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Thursday, April 30, 2009

Swine Flu One Step Closer to Pandemic

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April 29, 2009 — Swine flu has pushed the World Health Organization to raise its pandemic alert level to phase 5, which means that a pandemic is imminent.

It's the second time in a week that the World Health Organization (WHO) has raised its pandemic alert level, which ranges from phase 1 (low risk of a pandemic) to phase 6 (a full-blown pandemic is under way).

"The biggest question is, how severe will the pandemic be?" WHO Director-General Margaret Chan said today in a news conference in Geneva. "We do not have all the answers right now, but we will get them."

Chan said the swine flu situation is changing rapidly and the swine flu virus is still "poorly understood."

Chan called on all governments around the world to "immediately activate their pandemic preparedness plan," noting that each country is free to make its own pandemic plans -- and that many countries have been working on pandemic preparedness for years, thanks to concerns about bird flu ( avian flu). "The world is better prepared for an influenza pandemic than at any time in history."

Earlier today, CDC Acting Director Richard Besser, MD, said that the U.S. is at a "pre-pandemic" level and that it matters less what the situation is called than what's being done about it, and that the U.S. is taking "aggressive" action to limit swine flu's impact on human health.

WHO Pandemic Levels

Here is a quick look at the WHO's pandemic alert phases:

  • Phase 1: A virus in animals has caused no known infections in humans.
  • Phase 2: An animal flu virus has caused infection in humans.
  • Phase 3: Sporadic cases or small clusters of disease occur in humans. Human-to-human transmission, if any, is insufficient to cause community-level outbreaks.
  • Phase 4: The risk for a pandemic is greatly increased but not certain. The disease-causing virus is able to cause community-level outbreaks.
  • Phase 5: Still not a pandemic, but spread of disease between humans is occurring in more than one country of one WHO region.
  • Phase 6: This is the pandemic level. Community-level outbreaks are in at least one additional country in a different WHO region from phase 5. A global pandemic is under way.

Note that all of those phases are about how the virus is (or isn't) spreading -- they're not about the severity of the disease.

91 Cases in U.S.

At least 91 people in 10 U.S. states have swine flu, and there has been one death of a swine flu patient in the U.S., according to the CDC.

The patient who died was a 22-month-old boy from Mexico who died at a hospital in the Houston area. He had several underlying health problems, according to the Texas Department of State Health Services.

Here is the CDC's latest tally of lab-confirmed swine flu cases:

  • New York: 51 cases
  • Texas: 16 cases
  • California: 14 cases
  • Kansas: 2 cases
  • Massachusetts: 2 cases
  • Michigan: 2 cases
  • Arizona: 1 case
  • Indiana: 1 case
  • Nevada: 1 case
  • Ohio: 1 case

But the situation is changing so quickly that "these numbers are almost out of date by the time I say them," Besser said today at a press conference.

Besser noted that health officials expect to see a "spectrum" of disease severity in the U.S. "Unfortunately, I anticipate that we will see more deaths."

Swine Flu Numbers Changing Constantly

The CDC and the World Health Organization (WHO) only report lab-confirmed cases -- not probable or suspected cases -- and they only do it once a day. So there may be a lag time before cases confirmed at the state or local level make it into the official tally.

The WHO today reported 114 lab-confirmed swine flu cases worldwide, but that figure is based on yesterday's CDC numbers and doesn't include three cases reported in Germany, one in Austria, and additional cases in New Zealand.

"It is clear that the virus is spreading; we don't see any evidence that it's slowing," Keiji Fukuda, MD, the WHO's assistant director-general for health security and environment, said at a news conference in Geneva earlier today.

Swine Flu Vaccine Work Under Way

Scientists are already working on creating a vaccine against the new swine flu virus.

"We're in full gear; the process is more speedy than [it's] ever been before, " Kathleen Sebelius, the new Secretary of the Department of Health and Human Services (HHS), said today at a joint news conference with the HHS, CDC, FDA, and the National Institutes of Health.

A swine flu vaccine may be created by early fall, but that doesn't mean it will be ready for distribution by then, health officials noted at the news conference.

Developing a vaccine means conducting clinical trials to see if the vaccine is safe, if it works, and what dose is needed, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said at the news conference.

Fauci predicted that clinical trials of a vaccine against the new flu virus -- which he calls the H1N1 virus -- will "probably begin within a couple of months" and take several months.

'Serious Virus'

During today's joint news conference, a reporter asked why officials are so concerned about the new flu virus, given the fact that normal seasonal flu kills an average of 36,000 people in the U.S. during a typical flu season.

The reason is that it's a new, unpredictable virus that "has pandemic potential," Fauci replied. "It really is something different."

"This is a serious virus, this is a serious outbreak," Besser agreed.

"You don't know if it's going to fizzle out in a couple weeks or become more or less virulent or severe in the diseases it causes," Besser said. "If we could see into the future, that would be wonderful. But that's not the case. That's why we're being aggressive."


Margaret Chan, director-general, World Health Organization.

WebMD Health News: "CDC Confirms First U.S. Swine Flu Death."

Richard Besser, MD, acting director, CDC.

Keiji Fukuda, MD, assistant director-general, health security and environment, World Health Organization.

Kathleen Sebelius, secretary, Department of Health and Human Services.

Anthony Fauci, MD, director, National Institute of Allergy and Infectious Diseases.

Article copyright - #1 source of information to update nurses all over the world. All rights reserved. No part of an article may be reproduced without the prior permission.

Wednesday, April 29, 2009

Frye's Nclex Bullets - Nursing for Nurses

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Phenelzine sulfate is in the monoamine oxidase inhibitor (MAOI) class of antidepressant medications. An individual on an MAOI must avoid aged cheeses, alcoholic beverages, avocados, bananas, and caffeine drinks. There are also other food items to avoid, including chocolate, meat tenderizers, pickled herring, raisins, sour cream, yogurt, and soy sauce. Medications that should be avoided include amphetamines, antiasthmatics, and certain antidepressants. The client should also avoid antihistamines, antihypertensive medications, levodopa (L-Dopa), and meperidine (Demerol).

Incentive spirometry is not effective if the client breathes through the nose. The client should exhale, form a tight seal around the mouthpiece, inhale slowly, hold to the count of three, and remove the mouthpiece to exhale. The client should repeat the exercise approximately 10 times every hour for best results.

Proper positioning can decrease episodes of dyspnea in a client. These include sitting upright while leaning on an overbed table, sitting upright in a chair with the arms resting on the knees, and leaning against a wall while standing.

Pleurisy, also known as pleuritis, is an inflammation of the pleura, the lining of the pleural cavity surrounding the lungs, which can cause painful respiration (also called pleuritic chest pain) and other symptoms. Pleurisy can be generated by a variety of infectious and non-infectious causes.

The client with pleurisy should splint the chest wall during coughing and deep breathing. The client may also lie on the affected side to minimize movement of the affected chest wall. Taking small, shallow breaths promotes atelectasis. The client should take medication cautiously so that adequate coughing and deep breathing is performed and an adequate level of comfort is maintained.

Agranulocytosis is an adverse effect of carbamazepine (Tegretol) and places the client at risk for infection. If the client develops a fever or a sore throat, the physician should be notified. Unusual bruising or bleeding are also adverse effects of the medication and need to be reported to the physician if they occur.

Carbamazepine ("CBZ") is an anticonvulsant and mood stabilizing drug used primarily in the treatment of epilepsy and bipolar disorder. It is also used to treat ADD, ADHD, schizophrenia, Phantom limb syndrome, Paroxysmal extreme pain disorder, and trigeminal neuralgia.

NG tubes are discontinued when normal function returns to the GI tract. The tube will be removed before GI healing. Food would not be administered unless bowel function returns.

Fat emulsion therapy can cause overloading syndrome (focal seizures, fever, shock) and adverse effects, including chest pain, chills, and shock. The priority action is to stop the infusion and limit the adverse response before obtaining additional assistance.

Caregiver strain can occur when a client is significantly dependent on someone for personal and health care needs

Warfarin sodium (Coumadin) is an oral anticoagulant that is used mainly to prevent thromboembolitic events, such as thrombophlebitis, pulmonary embolism, and embolism formation caused by atrial fibrillation or other disorders. Oral anticoagulants prolong the clotting time and are monitored by the prothrombin time (PT) and the International Normalized Ratio (INR). Client education should include signs and symptoms of adverse effects and dietary restrictions such as limiting foods high in vitamin K (leafy green vegetables, liver, cheese, and egg yolk) because these increase clotting times.

In treating STDs, all sexual contacts must be contacted and treated with medication. Clients should always use a condom with any sexual contact. Treatment of a teenager at a GYN clinic is confidential and parents will not be contacted, even if the client is under 18 years of age. Any client should always finish the course of antibiotics prescribed by the health care provider.

The client should be taught to report blood glucose levels that exceed 250 mg/dL, unless otherwise instructed by the physician.

Aspirin is irritating to the gastrointestinal (GI) tract of the client with a history of gastritis. The client should be advised to take analgesics that do not contain aspirin, such as acetaminophen (Tylenol). The other medications listed have aspirin in them. Another category of medications that is irritating to the GI tract is the nonsteroidal antiinflammatory drugs (NSAIDs).

Buerger’s disease occurs predominantly in men between 25 to 40 years of age who smoke cigarettes. A familial tendency is noted, but cigarette smoking is consistently a risk factor.

Common client teaching points about beta-adrenergic blocking agents include to take the pulse daily and hold for a rate under 60 beats per minute (and notify physician) and to report shortness of breath. The client should not discontinue or change the medication dose. The client is also instructed to keep enough medication on hand so as not to run out, to change positions slowly, not to take over-the-counter medications (especially decongestants, cough, and cold preparations) without consulting the physician, and to carry medical identification stating a beta-blocker is being taken.

Lovastatin (Mevacor) is a reductase inhibitor. It results in an increase in the high-density lipoprotein (HDL) cholesterol and a decrease in the triglycerides and low-density lipoprotein (LDL) cholesterol. This medication is converted by the liver to active metabolites, and therefore is not used in clients with active hepatic disease or elevated transaminase levels. For this reason, clients are recommended to have periodic liver function studies. Periodic cholesterol levels are also needed to monitor the effectiveness of therapy.

Client taking Clonazepam (Klonopin) experiencing signs and symptoms of toxicity with the administration of clonazepam exhibit slurred speech, sedation, confusion, respiratory depression, hypotension, and eventually coma. Some drowsiness may occur but will decrease with continued use. The medication may be taken with food to decrease gastrointestinal irritation.

Persantine (Dipyridamole) combined with warfarin sodium is prescribed to protect the client’s artificial heart valves. Persantine does not prevent heart attacks or strokes. It is an antiplatelet medication, not an antihypertensive.

Discharge planning begins upon admission. Determination of the services, needs, supplies, and equipment requirements should not be made on the day of discharge.

After an acute MI, many clients are instructed to take one aspirin daily. Adverse effects include tinnitus, hearing loss, epigastric distress, gastrointestinal bleeding, and nausea. Following an acute MI, sexual intercourse usually can be resumed in 4 to 8 weeks if the physician agrees. Clients should be advised to purchase a new supply of nitroglycerin tablets every 6 to 9 months. Expiration dates on the medication bottle should also be checked. Activities that include lifting and reaching over the head should be avoided because they reduce cardiac output.

Infection and stopping insulin are precipitating factors for DKA. Nausea and abdominal pain that lasts more than one or two days need to be reported, because these signs may be indicative of DKA.

Clients with chronic venous insufficiency are advised to avoid crossing the legs, sitting in chairs where the feet don’t touch the floor, and wearing garters or sources of pressure above the legs (such as girdles). The client should wear elastic hose for 6 to 8 weeks, and in some situations for life. The client should sleep with the foot of the bed elevated to promote venous return during sleep. Venous problems are characterized by insufficient drainage of blood from the legs returning to the heart. Thus, interventions need to be aimed at promoting flow of blood out of the legs and back to the heart.

Standard postoperative care following vein ligation and stripping consists of bed rest for 24 hours, with ambulation for 5 to 10 minutes every 2 hours thereafter. Continuous elastic compression of the leg is maintained usually for one week following the procedure, followed by long-term use of elastic hose. The foot of the bed should be elevated to promote venous drainage.

Use of measures to prevent vasoconstriction are helpful in managing Raynaud’s disease. The hands and feet should be kept dry. Gloves and warm fabrics should be worn in cold weather, and the client should avoid exposure to nicotine and caffeine. Avoidance of situations that trigger stress is also helpful.

Long-term management of peripheral arterial disease consists of measures that increase peripheral circulation (exercise), promote vasodilation (warmth), relieve pain, and maintain tissue integrity (foot care and nutrition). Application of heat directly to the extremity is contraindicated. The limb may have decreased sensitivity and be more at risk for burns. Additionally, direct application of heat raises oxygen and nutritional requirements of the tissue even further.

Sodium intake can be increased by use of several types of products, including toothpaste and mouthwashes; over-the-counter (OTC) medications such as analgesics, antacids, cough remedies, laxatives, and sedatives; softened water, as well as some mineral waters. Water that is bottled, distilled, deionized, or demineralized may be used for drinking and cooking. Clients are advised to read labels for sodium content.

The uterus is theoretically sterile during pregnancy until the membranes rupture. It is capable of being invaded by pathogens after membrane rupture.

Appropriate hand washing by staff and parents has been effective in the prevention of nosocomial infections in nursery units. This action also promotes parents taking an active part in the care of their infant.

To assess the ulnar nerve status, the client is asked to spread all of the fingers wide and resist pressure. Weakness against pressure may indicate compromise of the ulnar nerve.

The primary diagnostic tool for pulmonary tuberculosis is a sputum culture. A negative culture indicates effectiveness of treatment. Nausea and vomiting and clay-colored stools are side effects of the medication used to treat tuberculosis. Their presence or absence does not measure the therapeutic effectiveness of the medication. The Mantoux test is a screening tool, not a diagnostic test for tuberculosis. Because the Mantoux test indicates exposure to the organism but not active disease, the test results will remain positive.

Hypoglycemia is a problem during pregnancy and needs to be assessed. A diabetic pregnant client has a higher incidence of developing pregnancy-induced hypertension than the nondiabetic pregnant client. Insulin needs will increase during the last trimester because of increased placenta degradation. Ultrasounds are done frequently during a diabetic pregnancy to check for congenital anomalies and determine appropriate growth patterns.

Aspirin can interact with the anticoagulant medication and increase clotting time beyond therapeutic ranges. Avoiding aspirin is a priority. Not all activities need to be avoided. Walking and climbing stairs are acceptable activities. The client does not need to avoid brushing the teeth; however, the client should be instructed to use a soft toothbrush.

The client has been unable to refuse requests in the past. Saying “no” now indicates that the client is trying to meet her own needs. “No” is being said now without guilt and apology. During the treatment process, the client has learned how to meet her own needs, and this can help to maintain health upon discharge.

Depression may be a recurring illness for some people. The client needs to understand the symptoms of depression and recognize when or if treatment needs to begin again. The other statements indicate that the client has learned some coping skills, such as setting limits, taking medications, and reframing an a potentially unpleasant experience into a more positive one.

Taking an axillary temperature for at least 5 minutes is most accurate.

Salt tablets should not be taken because they can contribute to dehydration. Frequent fluid breaks should be taken to prevent dehydration. Early detection of decreased body weight alerts an individual to drink fluids before becoming dehydrated. Sixteen ounces of fluid should be consumed for every pound lost to prevent dehydration.

The client taking sublingual nitroglycerin should lie down upon taking the medication because lightheadedness and dizziness may occur as a result of postural hypotension. The client should use up to three tablets at 5-minute intervals before seeking medical attention.

With a uric acid stone, the client should limit intake of foods high in purines. Organ meats, sardines, herring, and other high-purine foods are eliminated from the diet. Foods with moderate levels of purines, such as red and white meats and some seafood, are also limited.

LGA infants tend to be more difficult to arouse and therefore will need to be aroused to facilitate nutritional intake and attachment opportunities. These infants also have problems maintaining a quiet alert state. It is beneficial for the mother to interact with the infant during this time to enhance and lengthen the quiet alert state. Even though the infant is large, motor function is not usually as mature as in the term infant. LGA infants need to be aroused for feedings, usually every 2 1/2 to 3 hours for breast feeding.

In polymyositis, necrosis and inflammation are seen in muscle fibers and myocardial fibers.

The client who has chest tubes following thoracic surgery should be encouraged to cough and deep breathe every 1 to 2 hours after surgery. This helps facilitate drainage of fluid from the pleural space, as well as facilitate the clearance of secretions from the respiratory tract. Milking and stripping of the chest tube may be done when there is an occlusion, such as with a small clot. Even then, it is done only with a physician’s order or when allowed by agency policy. The client is maintained in semi-Fowler’s position and may lie on the back or on the nonoperative side. The client may be allowed to lie on the operative side according to surgeon preference, but care must be taken not to compress the chest tube or attached drainage tubing. Ambulation is generally allowed and also facilitates optimal respiratory function.

The Mantoux skin test for tuberculosis is read in 48 to 72 hours

The client with Ineffective Airway Clearance has ineffective coughing and excess sputum in the airways. The nurse assesses for knowledge of contributing factors, such as dehydration and lack of knowledge of proper coughing techniques. Reduction of these factors helps limit exacerbations of the disease.

When a client is in a state of immunosuppression or has decreased levels of some normal oral flora, an overgrowth of the normal flora Candida can occur. Careful routine mouth care is helpful in preventing recurrence of Candida infections. The client should use a mouthwash consisting of warm saline (or water). Red meat will not prevent thrush.

The client should be taught that ketoconazole (Nizoral) is an antifungal medication. It should be taken with food or milk. Antacids should be avoided for 2 hours after it is taken because gastric acid is needed to activate the medication. The client should avoid concurrent use of alcohol, because the medication is hepatotoxic. The client should also avoid exposure to sunlight, because the medication increases photosensitivity.

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Tuesday, April 28, 2009

Be wary of the RN contract trap

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For many foreign nurses (RNs) the chance to immigrate to the US is the opportunity of a life time. For so many, immigrating to the US is the reason they went to nursing school and took up the profession. Many others, such as marketing majors, physicians, computer engineers, etc. have switched professions to become nurses in order to immigrate to the US.

The shortage spurred the growth and creation of hybrid industries such as nurse registries and temporary nursing staff companies. These types of companies assign nurses on a temporary basis with their client hospitals, medical facilities, and private homes.

A nurse working for one of these companies for example, might find herself working at Hospital A for 2 days out of the week and Hospital B for 3 days. Then, a few months later, working 4 days for Hospital C. The RN goes wherever her employer has been contracted to provide services. She is not an employee of the hospital, but rather the registry company.

Because of the shortage, various RN employers (hospitals, agencies, RN staffing companies) heavily recruit for RNs overseas. Foreign RNs who wish to immigrate are delighted at the opportunity the recruiters offer and are often all too eager to sign up.

While this path may be one of the easiest ways to immigrate, it is not without its pitfalls. Employment-based sponsorship means the RN will be allowed to immigrate if the RN intends to work on a permanent basis for the petitioning employer. This is a critical condition of immigrating that carries consequences if not fulfilled.

During the typical recruitment process, the RNs are promised sponsorship in exchange for working for the employer. Contracts are prepared and representations are made regarding the nature of work, type of work, place of work, working conditions and wages. Many RNs are so eager to immigrate, they do not carefully read these contractual documents, ask serious questions regarding the terms and conditions, or have the contracts reviewed by their own attorney.

In the excitement of the prospect of immigrating to the US many RNs are seduced with the notion that the dream job awaits them in the US. For some this is true, but for many, it has drastic consequences. The RNs gloss over the contracts and assume an attitude of, "I’ll deal with it later."

The most common contractual clause that wreaks havoc on an immigrating RN’s life is the breach of contract damages clause. Most contracts typically require the RN to work for a specific number of years and failure to do so triggers the damages clause. The damages can range from $15,00 to $50,000 dollars!

Many RNs signing these contracts are unfamiliar with the litigious culture in the U.S. Some come to the U.S. and find the working conditions and salaries they were told they would receive are not the same as represented when first recruited. Some conditions are so unbearable.

For example, being placed in graveyard shifts in hospitals far from home. Or, not being placed in any hospital and collecting no salary while the sponsor tries to obtain a new client for the RNs placement. Many of these RNs then leave their employers and this is when additional tragedy strikes.

The employer begins a campaign of harassment and may sue for breach of contract and obtains a judgment against the RN for the penalty amount. The judgment typically comes with a wage garnishment order. This means the RN’s new employer is required to pay a portion of the RN’s wages to the sponsor to cover the judgment. Because RNs are in a licensed occupation requiring a reporting of where they work, it is very simple for the sponsor to locate the RN and exact the judgment.

But, worse than a breach of contract is the possible immigration consequence. The RN has obtained permanent residency because she stated she intends to work on a permanent basis for her sponsor. By leaving or changing employers shortly after entering the U.S., she has now opened the door for the Immigration Service to revoke the green card! Some employers immediately notify the Immigration Service when an RN leaves exposing the RN to possible green card revocation and deportation.

For many others, the immigration consequence comes several years later when the RN is applying for U.S. citizenship. The Immigration Service reviews the basis of the green card and determines how long the RN worked for her sponsor. If it determines that the RN has only worked for a short period of time, it may begin revocation and deportation proceedings against both the RN and her family members who obtained green cards through her.

These tragic consequences can be avoided by careful review in the beginning. For many of those currently in the position, there is still immigration and contractual relief available. The U.S. Constitution prohibits slavery and indentured servitude and because in many cases the sponsoring employer breaches the contract, the employee is not liable for any damages. This core constitutional value is the basis for providing relief to those forced to leave their sponsors. This will be the subject of our second part of this article.

Author's Note: The analysis and suggestions offered in this column do not create a lawyer-client relationship and are not a substitute for the individual legal research and personalized representation that is essential to every case. - OFW GUIDE


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Monday, April 27, 2009

Labor and Delivery Nursing: How to Become a Labor and Delivery Nurse?

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How to Become a Labor and Delivery Nurse?

The role of a Labor and Delivery Nurse is to provide care to pregnant women in addition to the actual birth process. As a labor and delivery nurse or a nurse midwife, you have to assess complications during pregnancy to provide postpartum care. Labor and delivery nurses provides support and empathy to expecting mothers because their road to delivering a baby is someone a mix of excitement and fear.

As a labor and delivery nurse, you will be face with frightened angry pregnant patient that expect you to do something to relieve their pains. It is your role as a labor and delivery nurse to keep them calm, provide support and assess their status to prevent complications.

Inorder to become a Labor and Delivery Nurse you may have to work as a general care nurse for a period of time to gain some of the required skills before moving into being a labor and delivery nurse. However, due to the need for labor and delivery nurses, some hospitals are hiring graduates and placing them in a program for six months to a year where they work closely with and learn from experienced labor and delivery nurses.

To specialize as a Nurse Midwife / Labor & Delivery Nurse, Certification exams can be taken after 2 years of working in a specialized field of care, and upon successful completion the nurse may use RN,C as part of their title. Two areas to consider are neonatal care, for seriously ill or premature newborns, and becoming a Certified Nurse Midwife. Nurse Midwives have advanced education and training beyond their registered nursing degree. These nurses treat women before, during and after birth, and usually stay with a patient for the length of their labor and delivery to offer support.

Labor and Delivery Nursing
Guide to Evidenced-based Practice

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Download Nursing Softwares: FREE Healthcare Palm Software Downloads

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I often see in forums and other blogs, many nursing students and nursing professionals are looking for nursing software application that they can install in their Personal Data Assistant (PDA). As a nurse, you are face with challenging task and most often nurses and nursing students needs a quick and easy nursing application software offering easy access to the clinical information they need right in the palms of their hands.

This post will provide you lots of FREE Nursing Application Softwares available for you to download and quickly install. Take note that this website is not in any way responsible for any damages that might occur when installing theses Medical Softwares applications for your PDAs.

The cool thing about these softwares is that it makes your job easier and makes you efficient. You can lessen your errors and can make quick and accurate calculations all the time.

Freeware: minimum requirement • Palm OS v2.0 •
A program that will completely analyze arterial blood gases for you! No longer will you be confused by ABG's. Not only will the program tell you whether or not you have a metabolic or respiratory acidosis or alkalosis, but it will also calculate expected PCO2 and expected HCO3 when needed, and will then tell you if there is a concominant acid-base disorder. It will even calculate Anion Gap and Delta-Delta if necessary (not sure what Delta-Delta is? Download the program and we will tell you!). Compiled into fast, efficient machine code using Quartus Forth. Only needs 14K of your precious memory (no 50+ K math libraries required!).
Download ABG Pro Nursing Software

ACLS 2001 Review Flash Cards 1.2
Freeware: minimum requirement • Palm OS v3.3 • QuizApp (Free)
These flash cards are a review of the newly published ACLS protocols. The cards consists of 390 question and answer sets that were developed by physicians who are board certified in Emergency Medicine and Anesthesiology. The cards can be played back in sequence, by category and randomly. Scoring is provided both as an overall grade and by category. Advanced text formating, such as bold, italics and bullet lists, make for easier reading and understanding. This card set is not meant to be a substitute for the standard textbooks of ACLS, such as the American Heart Association ACLS Provider Manual.
Download ACLS 2001 Review Flash Cards 1.2 Nursing Software

Freeware: minimum requirement • Palm OS v2.0
The ActiveECG program runs on any Palm Powered device with ROM version 2.0 or later. It demonstrates 13 different rhythms (normal sinus rhythm and 12 arrhythmias). It's a great teaching tool for showing different cardiac rhythms in real time!
Download ActiveECG Healthcare Software

Anemia Guide
Freeware: minimum requirement • Any Palm OS • TealInfo
This TealInfo folio is a guide to Anemia in children and adults. After picking a class of anemia (microcytic, normocytic or macrocytic), you can choose a type of anemia (for example, iron deficiency, thalesemia, chronic disease, lead poisoning, hemolysis, aplastic anemia, vitamin B12 or folate deficiency, etc) and see common lab values for that type of anemia and other details.
Download Anemia Guide Nursing Software for PDA

Apache II Score
Freeware: minimum requirement • Any Palm OS • HanDBase
Scoring system developed for quantifyng the severity of the illness for the intensive care patients, archive with date and patient name.
Download Apache II Score Software for any Palm OS • HanDBase

Freeware: minimum requirement • Palm OS V2.0
A comprehensive guide to the diagnosis and management of asthma. This e-book designed for the iSilo document reader contains more than 170 pages of information woven together with hyperlinks to make finding the information you need fast and easy. Includes a step-by-step diagnostic algorithm, differential diagnosis, normal peak flow readings, classification of severity, and recommendations for treatment of chronic asthma and asthma exacerbations.

Includes information from the 1997 NAEPP Asthma Guidelines and an up-to-date survey of the asthma literature from 1998 through April 2001 with detailed references.
Download AsthmaMeister Nursing Software

Freeware: minimum requirement • Palm OS v3.1•
This application keeps track of the blood pressure readings. The readings are hightlighted with different colours based on the pressure values. The program also shows the overall average statistics and the weekly distribution.
All the pressure values can be ploted on several graphs with the ideal, borderline and hypertension lines.
Download BloodPressMgr Nursing Software Application

Freeware: minimum requirement • Palm OS v3.1•
Chemical Agents: Chloropicrin, Cyanogen Chloride, Diphosgene, Hydrochloric Acid, Hydrogen Cyanide, Lewisite, Mustard Gas, Nitrogen Dioxide, Perfluoroisobutylene, Phosgene, Phosgene oxime, 3-Quinuclidinylbenzilate (QNB), Sulfur Dioxide, T-2 Mycotoxin, Titanium Tetrachloride, White Phosphorus Biological Agents: Anthrax, Botulism, Brucellosis, Ebola, Lassa Fever, Plague, Ricin, Smallpox, Tularemia Nerve Gases: Sarin, Soman, Tabun, VX (Does not contain care instructions or recommended drugs/dosages and lab tests. For the professional version vist the developers home page)
Download BioChem Software for Palm OS

BMI Calculator
Freeware: minimum requirement • Palm OS v2.0•
The calculator contains a chart which shows the categories of BMI values for adults. It also gives some background on the use of BMI in the clinical area. The BMI is considered accurate in the clinical setting as a method of determining body fat of the adult.
Download BMI Calculator Nursing Software for Palm

Brain SCAN
Freeware: minimum requirement • Palm OS v 3.0
A seizure diagnostic tool. The "traditional" tool used to diagnose Pseudoseizures is a 512Hz Tuning Fork which is placed on the forehead of the person faking a seizure. They usually respond to the vibratory sensation by going into a very theatrical self-induced convulsions. By replacing the vibratory sensation of the tuning fork with an auditory stimulus (i.e. BrainSCAN) the same effect can be achieved. It is designed to reveal if a patient may be falsifying a seizure disorder. The help menu also provides tips on how to differentiate between real and false seizures.
Download Brain SCAN Nursing Application Software

Freeware: minimum requirement • Palm OS v2.0•
BreastCa is a breast cancer risk prediction tool. In particular, it is designed to be a fast, easy-to-use, and accurate implementation of two commonly-used models of breast cancer risk prediction: the Gail and Claus models.The most commonly used model for breast cancer prediction was originally developed by Gail et al. in 1989 (model 1) using data on women participating in the Breast Cancer Detection and Demonstration Project (BCDDP).The other commonly-used model was developed by Claus et al. on the basis of data from the Cancer and Steroid Hormone Study (CASH), and concentrates solely on family history risk factors.
Download BreastCa Medical Software

Freeware: minimum requirement • Palm OS v3.0
CardioMath is a calculator with over 50 commonly used formulas in cardiovascular medicine. It is designed to assist physicians, nurses, pharmacists, technologists, technicians, and other allied health professionals in the field of cardiovascular medicine to perform essential day-to-day calculations accurately and efficiently. These formulas are also commonly used by medical professionals involved in intensive and emergency care, internal medicine and rehabilitation. In addition, this program also serves as a reference and an education aid to these calculations.

CardioMath covers the following major areas in cardiovascular medicine ... - Echocardiography - EKG - Epidemiology - Exercise Stress Test - Hemodynamics - Unit Conversion (SI & US)
Download CardioMath Medical Application

Clinical Log 1.1
Freeware: minimum requirement • Palm OS v3.0 • HanDBase
Clinical Log 1.1 is a HanDBase applet Lyn created for keeping track of her clinical hours in her MSN-FNP classes. It can be individualized by using the popup list function to enter various clinical areas. You can view a running total of clinical hours and use the filter function to isolate total hours spent in a particular area. A brief 'How To' file is included to get you started. Please note that this applet will not track time over midnight from one day to the next.
Download Clinical Log 1.1 PDA Application Software

Doser 4.2
"No nag shareware": minimum requirement • Palm OS v2.0•
This is a program that calculates mcg/kg/min mg/kg/hr, rate mcg/kg/hr mg/kg/min useful for calculating various drug infusions.
Download Doser 4.2 Application for Palm

Drips 1.40
Freeware: minimum requirement • Palm OS v3.0•
Calculates IV doses for drugs. It allows use of multiple units e.g. lbs vs kg or mcg/kg/min vs mg/min.
You can save frequently used patterns / drug mixes, and beam them
Download Drips 1.40 Application

EBM Calculator
Freeware: minimum requirement • Palm OS v3.1• MathLib (included in download)
EBM Calculator is designed to calculate relevant statistics for: - Diagnostic studies, Prospective Studies, Case Control Studies, Randomized Control Trials(RCT)
Features: - Graphing function for pre-test probability and post-test probability with the calculated likelihood ratio in the Diagnostic Studies, Save the results for later retrieval, Convert ORs to NNTs
Download EBM Calculator

EBM Tables 2.0
Freeware: minimum requirement • Palm OS v3.1• MathLib (included in download)
EBM Tables - NNT Tables version 2.0 is an enhanced version of our previous NNT Tables. It now uses a common interface for NNT Tables, LR Tables, and SnNouts/SpPins Tables. Each set of tables contains it's own pdb file that you can load to your palm.

Features: Search function - allows user to search for specific keywords, Uses pdb files - the user can load one or more of the tables to the palm, NNT Tables - pdb file, LR Tables - pdb file, SnNouts/SpPins Tables - pdb file, Remove Database(s) - removes one or more database files (pdb).
Download EBM Tables 2.0 Software

Freeware: minimum requirement • Palm OS v2.0• HanDBase
eDrugsDataHDB contains information on over 2,450 generic drug listings. It gives the generic name, trade names, use or class, usual dose, pregnancy risk factor and additional information for each listing. It contains over 12,000 drug names and dosage forms.
Download eDrugsDataHDB Nursing Software for Palm OS

Freeware: minimum requirement • Palm OS v2.0• HanDBase
eDrugsRenalHDB is an add-on applet for HanDBase that contains a listing of 560 medications and recommended dosage adjustments for patients with renal insufficiency. Each listing displays generic name, trade name, class, and dosage recommendations for GFR 50-90, GFR 10-50, and GFR <10. target="_blank" href="">Download eDrugsRenalHDB

EMS Management System
Freeware: minimum requirement • Palm OS v3.3 • ThinkDB
The EMS Management System is a comprehensive ThinkDB application that allows EMS personnel to manage most aspects of their organization's operations including, but not limited to, Run Sheets, Triage, Personnel and Training.
Download EMS Management System Nursing Software

FDA CFR Clinical Trials
Freeware: minimum requirement • Palm OS v3.0 • iSilo

Code of Federal Regulations
Title 21, Volume 1
Revised as of April 1, 2003

TITLE 21 Part 50, Part 54, Part 56 and Part 312
Download FDA CFR Clinical Trials

Freeware: minimum requirement • Palm OS v3.3
Anesthesia resources version 1.0 contains information about perioperative management of pre-eclampsia, intracranial hypertension, sleep apnea, and more.

It also contains brief descriptions of 200 syndromes, and a Spanish to English medical phrasebook.
Download GASNet PDA

Glasgow Coma Scale
Freeware: minimum requirement • Palm OS v2.0 •
Commonly used standardized test, the Glasgow Coma Scale, evaluates brain injuries. It rates three categories of patient responses; Eye opening, best Motor response, and best Verbal response. Levels of responses indicate the degree of nervous system or brain impairment. Summed Glasgow Coma Scale Score = E+M+V (3-15)
Download Glasgow Coma Scale Application

Freeware: minimum requirement • Palm OS v3.0 • iSilo
HIPAA on HAND contains the Regulation Text Only of the HIPAA Regulations & Standards. And was transcribed from: The Office for Civil Rights website on Medical Privacy - National Standards to Protect the Privacy of Personal Health Information.

HIPAA on Hand is a PDA reference and is intended only as a quick reference guide.
Download HIPAA on HAND Software

Freeware: minimum requirement • Palm OS v3.0 • MathLib
50 adult ICU applications that assist with 78 medical equations including pulmonary, cardiology,BNP CHF nomogram, pharmacokinetic drug dosing, renal, electrolytes, nutrition, TPN, biostatistics, unit conversions, rules of thumb, plus an RPN scientific/financial calculator.(Requires MathLib to run download it here)

Download ICUmath Nursing Software

IVRate Calc
Sharware: minimum requirement • Palm OS v2.0
Calculate an intravenous drip rate in ml/hr. It features a user editable database of drugs to speed data entry. Or, you can choose not to use any of the drugs in the database and just enter the drug concentration manually. It requires no external math libraries or other programs.
Download IVRate Calc Application for Nurses and Medical

Freeware: minimum requirement • any Palm OS • iSilo
A Guide to the Management of High Cholesterol, Based on the recommendations of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on the detection, evaluation, and treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)

The most up-to-date (May 2001) recommendations for lipid management released by NCEP's ATP III (an NHLBI / NIH program). Evidence based recommendations from the U.S. Preventive Services Task Force 2001 Update on Lipid Disorders in Adults. Algorithm for Determining 10 Year Risk of Coronary Heart Disease Clinical Risk.
Download Lipids Medical Software

Lung Injury Score

Freeware: minimum requirement • Palm OS v3.0
This is a simple calculator to determine the extent of lung damage present in your patients that have ARDS and that are on the ventilator. It is quite simple to use and the extent of damage to their lungs is easily stratified into a None, Mild, Moderate, or Severe probability of lung injury. Simply select from the drop-down menus and hit Lung Injury Score to calculate the extent of injury.

Those who chose to register will obtain FREE lifetime updates and bug fixes
Download Lung Injury Score Software for Palm

Freeware: minimum requirement • any Palm OS • iSilo
An electrolyte and acid-base management tool. It includes everything you will want to know about the symptoms, physical findings, causes, diagnosis and management of common and uncommon electrolyte disorders. This trial version has more than 380 pages of information woven together with hyperlinks to make finding the information you need easy. The registserd version is composed of more than 600 pages of information. Registration is free at the developers website.
Download LyteMeister Nursing Software

Freeware: minimum requirement • Palm OS v2.0 •
Rapid calculation of common equations used in internal medicine. A must have application!
Download MedCalc Nursing Application

Medical Abbreviations
Freeware: minimum requirement • Palm OS v2.0 • BDicty
Medical Abbreviations lexicon contains 440 entries. And a free public version of BDicty
Download Medical Abbreviations Nursing Software Application

Medical MathPad
Freeware: minimum requirement • Palm OS v2.0
MathPad equations for doing complex medical calculations, including A-a gradient, anion gap, body surface area/ body mass index, cardiovascular drips, emergency medicine doses, fractional excretion of Na, free water deficit, glasgow coma scale, isotonic dehydration, maintenance fluids, Na deficit, peak flows, plasma osmolality, schwartz equation, serum Na corrected, and WBC indices.
Download Medical MathPad Nursing App

Medical Mnemonics
Freeware: minimum requirement • Palm OS v 2.0
Remember the important details even when you're on the go with a custom-made application dedicated to medical mnemonics. Gain some extra study-time by practicing recall while between appointments. All mnemonics and their diagrams, as well as individual program displays, can be customized to suit personal learning. Medical Mnemonics program comes with hundreds of useful mnemonics that have been compiled over the years. Regular updates are sent automatically to registered users.
Download Medical Mnemonics Medical Software

Freeware: minimum requirement • any Palm OS
MedMath is a medical calculator for rapid calculation of common formulas in adult internal medicine. Features more than 20 formulas sorted by category, with selectable units and onscreen numeric keypad. Runs on all Palm platforms without external libraries.
Download MedMath Software Application for Nurses

Nursing Diagnosis
Freeware: minimum requirement • Palm OS v 3.1• iSilo
Nursing Diagnosis is a quick reference guide to search the nursing diagnosis, it is compiled according to the NANDA list
Download Nursing Diagnosis Software

Freeware: minimum requirement • Palm OS v 3.0
ECG/EKG field guide. It features 25 arrhythmias with explanations of P, PRI, QRS, Rate, Rhythm, etc.
Push button explanations and zooming.
Download PalmEKG Palm Software

Freeware: minimum requirement • Palm OS v 2.0
This is a program that calculates various drugs that are most commonly used in a pediatric I.C.U. It calculates reanimation intubation and vasoactive drugs by simply entering the weight of the patient.
Download PICU Palm Software for Nurses

Freeware: minimum requirement • Palm OS v 3.0
The ultimate procedures tracking database. Developed in a large residency program for tracking the essential information for procedures in the easiest, fastest, and most convenient method. Allows 2 procedures per patient, and has customizable findings fields. You can enter the date, role (i.e. primary, observed, assisted), location, and the attending physician (unless you are the attending).
Download PocketProcedures Palm Application for Nurses

PT info database
Freeware: minimum requirement • Palm OS v3.0 • HanDBase
This HanDBase database allows the user to track patients, needed treatments, and medications.
Download PT info database Medical Software Application

RSI (Rapid Sequence Intubation)
Freeware: minimum requirement • Palm OS v 2.0
RSI ( Rapid Sequence Intubation) is a program that Spiros developed for Medflight of Ohio. It calculates drugs used in their rapid sequence intubation protocol (adult & pediatric), just by entering the weight.
Download RSI (Rapid Sequence Intubation) Medical Software for PDA

STAT Cardiac Clearance
Freeware: minimum requirement • Palm OS v 2.0
An application that guides clinicians through the complex algorithms established by the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the American College of Physicians for evaluating patients prior to noncardiac surgery. Two step-by-step, side-by-side algorithms based on the most recognized guidelines for perioperative cardiovascular evaluation: American College of Cardiology / American Heart Association (1996) and American College of Physicians (1997) NOTE: This application is currently in beta testing and is for demonstration purposes only.
Download STAT Cardiac Clearance Medical PDA Software

STAT Cardiac Risk
Freeware: minimum requirement • Palm OS v 2.0
An application that estimates coronary heart disease risk using the Framingham Heart Study Prediction Scores (1998 update). Enter in age, sex, total cholesterol, HDL, blood pressure, smoking, and diabetes status and see the absolute risk of angina pectoris or MI over the course of 10 years. It helps clinicians to communicate the total effect of multiple risk factors for heart disease.
Download STAT Cardiac Risk Software

STAT Cholesterol
Freeware: minimum requirement • Palm OS v 2.0
An application that guides clinicians through the new ATP III cholesterol guidelines. It calculates absolute risk of MI using the point method outlined in the ATP III Executive Summary. It also includes calculation of risk for any symptomatic coronary heart disease using the 1998 Framingham method. NOTE: This application is currently in beta testing and is for demonstration purposes only.
Download STAT Cholesterol Nursing Medical Software

Article copyright - #1 source of information to update nurses all over the world. All rights reserved. No part of an article may be reproduced without the prior permission.

Sunday, April 26, 2009

Nursing Skills: Reconstitution of a Powdered Medication (Videos)

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Demonstration of how to reconstitute and draw up a powdered medication.

Article copyright - #1 source of information to update nurses all over the world. All rights reserved. No part of an article may be reproduced without the prior permission.

Saturday, April 25, 2009

Nursing Skills: Tracheostomy Care (Videos)

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Demonstration of how to perform tracheostomy care for a patient.

Article copyright - #1 source of information to update nurses all over the world. All rights reserved. No part of an article may be reproduced without the prior permission.

Friday, April 24, 2009

Nursing Skills: IV Maintenance (Videos)

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Demonstration of IV site assessment, spike & prime of IV fluids & tubing, saline lock flush, and connection of IV tubing to patient's saline lock.

Article copyright - #1 source of information to update nurses all over the world. All rights reserved. No part of an article may be reproduced without the prior permission.

Thursday, April 23, 2009

Nursing Pay Scale: Wages for Registered Nurses

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Someone ask me what is the usual nursing pay scale? I think what he meant to ask is how much does a registered nurse today earns. Nursing pay scale usually depends on the hospital where the nurse work, how long he/she has been working there and other factors. A cool tool that you can use to checkout your own nursing pay scale depending on your skills and experience is to checkout You enter your profession [nurse], number of years of experience, where you live or will work, if you specialize on a certain position, you degree and certification, etc., it will even tell you what stuff you need to work on so that your wage rate will increase.

Experts attribute the shortage to a variety of factors:

• The aging population is causing the demand for nurses to swell.

• Advances in health care treatments that did not exist years ago are creating more demand for nursing staff.

• Women who traditionally flocked to the nursing field have more professional opportunities today.

• Nurses have more opportunities to work in non-hospital settings, such as offices and outpatient surgery centers, which do not require staff 24 hours a day.

There are lots of ways to boost your nursing pay scale. Below are some of the ways you can improve yourself to increase your chance of earning more. With this retrogression, its hard for nurses to go abroad, but one way to quality yourself for an H1-B (SKILLED WORKER) is to specialize. Checkout my article on H1-B visas for nurse.

1. Specialize. For example, nurse midwife, critical care nurse, etc.

2. Enroll for your master's degree.

3. Gather experience. Red cross volunteer.

4. Certifications.

Click on a job title link below to view a salary range / wages for registered nurses

Case Manager pay scale

Certified Nurse Midwife pay scale

Certified Nursing Assistant - Occupational Health pay scale

Certified Nursing Associate pay scale

Charge Nurse pay scale

Chief Nurse Anesthetist pay scale

Chief Nursing Executive pay scale

Clinical Nurse - Home Care pay scale

Clinical Nurse Specialist pay scale

Diabetes Educator pay scale

Director of (Hospital Operated) Nursing Home pay scale

Director of Nursing School pay scale

Head Critical Care Unit Nurse pay scale

Head Emergency Room Nurse pay scale

Head Intensive Care Nurse pay scale

Head Nurse - Quality Improvement pay scale

Head Obstetrics Nurse pay scale

Head Occupational Health Nurse pay scale

Head Operating Room Nurse pay scale

Head Psychiatric Unit Nurse pay scale

Home Care Case Manager pay scale

Home Care Licensed Practical Nurse pay scale

Home Care Nursing Education Coordinator pay scale

Home Care Staff Nurse - RN pay scale

Home Care Staff Nurse - RN - Psychiatric Unit pay scale

Infushion Therapy Staff Nurse - RN pay scale

Lactation Consultant pay scale

Licensed Practical Nurse (LPN) pay scale

Licensed Practical Nurse (LPN) - Outpatient Clinic pay scale

Licensed Practical Nurse - Occupational Health pay scale

Long-Term Care Certified Nurse Assistant (CNA) pay scale

Long-Term Care Licensed Practical Nurse (LPN) pay scale

Long-Term Care Registered Nurse (RN) pay scale

Long-Term Nurse Manager pay scale

Nurse Anesthetist pay scale

Nurse Manager pay scale

Nurse Practitioner pay scale

Nurse Practitioner - Emergency Room pay scale

Nurse Practitioner - Specialty Care pay scale

Nurse Recruiter pay scale

Nursing Assistant pay scale

Nursing Director pay scale

Nursing Education Coordinator pay scale

Nursing Home Certified Nursing Assistant [CNA] pay scale

Nursing Home Head Nurse pay scale

Nursing Home Licensed Practical Nurse pay scale

Nursing Home Nurse Practitioner pay scale

Nursing Home Nursing Supervisor pay scale

Nursing Home Staff Nurse (RN) pay scale

Nursing Services Instructor pay scale

Nursing Supervisor pay scale

Nursing Unit Administrative Assistant pay scale

Occupational Nurse pay scale

Outpatient Care Staff Nurse - RN pay scale

Quality Management Director - Healthcare pay scale

Research Registered Nurse (RN) pay scale

School Nurse pay scale

Specialty Nurse pay scale

Staff Nurse - RN pay scale

Staff Nurse - RN - Infection Control pay scale

Staff Nurse - RN - Intensive Care Unit pay scale

Staff Nurse - RN - Pediatrics pay scale

Staff Nurse - RN - Surgical First Assistant pay scale

Staff RN - Critical Care Unit Nurse pay scale

Staff RN - Emergency Room Nurse pay scale

Staff RN - Flight Transport Nurse pay scale

Staff RN - Geriatric Nurse pay scale

Staff RN - Obstetrics Nurse pay scale

Staff RN - Oncology Nurse pay scale

Staff RN - Operating Room Nurse pay scale

Staff RN - Psychiatric Unit Nurse pay scale

Staff RN - Recovery Room Nurse pay scale

Staff RN - Renal Dialysis Nurse pay scale

Transplant Nurse Coordinator pay scale

Good Luck! Please dont hessitate to voice out your comments. Lets share our opinions. Add your comments below.

Article copyright - #1 source of information to update nurses all over the world. All rights reserved. No part of an article may be reproduced without the prior permission.

Tuesday, April 21, 2009

Fundamentals of Nursing: Blood Administration

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Blood Administration - Presentation Transcript

1. Blood Administration Reference: 1. Only two units per filter. 2. Verify units. 3. Use within four hours after removal from blood bank. 4. Use 20 ga. or larger catheter. 5. Obtain Informed consent. 6. PRBC replaces RBCs only. 7. If more than 6-8 units of PRBC are given then give FFP with every other unit. 8. Give platelets one for every unit of PRBC after eight units. ESSENTIAL INFORMATION: 1. Clinical Pathology and Transfusion Medicine Guide 2. Nursing Department Policy: Infusion of Blood and Blood Components. 3. Department of Transfusion Medicine (DTM) Procedure: Infusion of Non-cryopreserved Cellular Components. 4. Circular of Information For the Use of Human Blood and Blood Components, American Association of Blood Banks. July 1998 (Distributed by DTM) EQUIPMENT: STEPS KEY POINTS Verify physician order for type and crossmatch Draw blood sample for crossmatching Place patient labels on large red top tube Patient label includes patient name and hospital ID#. Use a ballpoint pen and press hard when Blood samples, which are missing any writing: patient name, ID#, date of this information, are rejected. A specimen collected, and initials of person new sample will then need to be collecting specimen. drawn and properly labeled. Identify the patient using at least 2 forms The major cause of acute transfusion- of identification, ex., hospital related death is error in identification. identification bracelet, MAS data, asking Patient identification is the most the patient to state his/her name. Or the important step in the transfusion new picture hospital card. Sign blood procedure. product request form indicating you verified patient Identification. Collect blood specimen in large red top To prevent hemolysis of the blood tube. If venipuncture required, use 20 sample, a 22 gauge needle or larger gauge needle or larger for adults and a should be used to obtain the blood 22 or 23 gauge needle for children. sample. The minimum sample volume needed is 8 ml. Will have to draw one tube for each two units. Keep in mind the expiration dates of The crossmatch sample expires on
2. crosmatches for most hospitals. 11:59 p.m. on the third day after the day it is drawn, i.e. a sample drawn anytime Tuesday the 23rd, will expire at 11:59 p.m. on Friday the 26th. Blood Transfusion Preparation – Verify Order for Blood Product, Identification & Consent Check physician’s order to determine: Allow 30 – 60 minutes for oral a. product to be administered medications, 10 minutes for IV b. number of units or volume to be medications to become effective. administered c. date to be administered d. special processing e. duration of infusion f. pre-medication orders, if indicated For whole blood, red blood cells or granulocytes, verify in the computer or with the blood bank.results of: a. blood grouping b. Rh type c. number of units crossmatched d. number of units set up Verify informed consent has been Consent required for ALL blood obtained and signed in the past year, products. except for emergency transfusions. Ensure the inpatient is wearing hospital Required for ALL blood products. ID bracelet. Ask lucid patients to state full name and date of birth. If not lucid, ask responsible visitor. Establish Line & Check Client’s VS Establish or verify patency of peripheral When infusion pump is used, 20 or central venous access device. gauge needle or larger is recommended to prevent lysis of red blood cells. 23-gauge needle can be used for transfusing pediatric patients. Obtain and record patient’s baseline Febrile patients destroy cells vital signs. Conduct patient teaching and rapidly. If febrile, notify physician to alert staff to the following symptoms: decide if transfusion can wait or if • Chest pain. patient should receive acetaminophen • Flushing. as a pre- medication. • Shivering. • Abdominal discomfort. • Rashes. • Shortness of breath. • Pain in the loins or extremities. • Blood in urine. • A feeling of restlessness or anxiety. • Feeling generally unwell Pick up Blood from Blood Bank
3. When the patient is ready to be There should be a four hour time transfused, take pick up slip to blood lapse between completing infusion of bank to obtain blood. Amphotericin and beginning transfusion of granulocytes or vice versa. It is advisable that all other blood products be separated from Amphotericin by two hours. Blood products must be hung within 30 minutes of leaving the Blood Bank refrigerator. The Blood Bank will usually only release one blood product at a time. However, with physician phone call multiple units may be issued during an emergency. Blood products MUST NEVER be placed in the refrigerator on the patient care unit. Check the appearance of unit for If appearance is suspicious, return it presence of clots, brown discoloration, to Blood Bank, as it may not be clumps or abnormal cloudiness, and appropriate for infusion. integrity of seals. Warming is not normally necessary and blood components should never be put in a bowl of warm water, on a radiator or in a microwave oven: this is dangerous, as it will damage the cells. Two qualified health professionals trained All three records must correspond in blood administration procedures exactly. compare: All identification attached to the a. Blood product received on the unit container must remain attached until to product requested in the the transfusion has been terminated. medical order. b. Blood type and Rh type recorded in computer with the container bag and container label ensuring that they are either identical or compatible. c. The blood product number on the blood container with the product number on the blood container tag. d. Compare the expiration date and time, if present, on the blood container label to the current date and time. Immediately before the transfusion, The major cause of acute transfusion- in the presence of the recipient, two related death is error in identification. qualified health professionals identify the Proper patient and unit identification patient using at least 2 forms of is one of the most important steps in identification: the transfusion process. If any a. Verify the patient’s name and discrepancy is noted, notify Blood medical record number on the Bank at once and return the blood blood unit with the information on product until the discrepancy is
4. the recipient’s identification resolved. bracelet and the information recorded in the patient record. Identify patients with patient hospital b. Ask the patient to state his/her ID band or hospital label and ask the name. patient to state their name. Correlate c. Verify the information on the this information with blood patient wristband and blood unit. component’s tag. Start the Infusion Set Prime the administration set with the Use of other IV solutions damages blood product or 0.9% Sodium Chloride. blood components. a. Add a three-way stopcock onto the During a reaction, 0.9% Sodium end of the blood administration Chloride may be administered set. Have 0.9% Sodium Chloride through the stopcock without infusing solution and IV tubing unopened the additional blood product in the and available in room for tubing emergency use or attached to Leukocyte depletion filter may be stopcock. used to prevent repeat febrile b. If a leukocyte-depletion filter is reactions, decrease the risk of CMV indicated, follow the transmission, and decrease the risk manufacturer’s and blood Bank of alloimmunization. Do not flush instructions for set up. filter with saline. Leukocyte depletion filters are not to be used when administering granulocytes. Connect the blood administration set to During a blood transfusion, it is the IV extension set either directly or recommended that no intravenous through the intermittent infusion cap via drugs are added to the same cannula needleless system. or giving set, because of the risk of interactions Adjust the rate of flow for first few . minutes A volumetric infusion pump may be For adults: used to administer blood products. • Platelets or plasma - 2-5 Symptoms of an immediate adverse cc/min for 5 minutes reaction are usually manifested • Whole blood, RBC or during infusion of the initial 50 cc. If granulocytes - 2cc/min for 15 an incompatible transfusion is minutes terminated early, acute renal necrosis Patient should be observed closely for the and death may be prevented. first 15 minutes. For pediatric patients, volume of For pediatric patients: blood products (excluding • transfuse 5% of the total volume granulocytes) to be transfused should ordered in the first five minutes be ordered based on the child’s of platelet or plasma infusion weight, i.e. 10 - 15 ml/kg. • first 15 minutes of whole blood, RBC’s or granulocyte infusion. Remain with the patient for the first 15 minutes after the start of the infusion. Monitoring for Adverse Reaction At the end of the first 15 minutes, The desirable rate of infusion
5. obtain and record TPR and BP. If vital depends upon patient’s blood volume, signs are within normal range and the cardiac status, and hemodynamic patient has no signs/symptoms of an condition. Suggested rates for adults adverse reaction, change the rate to are: infuse the unit within the time period PRBCs: 100-230 cc/hr specified in the physician’s order. Granulocytes: 75-100 cc/hr Plasma/platelets: 200 – 300 cc/hr The volume of a plateletpheresis bag varies from 120 cc to 400 cc. The entire platelet product should be given within one hour, if possible. Continue to monitor the patient for signs . and symptoms of adverse reaction during Adverse transfusion reactions can transfusion and 1 hour post- transfusion. occur anytime during or after the If patient experiences a transfusion transfusion. reaction while transfusion is in progress, For treatment of adverse transfusion immediately stop the transfusion. reactions: see Clinical Pathology and Maintain patency of line with normal Transfusion Medicine Guide \"Adverse saline and notify MD. Reactions to Transfusions\". Complete transfusion as ordered not to Increased possibility of contamination exceed four hours. and decreased viability of cells if prolonged. Tubing sets can be used for second unit of blood if used within four hours. As there is a possibility of delayed transfusion reactions, some hospitals require empty transfusion packs to be kept to enable testing if required. Packs should only be stored for the required time as they are a source of infection in themselves if left for extended periods. At the conclusion of a blood product Do not flush leukocyte filters with transfusion in which no adverse reaction saline. occurred: a. Obtain 10 - 60 minute post transfusion CBC for post-count as indicated. b. Flush the blood administration set with 0.9% Sodium Chloride until the tubing is clear. c. Obtain and record vital signs. d. Disconnect and discard the empty blood product container in a contamination red bag. Adverse Reactions Pyrexia A temperature of more than 38 C might be due to: • n Pyrogens resulting from bacterial contamination. • n Reaction to white cells or platelets which can • also be accompanied by chills or rigors. • n Haemolytic blood reaction (see below). The appropriate action is to stop the transfusion and to seek medical advice.
6. Allergic reaction Allergic reactions can present as an urticarial rash or a mild pyrexia. This can also develop into oedema around the eyes or larynx and cause dyspnoea. Full anaphylaxis is uncommon. The appropriate action is to stop the transfusion and to seek medical advice. (Subsequent transfusions might require pre-medication with a prescription for an antihistamine and paracetamol.) Infection Although donated blood is screened for major viruses and bacteria (including HIV, hepatitis B, hepatitis C and syphilis), infections, although very rare, do occasionally occur. Much more common, however, is local phlebitis which occurs if a cannula remains in situ for too long: the most commonly isolated bacteria are staphylococci or corynebacteria. Platelets are stored at room temperature and so can act as an ideal medium for bacterial growth. The appropriate action is to check cannula insertion sites regularly for inflammation and infection, and to change the insertion site routinely every 72 hours. When using platelets, bags should be checked for discolouration, which may indicate the presence of bacteria. Haemolytic reaction A haemolytic reaction is caused by destruction of the donor red blood cells by antibodies in the recipient’s plasma. It can occur after only a few millilitres of blood are transfused, although a delayed reaction can occur up to two hours later. Haemolytic reactions can be fatal and as such, a suspected haemolytic reaction must always be responded to as a medical emergency. A haemolytic reaction is indicated by: • Breathlessness. • Collapse. • Tachycardia. • Hypertension followed by hypotension. • Chest or loin pain. • Subsequently, the patient might develop: • Disseminated intravascular coagulation (DIC). • Circulatory and respiratory failure. • Renal failure. The appropriate actions are: 1. stop the transfusion 2. disconnect the pack and giving set 3. maintain the intravenous line with normal saline 4. seek urgent medical advice. This is an emergency, life-threatening situation. Haemolytic reaction is most likely to be due to a patient receiving the wrong blood from one or more errors in the chain of events from taking a cross-match sample, the laboratory processes, the collection of blood for transfusion and administration into the recipient. All blood must be returned to the blood bank and an investigation must be carried out to ascertain the source(s) of the error. Circulatory overload Circulatory overload causes less of a problem now that concentrated red cells are used more frequently than whole blood. Problems can occur with older people, neonates or patients with megaloblastic anaemia. The action to take is to give diuretic therapy as prescribed, slow the rate of transfusion and observe closely for pulmonary and peripheral oedema. Iron overload Patients who receive multiple transfusions have an increased serum ferritin. At a level greater than 1,000mg per litre, the iron infiltrates organs such as the liver, heart and kidneys, which can lead to organ failure or even be fatal. In patients on multiple transfusion programmes, an iron chelater such as desferrioxamine can be prescribed to regulate the level of serum ferritin.

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