibiotics such as penicillins and cephalosporins. MRSA can be carried around by healthy individuals without any symptoms for weeks to years.
MRSA in a patient with a low colonisation level may not be detected by culture. Anterior nares specimen testing result in the highest identification rate for MRSA. Gloves should be worn when caring for infected wounds of patients with MRSA.
Patients are screened for MRSA on admission and more importantly before important procedures.
Treatment for MRSA decolonisation:
2% Mupirocin (Bactroban) nasal ointment 3 times per day for 5 days (apply small amount to inner nostrils using tube, press nostrils together and massage for about 1 minute).
Daily full body and hair washes with 4% chlorhexidine gluconate.
Isolation and Contact Precautions for Infection Prevention and Control
Isolation and contact precautions should be put in place in the case of current or previous 6 months colonisation or infection with MDRO. Contact precautions notice should be put up on the patient’s door, and related information should be provided for both the patient and relatives.
Contact precautions can be stopped:
if the organism is not cultured again
in case of 3 consecutive negative MRSA screen cultures
Terminal cleaning of patient’s room must be performed!
Infection Prevention and Control
5 Moments for Hand Hygiene
BEFORE patient contact
BEFORE aseptic task
AFTER body fluid exposure
AFTER patient contact
AFTER leaving patient surrounding
Soap & Water mechanically remove microorganisms and soil but DO NOT kill microorganisms; remove transient skin flora, but only limited resident flora.
Alcohol Rub DOES NOT mechanically remove microorganisms or soil, but kills microorganisms; kills transient skin flora, but only limited resident flora.
Aqueous Antiseptic Solutions mechanically remove and kill microorganisms and soil; remove and kill transient and some resident skin flora.
Standard Precautions for Infection Prevention and Control
Standard precautions should be applied by all staff in all healthcare settings to all patients regardless of diagnosis and infection status all the time.
Good hand hygiene practice
Use waterproof dressings to cover wounds or skin lesions
Use cough etiquette
Do not touch your eyes, nose, mouth or face, or adjust PPEs with contaminated hands or gloves
Limit contact with patient’s items in immediate surrounding area to the minimum
Use recommended PPEs for required tasks anticipating possible risks
Donning PPEs Sequence:
Gown
Mask
Visor
Gloves
Doffing PPEs Sequence:
Gloves
Visor
Gown
Mask
Swabbing Methods
Staphylococcus aureus produces a higher cultivation of bacteria in the nose and throat, thus swabbing methods used for MRSA are the nasal swab or the throat swab. Note however, that MRSA can also be found in other locations within the body, such as in wounds.
Nasal Swab
Throat Swab
Wound Swab
Urine Sampling
Sputum Sampling
Stool Sampling
Blood Cultures
Retrieved from https://studylib.net/doc/8188811/bd-vacutainer%C2%AE-system—st-vincent-s-university-hospital on 13th January 2022
Peripheral Vascular Catheter Care
Retrieved from https://www.facebook.com/641909052635080/photos/visual-infusion-phlebitis-score-detail-has-been-attached-hereindetail-topic-will/1149380728554574/ on 13th January 2022
Did you find the above nursing information useful? Follow us on Facebook and fill in your email address below to receive new blogposts in your inbox as soon as they’re published 🙂
Nutrition and hydration for older adults are key elements for better health and good quality of life. Unfortunately, malnutrition is very common in older adults. The older the person, the less nutrients are absorbed by the body from food. Adequate food intake and proper hydration promote quicker recovery and shorter hospitalisation periods, as well as avoidance of hospital readmission, following illness and surgery in older adults.
Retrieved from https://www.facebook.com/narayanisfitnactive/posts/new-food-pyramid-for-healthy-diet-narayanis-fit-active-gymwardhaman-nagar-nagpur/689653301412038/ on 9th January 2021
Retrieved from https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate-vs-usda-myplate/ on 9th January 2021
Ideal Meal Plan
An ideal meal plan should include:
Breakfast
Snack
Lunch
Snack
Dinner
Nutrition for Older Adults
A healthy balanced diet helps maintain physical and mental well-being. Eating less than required may lead to weight-loss, vulnerability to infection, reduced muscle strength, and fatigue. Causes of weight loss may include:
In older adults with late-stage dementia, the nurse should ensure adequate nutrition is being provided, and in some cases, a high-calorie diet may also be appropriate.
An older adult experiencing weight-loss should be referred to a nutritionist or dietitian.
Meal Supplementation for Older Adults
Meal supplement options for older adults include:
Snacks
Yoghurts
Protein Powder (check liver/kidney function prior to administering protein powder)
Enteral Feeds (can be administered in between meals or as replacements if needed)
Vitamin supplements can be avoided if the person eats a varied and balanced nutritional diet.
Arthritis (certain proteins eg. nuts, legumes, and seeds, deposit fats in joints, which is very helpful for patients with arthritis)
Refeeding Syndrome (shifts in fluids and electrolytes resulting from hormonal and metabolic changes which may occur in malnourished individuals receiving enteral or parenteral artificial feeding that may lead to death)
Common Problems in Older Adults
anaemia
depression
overweight / underweight
constipation
food allergies
inability to chew food appropriately
dysphagia (problems encountered in swallowing)
cooking methods
Assessing Older Adults
Nutrition and hydration in older adults should be assessed:
to identify any existing problems
to provide help with existing problems
to promote safety
to improve quality of life
to improve current available services
to create new / better services
Encouraging Nutrition Intake in Older Adults
provide regular snacks or small meals
foods with low glycemic index (low GI) are more digestible
provide food that the older adult actually likes
provide appealing foods for appetite stimulation
experiment with different types of food such as smoothies and milkshakes
experiment with foods containing strong flavours and sweet flavours
find the right time to offer foods based on the individual’s day/night routines
provide dessert even if main meal is left unfinished or untouched, as it may be preferred
avoid giving cold food – reheat if necessary
if the older person finds it difficult to chew or swallow food, try opting for softer-textured foods such as scrambled egg or stewed apple before considering pureed food
provide encouragement
provide a relaxed friendly atmosphere
The Importance of Hydration for Older Adults
Water is helpful for bloating, oxygen saturation, headaches, circulation, depression, digestion, kidney function, metabolism, and promotes healthy skin. Moreover, the brain requires water to function well. More than 2/3 of the brain is made up of water. With age increase comes a reduction of thirst sensation, which may lead to dehydration.
Older adults with dementia may become easily dehydrated if they are unable to communicate or recognise thirst cues, or if they forget to drink. Dehydration may lead to headaches, confusion, UTIs and constipation, all of which can worsen the symptoms of dementia.
Older adults should be encouraged to drink between 1.5-2.5 liters of fluid on a daily basis.
Older adults may be taught to check their hydration level by observing their urine’s colour and smell.
Retrieved from https://www.pinterest.com/pin/174162710566911662/ on 9th January 2021
Retrieved from https://www.quotemaster.org/water+drinking on 9th January 2021
Retrieved from https://www.continencesupportnow.com/topic/Fluid%20intake on 9th January 2021
Retrieved from https://www.healthworks.my/hydrate/ on 9th January 2021
Did you find the above nursing information useful? Follow us on Facebook and fill in your email address below to receive new blogposts in your inbox as soon as they’re published 🙂
