Complimentary and Alternative Therapies
Complimentary Therapies
Definition
Therapies used in addition to conventional treatment recommended by the person’s health care provider
As the name implies, it compliments the conventional treatments
Alternative Therapies
Definition
May include the same interventions as complementary therapies but frequently become the primary treatment modality that replaces Western Medicine
Types of Complimentary and Alternative Therapies
Biobehavioral therapies
Manual therapies
Traditional and ethnomedicine therapies
Herbal Therapies
Biobehavioral Therapies
Biobehavioral Therapies
Designed to each individuals
Includes ways to change behavior to:
Alter physical responses to stress
Improve symptoms like muscle tension and GI pain
Biobehavioral Therapies
Principles
The individual should be actively involved in the treatment
Individuals achieve better response if they practice the techniques daily
Individual commits to implementing and maintaining therapy
Biobehavioral Therapies
Types:
Relaxation therapies
Imagery
Biofeedback
Hypnotherapy
Meditation
Biobehavioral Therapies
Relaxation Therapy
Relaxation Therapy
Relaxation
State of generalized decreased cognitive, physiological and/or behavioral arousal
Arousal deduction
Relaxation response
Decreased cardiac and respiratory rate, blood pressure and oxygen consumption
Relaxation Therapy
Involves cognitive skills derived from relaxation training. These skills include:
Focusing
Ability to identify, differentiate, maintain attention to simple stimuli for extended period
Passivity
Ability to stop unnecessary analytic activity
Receptivity
Ability to tolerate and accept experiences that may be uncertain
Clinical Applications of Relaxation Therapy
Relaxation alone or in combination with deep breathing or imagery can reduce pain
Head ache
Post operative pain
Labor pain
Chronic low back pain
Clinical Applications of Relaxation Therapy
Can reduce cancer treatment-related nausea and vomiting
Can improve emotional well-being and immune function
Limitations of Relaxation Therapy
Loss of Control
Feeling like they are floating which then becomes relaxation-induced anxiety
Relaxed state has been found to potentiate effects of some medications, leading to toxic levels
Imagery
Imagery
Uses the conscious mind to create mental images to evoke physical changes in the body
Frequently combined with some form of relaxation technique
Can be self-directed or guided
Clinical Applications of Imagery
Imagery
Imagery has been used to visualize cancer cells being destroyed by the immune system
Control or relief of pain
Achieve calmness and serenity
Used in chronic treatment for asthma, hypertension and premenstrual syndrome
Limitations of Imagery
One of the least clearly defined interventions
Side effects can range from being highly structured to consisting of spontaneous daydreams by the individual
Biofeedback
Biofeedback
Group of therapeutic procedures that use electronic or electromechanical instruments to measure and provide information about a client’s neuromuscular and autonomic nervous system responses
Feedback is given in analog (binary), auditory and visual feedback signals
Clinical Applications of Biofeedback
Assists in the muscle rehabilitation of paralyzed patients
Patients get to know the amount of muscle tension generated when they attempt to contract the muscle
Also used in treating Raynaud’s disease
Information regarding the peripheral skin temperature
Limitations of Biofeedback
During Biofeedback and relaxation techniques, repressed emotions might be identified and clients may not cope with this
Not recommended for clients with bipolar and schizophrenia
Hypnotherapy
Hypnotherapy
Hypnosis
Defined as trancelike state of heightened susceptibility
Its purpose is to induce a hypnotic state during which posthypnotic suggestions are implanted
Hypnotherapy
3 Levels of Trance
Light Trance
Client’s eyes are closed; the person is deeply relaxed and accepts suggestions
2. Medium Trance
Physiological processes are decreased
There is partial sensitivity to pain with total cessation of allergic reaction
Hypnotherapy
3 Levels of Trance
Deep Trance
Total anesthesia can occur
Eyes are open and most posthypnotic suggestions are successful
Clinical Applications of Hypnotherapy
Clinical Applications of Hypnotherapy
Used to treat asthmatic patients, especially children
Used to reduce examination stress
Facilitates smoking cessation
Manage chronic pain
Relieves symptoms of fibromyalgia
Limitations of Hypnotherapy
The success is dependent on the ability of the client to be hypnotized
Clients may have negative expectations or fears regarding hypnosis
Some clients report numbness, tingling and itching sensation after hypnotherapy
Meditation
Meditation
Defined as any activity that limits stimulus by directing attention to a single unchanging or repetitive stimulus
Includes transcendental meditation, Chinese Tao, Yoga, Japanese Zen, Christian Prayer and Moslem Sufism
Meditation
Regardless of method or type, they all evoke a restful state, lower oxygen consumption, reduction in respiratory and cardiac rate and subjective report of reduced anxiety
Clinical Applications of Meditation
Clinical Applications of Meditation
Improves breathing pattern for asthmatics
Lowers blood pressure for hypertensive clients
Lowers blood sugar for diabetics
Improves sleep-onset insomnia
Reduces anxiety
Limitations of Meditation
Contraindicated for persons who has fear of losing control
Augments effect of certain medication
Antihypertensive medications
Thyroid-controlling medications
Anxiolytics
Anti-depressants
Manual Healing Therapies
Based on the theory that energy systems of the body needs to be balanced in an effort to enhance healing
A number of these therapies originated from Ancient Chinese healing disciplines
Manual Healing Therapies
Included are the ff:
Therapeutic touch
Chiropractic therapy
Therapeutic Touch
Contemporary manual healing therapy
A natural human potential that consists of placing the practitioner’s hands either on or close to the body of a person
Clinical Applications of Therapeutic Touch
Some earliest studies found that it was able to:
Increase hemoglobin
Effective in reducing anxiety levels of client’s with cardiovascular disease
Reduces headache pain and improving mood of bereaved adults
Helps in managing suicidal tendencies
Limitations of Therapeutic Touch
Contraindicated for client’s who:
Are physically abused
Have psychiatric problems
Premature infants and pregnant women (who are likely to be sensitive to energy changes)
Chiropractic Therapy
Developed in Iowa (1895)
Intervertebral manipulation that is characterized as specific, high-velocity, controlled forceful thrusts directed at certain joints
Use of forceful movement of a joint beyond its active limitation
Does not use drug intervention
Clinical Applications of Chiropractic Therapy
Vertebral subluxation
Headaches
Dysmenorrhea
Vertigo
Tinnitus
Increases activity of polymorphonuclear and monocytes
Limitations of Chiropractic Therapy
Bone Malignancy
Bone Infection
Fractures
Dislocations
Rheumatoid arthropaties
Traditional and Ethnomedicine Therapies
Traditional Chinese Medicine
Has its roots in Taoism
Based on the concept of Yin and Yang
Night and Day
Cold and Warm
Shady and Sunny
Yin represents inner organs of the body
Yang represents the outside parts
Traditional and Ethnomedicine Therapies
Acupuncture
Method of stimulating certain points (acupoints) on the body by inserting special needles to modify the perception of pain, normalize body function and treat or prevent diseases.
Used to regulate the flow of qi
Clinical Application of Acupuncture
Used for patients with:
Low back pain
Myofascial pain
Osteoarthritis
Sciatica
Shoulder pain
Perimenstrual symptoms
Limitations of Acupuncture
Infection from inadequately sterilized needles
Bleeding
Faintaing
Not recommended for:
Pregnant patients
Patients with HIV
Patients with bleeding tendencies
Herbal Therapies
Oldest medicine known to man
Used by developing countries due to economic reasons
Taken from plants, animals and minerals
Active ingredients are packed in capsules, syrups, elixirs, pills and tablets
The goal is to restore balance within the individual by facilitating the person’s self-healing ability.
Clinical Applications of Herbal Medicine
Some examples include:
St. John’s Wort
Mild antidepressant and mild sedative property
Clinical Applications of Herbal Medicine
2. Milk Thistle
Used to protect the liver by its anti-oxidant property
Limitations of Herbal Therapy
Contaminations such as pesticides and heavy metals incorporated with the herbs
Some herbs contain toxic products that can cause cancer
Comfrey which was used for wound healing properties are highly carcinogenic
Nursing Responsibilities
Complimentary and Alternative Therapies
Nursing Responsibilities
Nurses practicing complimentary and alternative therapies should be knowledgeable about the use of such methods
Nurses should be able to provide advices to clients regarding when to seek conventional therapy
Nursing Responsibilities
Nurses must be aware of their State Nurse Practice Acts with regard to complementary therapies
Saturday, January 3, 2009
Assistive Device for Walking
Assistive Devices for Walking
Canes
Walkers
Crutches
Canes
Canes
Lightweight, easily movable devices
Waist-high and made of wood or metal
2 types: Single straight and the quad cane
Single canes should be kept on the stronger side of the body
Quad cane is used by client’s with partial or complete leg paralysis
Used by patient with decreased leg strength
Canes
Client places the cane forward 6 to 10 inches, keeping body weight on both legs
Weaker leg is moved forward first so that body weight is divided between the cane and stronger leg
Canes
Stronger leg is then advanced past the cane, body weight is now supported by the cane
During walking, client must observe these steps
Walkers
Walkers
Extremely light, movable devices that are waist high and made of metal tubing
Has four widely spaced sturdy legs
The client holds the handgrips on the upper bars, takes a step, moves the walker forward and takes another step
Crutches
Crutches
A wooden or metal staff
Short-term use: Damage to ligaments of knee
Long-term use: Paralysis of the lower extremity
Proper measurement of crutches is essential before client use
2 types:
Lofstrand or forearm crutch
Axillary crutch
Measuring for Crutches
Measuring for Crutches
Measurement should include client’s height, the angle of elbow flexion and the distance between the crutch pad and the axilla
Handgrips should be positioned so that the client’s weight is not supported by the axilla
Measuring for Crutches
3 to 4 fingerwidths distance from the crutch pad and the axilla should be present
6 inches lateral from the clients heel
Usually measured while the patient is lying supine with the aid of a measuring tape
Crutch Gait
Crutch Gait
Four-point gait
Three-point gait
Two-point gait
Swing-to or swing through gait
Ascending and descending stairs
Four- point gait
Advance right crutch, then left foot, then left crutch, then right foot
Places weight on legs while crutches provide stability; there are always three points
Three-point Gait
Advance both crutches and affected extremity at same time, then advance unaffected extremity
Place weight in unaffected leg and crutches, with light weight on affected leg
Two-Point Gait
Advance right crutch and left foot together, then left foot and right crutch together
Places partial weight on both legs
Swing-to or swing through gait
Advance both crutches at same time and swing body forward to crutches or pass them.
Provides additional stability for clients with bilateral leg disability
Ascending or Descending Stairs Using Crutches
Instruct client to ascend stairs by leading with unaffected leg
Crutches and affected leg follow together when ascending.
Crutches and affected leg lead and the unaffected leg follows when descending
Ascending and Descending Stairs
Remember:” Up with the good, down with the bad”.
Canes
Walkers
Crutches
Canes
Canes
Lightweight, easily movable devices
Waist-high and made of wood or metal
2 types: Single straight and the quad cane
Single canes should be kept on the stronger side of the body
Quad cane is used by client’s with partial or complete leg paralysis
Used by patient with decreased leg strength
Canes
Client places the cane forward 6 to 10 inches, keeping body weight on both legs
Weaker leg is moved forward first so that body weight is divided between the cane and stronger leg
Canes
Stronger leg is then advanced past the cane, body weight is now supported by the cane
During walking, client must observe these steps
Walkers
Walkers
Extremely light, movable devices that are waist high and made of metal tubing
Has four widely spaced sturdy legs
The client holds the handgrips on the upper bars, takes a step, moves the walker forward and takes another step
Crutches
Crutches
A wooden or metal staff
Short-term use: Damage to ligaments of knee
Long-term use: Paralysis of the lower extremity
Proper measurement of crutches is essential before client use
2 types:
Lofstrand or forearm crutch
Axillary crutch
Measuring for Crutches
Measuring for Crutches
Measurement should include client’s height, the angle of elbow flexion and the distance between the crutch pad and the axilla
Handgrips should be positioned so that the client’s weight is not supported by the axilla
Measuring for Crutches
3 to 4 fingerwidths distance from the crutch pad and the axilla should be present
6 inches lateral from the clients heel
Usually measured while the patient is lying supine with the aid of a measuring tape
Crutch Gait
Crutch Gait
Four-point gait
Three-point gait
Two-point gait
Swing-to or swing through gait
Ascending and descending stairs
Four- point gait
Advance right crutch, then left foot, then left crutch, then right foot
Places weight on legs while crutches provide stability; there are always three points
Three-point Gait
Advance both crutches and affected extremity at same time, then advance unaffected extremity
Place weight in unaffected leg and crutches, with light weight on affected leg
Two-Point Gait
Advance right crutch and left foot together, then left foot and right crutch together
Places partial weight on both legs
Swing-to or swing through gait
Advance both crutches at same time and swing body forward to crutches or pass them.
Provides additional stability for clients with bilateral leg disability
Ascending or Descending Stairs Using Crutches
Instruct client to ascend stairs by leading with unaffected leg
Crutches and affected leg follow together when ascending.
Crutches and affected leg lead and the unaffected leg follows when descending
Ascending and Descending Stairs
Remember:” Up with the good, down with the bad”.
Friday, January 2, 2009
Malaria
Definition:
Malaria is an acute and chronic parasitic disease transmitted by the bite of infected mosquitoes and it is confined mainly to tropical and subtropical areas.
This disease causes more disability and heavier economic burden than any parasitic disease.
Countries where malaria is endemic as of 2003 Malaria generally occurs in areas where environmental conditions allow parasite multiplication in the vector. Thus, malaria is usually restricted to tropical and subtropical areas (see map) and altitudes below 1,500 m. However, this distribution might be affected by climatic changes, especially global warming, and population movements. Both Plasmodium falciparum and P. malariae are encountered in all shaded areas of the map (with P. falciparum by far the most prevalent). Plasmodium vivax and P. ovale are traditionally thought to occupy complementary niches, with P. ovale predominating in Sub-Saharan Africa and P. vivax in the other areas; however these two species are not always distinguishable on the basis of morphologic characteristics alone; the use of molecular tools will help clarify their exact distribution.
Etiologic Agent:
Protozoa of genus plasmodia
1. The disease is caused by four species of protozoa:
a. Plasmodium falciparum (malignant tertian)
· This is considered as the most serious malarial infection because of the development of high parasitic densities in blood (RBC) with tendency to agglutinate and form into microemboli.
· This is most common in the Philippines.
b. Plasmodium vivax (Benign tertian)
· This is nonlife threatening except for the very young and the old.
· It is manifested by chills every 48 hours on the 3rd day onward especially if untreated.
c. Plasmodium malariae (Quartan)
· It is less frequently seen.
· This specie is nonlife threatening.
· Fever and chills usually occur every 72 hours usually on the 4th day after onset.
d. Plasmodium ovale is the rare type of protozoan species.
· This is rarely seen in the Philippines.
2. The primary vector of malaria is the female Anopheles mosquito which has the following characteristics:
a. It breeds in clear, flowing, and shaded streams usually in the mountains.
b. It is bigger in size than the ordinary mosquito.
c. It is brown in color.
d. It is a night-biting mosquito.
e. It usually does not bite a person in motion.
f. It assumes a 36ยบ position when it alights on walls, trees, curtains, and the like.
Incubation period:
12 days for P. Falciparum
14 days for P. vivax and ovale
30 days for P. malariae
Period of Communicability:
Untreated or insufficiently treated patient may be the source of mosquito infection for more than three years in P. malariae, one to two years in P. vivax, and not more than one year on P. falciparum.
Mode of Transmission:
The disease is transmitted mechanically through the bite of an infected female anopheles mosquito
It can be transmitted parenterally through blood transfusion.
On rare occasions, it is transmitted from shared contaminated needles.
However, transplacental transmission of congenital malaria is a rare case.
Clinical Manifestations:
Paroxysms with shaking chills
Rapidly rising fever with severe headache
Profuse sweating
Myalgia, with feeling of well-being in between
Splenomegally, hepatomegally
Orthostatic hypotension
Paroxysms may last for 12 hours, then, maybe repeated daily or after a day or two.
In children:
Fever maybe continuous
Convulsions and gastrointestinal symptoms are prominent
Splenomegally
In cerebral malaria
Changes in sensorium, severe headache, and vomiting
Jacksonian or grand mal seizure may occur
Diagnostic Procedure:
Malarial smear – In this procedure, a film of blood is placed on a slide, stained, and examined microscopically.
Rapid diagnostic test (RDT) – This is a blood test for malaria that can be conducted outside the laboratory and in the field. It gives a result within 10 to 15 minutes. This is done to detect malarial parasite antigen in the blood.
Pathogenesis:
The parasite enters the mosquito’s stomach through the infected human blood obtained by biting or during blood meal.
The parasite undergoes sexual conjugation.
After 10 to 14 days, a number of young parasites are released which work their way into the salivary gland of the mosquito.
The organisms are carried in the saliva into the victim when the mosquito bites again.
The female alone plays the role of a vector and definitive host in conveying the disease from man to man (sexual propagation).
In humans, the organisms invade the RBC where they grow and undergo sexual schizogony.
Erythrocytic merozoites are produced leading to the rupture of RBC upon the release of the tiny organisms.
Young merozoites invade a new batch of RBC, to start another schizonic cycle.
Nursing Management:
Source:
www.nursingcrib.com
Malaria is an acute and chronic parasitic disease transmitted by the bite of infected mosquitoes and it is confined mainly to tropical and subtropical areas.
This disease causes more disability and heavier economic burden than any parasitic disease.
Countries where malaria is endemic as of 2003 Malaria generally occurs in areas where environmental conditions allow parasite multiplication in the vector. Thus, malaria is usually restricted to tropical and subtropical areas (see map) and altitudes below 1,500 m. However, this distribution might be affected by climatic changes, especially global warming, and population movements. Both Plasmodium falciparum and P. malariae are encountered in all shaded areas of the map (with P. falciparum by far the most prevalent). Plasmodium vivax and P. ovale are traditionally thought to occupy complementary niches, with P. ovale predominating in Sub-Saharan Africa and P. vivax in the other areas; however these two species are not always distinguishable on the basis of morphologic characteristics alone; the use of molecular tools will help clarify their exact distribution.
Etiologic Agent:
Protozoa of genus plasmodia
1. The disease is caused by four species of protozoa:
a. Plasmodium falciparum (malignant tertian)
· This is considered as the most serious malarial infection because of the development of high parasitic densities in blood (RBC) with tendency to agglutinate and form into microemboli.
· This is most common in the Philippines.
b. Plasmodium vivax (Benign tertian)
· This is nonlife threatening except for the very young and the old.
· It is manifested by chills every 48 hours on the 3rd day onward especially if untreated.
c. Plasmodium malariae (Quartan)
· It is less frequently seen.
· This specie is nonlife threatening.
· Fever and chills usually occur every 72 hours usually on the 4th day after onset.
d. Plasmodium ovale is the rare type of protozoan species.
· This is rarely seen in the Philippines.
2. The primary vector of malaria is the female Anopheles mosquito which has the following characteristics:
a. It breeds in clear, flowing, and shaded streams usually in the mountains.
b. It is bigger in size than the ordinary mosquito.
c. It is brown in color.
d. It is a night-biting mosquito.
e. It usually does not bite a person in motion.
f. It assumes a 36ยบ position when it alights on walls, trees, curtains, and the like.
Incubation period:
12 days for P. Falciparum
14 days for P. vivax and ovale
30 days for P. malariae
Period of Communicability:
Untreated or insufficiently treated patient may be the source of mosquito infection for more than three years in P. malariae, one to two years in P. vivax, and not more than one year on P. falciparum.
Mode of Transmission:
The disease is transmitted mechanically through the bite of an infected female anopheles mosquito
It can be transmitted parenterally through blood transfusion.
On rare occasions, it is transmitted from shared contaminated needles.
However, transplacental transmission of congenital malaria is a rare case.
Clinical Manifestations:
Paroxysms with shaking chills
Rapidly rising fever with severe headache
Profuse sweating
Myalgia, with feeling of well-being in between
Splenomegally, hepatomegally
Orthostatic hypotension
Paroxysms may last for 12 hours, then, maybe repeated daily or after a day or two.
In children:
Fever maybe continuous
Convulsions and gastrointestinal symptoms are prominent
Splenomegally
In cerebral malaria
Changes in sensorium, severe headache, and vomiting
Jacksonian or grand mal seizure may occur
Diagnostic Procedure:
Malarial smear – In this procedure, a film of blood is placed on a slide, stained, and examined microscopically.
Rapid diagnostic test (RDT) – This is a blood test for malaria that can be conducted outside the laboratory and in the field. It gives a result within 10 to 15 minutes. This is done to detect malarial parasite antigen in the blood.
Pathogenesis:
The parasite enters the mosquito’s stomach through the infected human blood obtained by biting or during blood meal.
The parasite undergoes sexual conjugation.
After 10 to 14 days, a number of young parasites are released which work their way into the salivary gland of the mosquito.
The organisms are carried in the saliva into the victim when the mosquito bites again.
The female alone plays the role of a vector and definitive host in conveying the disease from man to man (sexual propagation).
In humans, the organisms invade the RBC where they grow and undergo sexual schizogony.
Erythrocytic merozoites are produced leading to the rupture of RBC upon the release of the tiny organisms.
Young merozoites invade a new batch of RBC, to start another schizonic cycle.
Nursing Management:
Source:
www.nursingcrib.com
Bulimia Nervosa
“The Diet-Binge-Purge Disorder”.
Is a disorder characterized by alternating dieting, binging and purging through vomiting, enema, and laxatives.
The person engages in episodes of starvation and other methods of controlling weight (diet pills, excessive exercise, enemas, diuretics, laxatives), then engages in uncontrolled and rapid eating for about two hours (over 8000 calories in 2 hours and 50,000 in 1 day) then terminates binging by inducing self to vomit, going to sleep or going to social activities.
Weight fluctuations are due to alternating fasting and binging.
Bulimia means insatiable appetite.
Binging means eating an unusually large amount of food over a short period of time.
Purging is an attempt to compensate for calories consumed via self-induced vomiting or abuse of laxatives, diuretics, or enemas.
A chronic disorder that usually manifest first during late adolescence and early adulthood, around the ages 15-24 years. It almost always occurs after a period of dieting.
The bulimic often belong to a family and society that place great value on external appearance. The person strives to be thin to be accepted because they believe self-worth requires being thin.
Usually of normal weight or obese, extrovert, reports self loathing, low self-esteem, has symptoms of depression, of fear of losing control, with self-destructive tendencies such as suicide.
These individuals are known to be perfectionist, achievers scholastically and professionally and highly dependent on the approval of others to maintain self-esteem. They hide their disorder because of fear of rejection.
Like anorexia, bulimia can kill. Even though bulimics put up a brave front, they are often depressed, lonely, ashamed, and empty inside. Friends may describe them as competent and fun to be with, but underneath, when they hide their guilty secrets, they are hurting. Feeling unworthy, they suffered from great difficulty talking about their feelings, which almost always include anxiety, depression, self-doubt, and deeply buried anger. Impulse control may be a problem like shoplifting, sexual adventurousness, alcohol and drug abuse, and other kinds of risk taking behavior in which the person acts with little consideration of consequences.
The person is aware that the behavior is abnormal, but is unable to stop because she is immobilized by her fear that she cannot stop her behavior voluntarily. The binge episode usually ends when the person becomes exhausted eating, develops GIT discomfort, runs out of food or is noticed by others.
After the episode she becomes guilty and depressed that she was unable to control herself, and engages in self-critism. Then she purges her self as a form of cleansing and punishment.
Common Complications Related to the Manner of Purging
Chronic inflammation of the lining of the esophagus due to induced vomiting, acidic gastric secretions irritates esophageal mucosa.
Rupture of esophagus and stomach.
Electrolyte imbalance causing cardiac arrythmias, hypokalemia due to diarrhea,hypochloremia due to vomiting, hyponatremia due to vomiting and diarrhea.
Dehydration.
Enlargement of the parotid gland.
Irritable bowel syndrome.
Rectal prolapse or abscess.
Dental erosion.
Chronic edema.
Fungal infection of vagina and rectum.
Nursing Diagnosis
Alterations in health maintenance.
Altered nutrition: Less than body requirements.
Altered nutrition: More than body requirements
Anxiety
Body image disturbance
Ineffective family coping; compromised
Ineffective individual coping
Self-esteem disturbance
Nursing Interventions
Patient with bulimia are aware of their problems and they want to be helped because they feel helpless and unable to control themselves during episodes of binging. But because of their intense desire to please and need to conform they may resort to manipulative behavior and tell half-truths during interview to gain trust and acceptance of nurses. Create an atmosphere of trust. Accept person as worthwhile individual. If they know that no rejection or punishment is forthcoming they disclose their problem, they will be more open and honest.
Develop strength to cope with problems. Encourage patient to discuss positive qualities about themselves to increase self-esteem.
Help patient identify feelings and situations associated with or that triggers binge eating.
Assist to explore alternative and positive ways of coping.
Encourage making a journal of incident and feelings before-during and after a binge episode.
Make a contract with the patient to approach the nurse when they feel the urge to binge so that feelings and alternative ways of coping can be explored.
Encourage adhering to meal and snack schedule of hospital. This decreases the incidence of binging, which is often precipitated by starvation and fasting.
Encourage participating in group activities with other persons having the same eating disorder to gain additional support.
For young adolescent living at home, encourage family therapy to correct dysfunctional family patterns.
Cognitive behavioral therapy is the ideal therapy to help the bulimic understand the problem and explore appropriate behaviors.
Posted By:
Lhynelli
Is a disorder characterized by alternating dieting, binging and purging through vomiting, enema, and laxatives.
The person engages in episodes of starvation and other methods of controlling weight (diet pills, excessive exercise, enemas, diuretics, laxatives), then engages in uncontrolled and rapid eating for about two hours (over 8000 calories in 2 hours and 50,000 in 1 day) then terminates binging by inducing self to vomit, going to sleep or going to social activities.
Weight fluctuations are due to alternating fasting and binging.
Bulimia means insatiable appetite.
Binging means eating an unusually large amount of food over a short period of time.
Purging is an attempt to compensate for calories consumed via self-induced vomiting or abuse of laxatives, diuretics, or enemas.
A chronic disorder that usually manifest first during late adolescence and early adulthood, around the ages 15-24 years. It almost always occurs after a period of dieting.
The bulimic often belong to a family and society that place great value on external appearance. The person strives to be thin to be accepted because they believe self-worth requires being thin.
Usually of normal weight or obese, extrovert, reports self loathing, low self-esteem, has symptoms of depression, of fear of losing control, with self-destructive tendencies such as suicide.
These individuals are known to be perfectionist, achievers scholastically and professionally and highly dependent on the approval of others to maintain self-esteem. They hide their disorder because of fear of rejection.
Like anorexia, bulimia can kill. Even though bulimics put up a brave front, they are often depressed, lonely, ashamed, and empty inside. Friends may describe them as competent and fun to be with, but underneath, when they hide their guilty secrets, they are hurting. Feeling unworthy, they suffered from great difficulty talking about their feelings, which almost always include anxiety, depression, self-doubt, and deeply buried anger. Impulse control may be a problem like shoplifting, sexual adventurousness, alcohol and drug abuse, and other kinds of risk taking behavior in which the person acts with little consideration of consequences.
The person is aware that the behavior is abnormal, but is unable to stop because she is immobilized by her fear that she cannot stop her behavior voluntarily. The binge episode usually ends when the person becomes exhausted eating, develops GIT discomfort, runs out of food or is noticed by others.
After the episode she becomes guilty and depressed that she was unable to control herself, and engages in self-critism. Then she purges her self as a form of cleansing and punishment.
Common Complications Related to the Manner of Purging
Chronic inflammation of the lining of the esophagus due to induced vomiting, acidic gastric secretions irritates esophageal mucosa.
Rupture of esophagus and stomach.
Electrolyte imbalance causing cardiac arrythmias, hypokalemia due to diarrhea,hypochloremia due to vomiting, hyponatremia due to vomiting and diarrhea.
Dehydration.
Enlargement of the parotid gland.
Irritable bowel syndrome.
Rectal prolapse or abscess.
Dental erosion.
Chronic edema.
Fungal infection of vagina and rectum.
Nursing Diagnosis
Alterations in health maintenance.
Altered nutrition: Less than body requirements.
Altered nutrition: More than body requirements
Anxiety
Body image disturbance
Ineffective family coping; compromised
Ineffective individual coping
Self-esteem disturbance
Nursing Interventions
Patient with bulimia are aware of their problems and they want to be helped because they feel helpless and unable to control themselves during episodes of binging. But because of their intense desire to please and need to conform they may resort to manipulative behavior and tell half-truths during interview to gain trust and acceptance of nurses. Create an atmosphere of trust. Accept person as worthwhile individual. If they know that no rejection or punishment is forthcoming they disclose their problem, they will be more open and honest.
Develop strength to cope with problems. Encourage patient to discuss positive qualities about themselves to increase self-esteem.
Help patient identify feelings and situations associated with or that triggers binge eating.
Assist to explore alternative and positive ways of coping.
Encourage making a journal of incident and feelings before-during and after a binge episode.
Make a contract with the patient to approach the nurse when they feel the urge to binge so that feelings and alternative ways of coping can be explored.
Encourage adhering to meal and snack schedule of hospital. This decreases the incidence of binging, which is often precipitated by starvation and fasting.
Encourage participating in group activities with other persons having the same eating disorder to gain additional support.
For young adolescent living at home, encourage family therapy to correct dysfunctional family patterns.
Cognitive behavioral therapy is the ideal therapy to help the bulimic understand the problem and explore appropriate behaviors.
Posted By:
Lhynelli
Hypertension
Hypertension refers to a state where a person’s blood pressure remains at an elevated level at all times. This condition is formally known as arterial hypertension and is popularly called high blood pressure.
Two types of hypertension:
Primary Hypertension - when a patient’s chronically elevated blood pressure does not have a specific medical cause that can be identified
Secondary Hypertension - When high blood pressure is caused by other health conditions like tumors of the adrenal gland, kidney disease of other problems.
Hypertension is a dangerous condition because it can lead to serious complications. Chronically elevated blood pressure increases the risk of developing heart failure, heart attacks, arterial aneurysm and strokes. Many cases of chronic renal failure have been linked to high blood pressure.
Signs and Symptoms:
Undiagnosed high blood pressure can lead to many physical problems including damage to major organs over a period of time. The symptoms of hypertension, if ignored, can lead to deterioration in kidney / liver function and cardiac problems. Hypertension can also damage vision, cause strokes and more.
Here are some of the common hypertension symptoms to be aware of.
Recurrent / persistent headaches
Vision problems including blurring of vision
Giddiness
Convulsions
Tremors in the hands or other body parts
Walking difficulties (formally called ataxia)
Source:
Wish Granted: How A Simple E-mail Changed the Life of a Family
It was August 2,2008. for Laish Christle Capiendo,Ruby Anna Bonifacio,Regine Bulacso,Eden Grace Alejandria,Norelette Adion.April Rose Bravo,Louiella Abella,Jeric Barroga Bianca Alfonso and Randy Angel,Group 9 of BSN III-C of CLDH-EI, it marked the end of their second week of exposure at San Jose de Urquico. but for baby JR, it was the day when God sent his angels to answer his family's prayers. on that saturday morning, the group 8 of BSN III-C led by their clinical instructor Ma'am Cynthia Capitulo, visited the home of feliciano family. there they saw Baby Jr. lying on his wooden crib. crying incessantly. Mixed emotions filled the hearts of the group. they related "shocked talaga kami. hindi namin alam kung maawa kami o matatakot sa nakita namin. at that time sya pala yung bata na ibinabalita mga isang buwan na yung nakakaraan"
they were deeply moved by compassion, there was only one thing that was evident to them: they have to help. suggestion we're brought out. some thought of contacting DSWD, while other suggested asking help from the local government. then an idea came to their mind: "Sumulat kaya sa wish ko lang?". touched by child's condition they composed an e-mail telling the current status of the child and his family. they also attanched pictures of baby Jr. serving as a proof how sad is his condition is. though they knew that there were just a small chance that their letter would be read, they gave it a try hoping that God will hear their prayers. four days after. they recieved a phone call from the senior employee of QTV channel 11 telling her of the broadcasting company's plans regarding Baby JR. They were even met by the employees who came all the way from tuguegarao. it was later found out that the group of employees was from Wish ko Lang. and the rest. as they often say. was history.
last August 23, 2008, the Philippines witnesses how the group of young student nurses tried to help an innocent child and his family, who had lose hope that their situation would get any better. suddenly, the tables turned. Mr. and Mrs. Feliciano had all that they have prayed for, all because of a simple e-mail made by a concerned students. they all served their purpose as God's instruments to show his glory and love.
though he was not able to see all that was happening during the shoots, Baby Jr felt the Lord's presence in everyone around him. as he was laid in his new crib, he stopped his inecessant crying and became silent. what happened next was a big suprise to all of them, a more precious gift to JR's parents than any of the showcases given to them. "Ngumiti sya. sabi nga nung mga magulang niy noon lang daw siya ngumiti. Naiyak nga kami noon kasi iba yung feeling na nakagawa ka ng mabuti, pati yung bata naramdaman niya yung saya" the group revealed.
The lesson? "there is no harm in trying" laish said "malay mo ' diba? kami ng group namin, we never expected na yung e-mail na yun ay mapapansin. sometimes you really have to take chances to get what you want, and in this case, to Help." she was right. grab the chance to do something good. who knows? maybe next time, it's your wish that's going to be granted.
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