Intra Venuous Therapy

Nurses from time to time will be required to perform tasks that demand mastery of a technical equipment procedure. To deliver a programmed regimen of medication, when a patient is a hard stick, to prevent repeated needle stick trauma and injuries to the epidermis, an intra venuous line is used. The vein inside the hand or arm is located and mapped.
An ideal site for connection of the vein to the external delivery device is located. This is where the vein will be connected to an attached ( or hung) intra-venuous line. Thus liquid medication can be set up to line-drip into the body via a plastic catheter.
After this site is located, the first attempt is executed. The procedure to install the exterior I.V. (catheter) is begun by setting up surgical drapes for infection control. Masks, gowns, and gloves should be worn. The internal vein location is sited on-screen using live EKG or radiographic video photography. This internal site is evaluated for positive and consistent blood flow and the successful circulation of the medication.
This attribute of vein quality is needed for best distribution of the treatment material throughout the corpus. If the ideal site cannot be mapped, the procedure should be rescheduled.
The vein physically is reached via needle treated with Lidocaine. After a few moments a burn and a mild pain will be felt. Pre-medication against patient discomfort should be anticipated. The catheter ligation is then performed. If the venal connection is not successful a repeated attempt may be made as long as site integrity is maintained. The ultimate site must be clean and free from lesions or irritation.
The catheterization must now take place. Usually I.V. lines are put in during in-patient visits to or in a hospital radiography lab. But specialty nurses are now licensed to do this as part of a mobile health services arrangement. The plan of care adapts to include I.V. therapy.
After images of the vein assist the surgeon, nurse, or technician in mapping the best external route from a vein, then the vein is connected to the epidermis via an exterior cannula and channels of plastic or vinyl tubing. The patient may require a PICC line, a Heplock, or a formal intra venuous line catherization.
The infusion of catheterization for Hep lock, I.V., and PICC line devices requires formal technical training. Physicians and other providers learn the I.V. technique, sterile procedure etiquette, and the immediate I.V. environmental infection control. The administration of an I.V. and the facility policies must be followed to the letter for site hygiene, optimum infection control, and medical treatment etiquette.
I.V. administration is a critical nursing skill that can save many lives.
. Focus on anatomy and needle stick skill sets is critical. Student nurses should petition for radiography internships if they are interested in I.V. catheterization as a career.
The site injection procedure is done via E.K.G. placement or radiology X-ray. Siting should be done by a nurse that knows or has become familiar with the patient.
The efficient I V. nurse will appraise how infusions will alter the patient’s daily routine. Minute details can affect placement success. Discussion of the patient’s daily routine is essential.
Will the patient eat before or after the medication? Will the rolling I.V. rack allow for bathroom access? Which arm or hand is best for the siting? How dies the patient sleep? Viability of the overall catherization effort for intra venuous infusion must be evaluated with respect to specific patients.
How old is the patient? How well can they manage to sit and be still and maintain drip flow? Have they managed an I.V. before? Are they in a skilled nursing or long term care facility? Do they thrash around uncontrollably during slumber? Patients can do damage to themselves or the I.V. line while moving during sleep.
Do they take a sleeping pill at night that limits control of the arm with the I.V. in it? How alert and ambulatory is the patient?Exploring these issues can ward off problems necessitating repeating the procedure. Conversation with the patient and issuing verbal prompts during the procedure can help I.V. line patients feel more in control.
All these factors can play a major role in the successful siting of an intra venous catheter device.
The epidermis is very sensitive to the strong adhesives used in the catheter site securement. Nurses should be careful not to strip the skin at the site. Attention should be paid to any allergies or past problems with bandages, metals, or tape. If the adhesives used in the I.V. siting cause an irritation, the dressing can come loose, the skin can over-adhere, or a site lesion cause an infection to spring from access to the vein.

Before scheduling the I.V. procedure, the patient’s chart and medical history must be reviewed. Sensitivity to the prescribed medication and success with previous regimens if intra venuous therapy should be evaluated. Upon efficient administration of a midline catheter or intravenuous line, repeated inspection and evaluation of the site should ensue. Then caretaking literature should be available for distribution, to the chart or to patient or resident.
If the veins have become occluded or blocked, the effort to site the catheter may need to be redone. The cost of these procedures to be repeated may be oppressive, not to mention the inconvenience, expense, and interruption of the ordered I.V. treatment.
There is some debate as to whether or not EKG or radiography siting procedure is preferable at the commencement of the ligation order. Hospital or facility policy must govern whether or not mobile services can be used in place of stationary institutional surgery centers. Specialty licensed and specially qualified nurses and technical personnel must be staffed for all of the above procedures.
Nurses should constantly monitor the catheter midline site for redness, stiffness, swelling and unusual pressure around the line-in. Remove and re-apply the sterile dressing as needed. Prevent loss of sterile I.V. conditions by using iodine or alcohol to clean residues or backflow from the insertion lesion.
When changing the adhesive tapes and cleaning the I.V. site cap, inspect the site area for unconventional blood spotting, movement of the line too far in or out of the I.V. site, or stained or fouled adhesive material next to the skin.
Always make sure to wash the hands in warm soapy water before contact with the site area and dressing materials. Allow adequate time for refrigerated material to come to room temperature. Check tags and labels upon fresh presentation of pharmaceuticals to the I.V stand, inside the patient room or clinic area.
Nurses and intra venuous medication administrators should always flush the line clean and make sure fouled tubing is removed from the site attachment immediately. Saline flushing schedules should be found on the patient’s chart or in the endorsement sheet. Counter signatures should reviewed for dressing and taping checks. I.D. tags and site condition checks should be conducted before the next I.V treatment.
Never flush against resistance. Review the infuaing catheter to adjust flow pressure. Advise the patient to notify nurses or caregivers to administrate prescribed anti-nausea medication if symptoms present.
Report unusually distressed wound sites to a charge nurse or physician for further instructions. Patients, nurses, and caregivers should be watchful for side effects throughout the duration of the I.V. administration. Upon successful completion of the I.V. treatment, nurses can refer back to the prescribing physician for further orders.

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Pyoderma Gangrenosum

Pyoderma Gangrenosum is a serious condition of the skin commonly denoted by cellulitis, ulcerous lesions, or wounds. Daily or weekly dressings are required as well as frequent I.V. infusions to combat secondary infections.
Pyoderma Gangrenosum is an exclusive diagnosis. This is unfortunate, as it leads many temporary and urgent care physicians to bypass the seriousness of the damage by referring to the lesions as ulcers, skin tears, and other superficial tissue damage events to the dermis and subdermis. Pyoderma Gangrenosum lesions are characterized by erosion of healthy via an enlarging or group of lesions. As the skin and nerves deteriorate the intense and the copious drainage make the patient’s life difficult.
Pyoderma Gangrenosum treatment plans require an extraordinary commitment of resources, supplies, nursing hours, consult dates, I.V. PICC line insertion, and even hospital stays or Emergency Room visits. The consult visits can become highly technical and a patient with Pyoderma Gangrenosum is well served to obtain a client advocate to meet their needs.
While Pyoderma Gangrenosum does present a flat-edged, wide-lesion wound area similar to some kinds of bed sores, they are much more infectious and extremely susceptible to Sepsis, C. differens infections and contagious MRSA infections. Pyoderma Gangrenosum patients should observe the best possible hygiene and infection control standards possible. Powdered, sterile, and/or Latex-free gloves must be worn by physicians and consultants present at an examination of the wounds or during any wrapping or re-wrapping of the wounds.
General advice given to patients with Pyoderma Gangrenosum is to diet, lose weight, exercise, and elevate the legs if the affected area is in bilateral lower extremities. Daily or twice daily dressing changes may be ordered as the drainage demands. Because the drainage causes the periwound to succumb to ongoing maceration, when the patient feels the bandages fill with liquid, they must report this to the nurse for a wound care session. Nurses must grow accustomed to checking in with the patient about how the wounds are draining and when another dressing is due. Such patients should be monitored for pain to allow direct contact with the wounds at the scheduled wound care time.

Gloves should be worn by all nursing staff during dressing changes, and even by the patient. Washing and shaving of the skin in the periwound may be necessary. Bathing should only take place immediately before a scheduled dressing change to preserve best standards of infection control.
During the wound care dressing change session, light bathing of the periwound skin can be conducted before placement of sterile topical gels and creams. For the heated skin symptom that often accompanies Pyoderma Gangrenosum, Silvadene silver cream has been shown effective to soothe the extreme pain present at the wound sites.
Because of the erosion of skin and nerve tissue during infection, a regimen of nerve pain medication is advised. Baclofen or Neurontin may be part of a 24 hour cycle of pain medication. NSAID therapy can also be used to lessen potential dependence on PRN opiate painkillers. As the Pyoderma improves or the skin infection conditions worsen, this regimen may need to be adjusted.
Pre-medication may be required for dressing changes when nerve and tissue damage has been severe. The pre-medication order should be arranged by the debridement doctor, the consulting physician, or the patient’s Primary Care Provider. Perspiration through hair follicles draws bacteria into the skin. Shaving and bathing of patients should be coordinated with nursing aides or personal residence staff accordingly.
Any situation where total cleanliness of the wound dressing area and sterility of medications is not present should be reported to the wound care team or the charge nurse immediately.
Although the Pyoderma lesions may present as what some nurses might consider mere “Pressure ulcers” that is not what they are.

Pyoderma Gangrenosum is not “gangrene”, as more ignorant members of the medical field are slow to grasp. Instead the Latin term refers to the spread of the immune disease through the tissues. Pyoderma can often be co-existent with systemic infections such as respiratory tract infections, colitis, cystic acne, and sepsis.
Treatment of Pyoderma Gangrenosum is a multipartite, multilayer effort best done with cooperation of the primary care provider, dermatologist, infectious disease specialist, vascular surgeon, and wound care team. The more sophisticated physicians in metropolitan and urban areas will have the experience treating pyoderma.
The systemic approach to ridding the body of pyoderma gangrenosum is to introduce as many cycles of antibiotic therapy as possible. Identifying the treatment method and material to be used is best done using blood tests and wound culture analyses from the affected lesions.The concurrent treatment for extreme site pain, nerve pain, and control of blood sugars must keep time with the infectious disease treatment.
A typical treatment therapy might be Vancomycin and Doripanem via intravenuous infusion, Bactrim
daily as oral antibiotic, and topical treatment of the skin lesions using the complementary spectrum of hydrogels as appropriate.Other nedications may be assigned as they register in sensitivity to the bacteria from the lab culture.
Sometimes Doxycycline or Cyclosporine is used to treat the Pyoderma condition. A key part of any treatment plan for a systemic condition of Pyoderma Gangrenosum is Prednisone. This use of a steroidal supplement can functiom to arrest the immune system disorder that causes the Pyodermic lesions to erupt. While an initial dose of Prednisone therapy can effectively battle back the worst of new lesions forming, the ongoing struggle to keep blood sugar low continues. Without controlled blood sugar, infection treatments will have
The would culture lab result will point the wound care team in the right direction concerning the effective treatment plan and schedule for wound care changes. One new and trending treatment is Tacrolimus to temper swelling and infection control. New studies have shown that Tacrolimus mixed with the Hydrogel Mupirocin retain highly effective resistance to pseudomonas, a common secondary infection.
Because Pyoderma starts as a lesion with no origin, many physicians and nurses speculate about the patient having contracted Pyoderma Gangrensum through contact
with pets or other animals. Dogs, for example, have been diagnosed with Pyoderma Gangrenosum. Due to the very high probability of bacteria contagion, victims of Pyoderma Gangrenosum cannot live with pets and expect any certain degree of recovery.
It requires a well-educated and proactive physician set to envision and implement a care plan for this disrase. The therapeutic relief of Pyoderma Gangrenosum. needs a patient and consistent evaluator of the effectiveness of current therapies. The patient may not always be ready to hear that a certain medication, device, or treatment is no longer working. In some cases a patient suffering from Pyoderma Gangrenosum will be referred to an amputation and limb preservation clinic for evaluation.

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Nurse Training Issues

Nurses need to be trained to treat patients and all their needs, as required. Nurses cannot pick and choose which chores they need to do on which patient, nor do they get to arrange the timeframe that suits them best. Often a case load of needy patients means that the nurse will be juggling various needy patients as well as performing paperwork responsibilities, charting, and intaking new patients at the same time. Not to mention answering the phone and dealing with walk-in clients.

Nurses must be ready to say “yes” to every task. They may be reassigned to other wards or areas as needed. Nurses must groom their computer and Internet research skills to match today’s technological advances. There will be slow days and there will fast days, but nurses are responsible for treating all patients at the highest level of care no matter what their time limitations are.

For example, in a clinical care situation in training, a nurse might have to alter the setting on a EKG machine or test out various pharmaceutical applications on a patient to achieve the best result for lowered blood pressure. But the time and physical availability for results and communications in real time versus training environment may not match the situation reality. Phones on the ward training, another nurse needing help, or a new admission coming onto the scene may distract a nurse.

Nursing students have a training experience that is simple cases of ongoing treatment cases. but in reality medical care plans are much more complex. Patients may be resistant to treatment or not observant of dietary restrictions or their rest order as given by the physician. Nurses on the job often give qualified objections because they have not had a chance to speak with the doctor before issuing pain or treatment medications to a patient they have never seen before. Patents are likewise alarmed they are not seen or given a consultation before a dosage regiment is instituted.

Nurses are the key communicators in this scenario. Nurses in this instance carry more responsibility to review both the patient set of criteria and the data involved with possible side effects of a drug. They must weight this information against the patient’s benefit, versus the entire set of pharmaceuticals being introduced to the patent’s bloodstream. Often a nurse can spot a contraindication before anyone else, and the thrust is upon them to do so. Nurse must also counsel the patient and asses them psychologically at all time. When shifts change, nurses must convey both verbally and in writing the most timely changes in patient assessment to the next charge nurse. These must be done in accurate medical terminology in a transparent style.

Is the patient a physical threat to themselves or others? Is the effect of any change or restriction in medication or privileges affecting them negatively? Are they speaking to themselves or others in a manner that shows a change in self esteem or motivation to heal? Some patients may create incidences of panic disorder and need to be housed a negative ion chamber. A psychological evaluation referral is appropriate at this time. They may try to not take their medication, create obstacles to treatment, or become even more ill. Student nurse skills must adapt and grow to meet the situation.

It is hard to train a nurse for the variety of challenges and issues that come up for their patients in this kind of scenario. Occasionally physicians will be flexible and change to the individual care plan will be made. It is vital to the medical outcome that these circumstances be communicated to the next nurses and on-call physicians. Being able to perform simple tasks like recording dosages and medical administration while balancing management of multiple patients can get tricky.

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PICC Line Administration Facts


A variety of skills are brought to bear on a daily multiple patient regimen, but nurses may need some more than others at critical junctures in the patient’s care plan. The most valuable skill a nurse can get trained on is opening a pick line in a patient. This is often referred to as finding a vein, or setting up a PICC line. The necessity for keeping the “pick” line in for every patient is a requirement for institutionalized healthcare practices and sound care plan advice.

The tap-in should be clean and free from swelling, tension, stiffness,’and/or causing discomfort for the patient. Blood, water, liquid of any type collecting under the dressing should be examined at once. Once affixed, tapes should be annotated with the date of line-in for future reference. Finding peripheral lines in veins must accord with circulatory norms. Nurses cannot begin to rely on easy veins and many long-term patients will need the best pick line insertion techniques when their pick line sites will begin to dry up.

The PICC line is not an easy skill to master. Connecting with the Superior Vena Cava is essential, and thus not just “any” vein can be used. In long term patients the proper veins ”hide” or “become smarter”, evading nurse’s or a technician’s search. This the need for mechanized equipment to find the proper vein is often required. A sonogram machine can be used to generate a visualization of the vein location for technical insertion point.

Nurses categorically check the line on every patient they have in their care roster, whether they are on IV drugs or not. Infection can start if a pick line is left in for too long. This is due to the procedural adaptation in every patient’s medical status whereby IV drug therapy becomes necessary. Grooming a patient’s line and monitoring its condition must be done at all times. Re-insertion of the line must be performed at once if problems arise.

Yet time and again the need for a re-insertion of a patient’s line can shed light on just how few nurses on the ward, if any, can find a vein and insert the pick line in a manner which will be sustained over a number of days. Patients may pull the line out, loosen it, or even worse, injure themselves. Nurse should explain to patients why they need to be conscientious about their line and work towards not straining it or causing tears at the skin’s opening.

This is a serious problem and could cause further delays and inefficiencies in nursing care down the line. Hunting through various staff wards for a nurse who can insert a pick line without the assistance of a sonogram is a seriocomic statement of what training nurses are expected to have versus what the actually bring to the job each day. Nurses should note in their charts the condition if each pick line and notify patient services if additional assistance is required.

Of course the heplock can always be used but that required a clean set of tubes every 72 hours and a clean insertion site. Many patients do not have the skin integrity or the vein strength for this. For this reason the PICC line is favored. To avoid delay in adminitrating an ordered dosage or maintenance regimen of material, make sure the entire case history of the patients dermal integrity is reviewed before any perforation is commenced.

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Chronic Pain Syndrome

A severely challenging condition threatening patients today is chronic pain syndrome. This occurs when various parts of the body and mind come together is a constantly recurring cycle of pain throughout the body. When it occurs, chronic pain syndrome can also affect certain areas of the body after they have been injured, wounded, or operated upon. The pain can be general or it may be concentrated, such as in the temples, legs, hands, or chest and back. A skilled physician experienced in observing chronic pain syndrome can assign this diagnosis and track the symptoms in their quality, severity, and consistency.
The hard part about treating chronic pain syndrome is that to many people it sounds like the typical complaining any patient might do. But the persistence of this kind of pain, its general presence, and the way it avoids being treated by drugstore or over-the-counter painkillers is one clue that chronic pain syndrome is present. Another trait of chronic pain syndrome is that it can subsume after a burst of general health, but then after a period the overall condition can suffer. The patient’s health will weaken and then the chronic pain syndrome can re-emerge when the patient’s overall sense of well-being or general health correspondingly weakens.
For reasons such as these, people in the main confuse chronic pain syndrome with “getting run down”. People in good health maintain regular cycles of endorphins and a balance of hormone. But depression and chronic pain sufferers actually alter the chemicals in their body and brain over a period of time when their behavior alters. Self-injury and accidents can occur as patients become more clumsy and careless dealing with another day in pain. Their impulses to deal with their stress and pain do not take healthy roads and the results can be seen in the way people stop taking care of themselves.
But with chronic pain syndrome, damaged nerves can keep up live pain enactions upon the central nervous system and mind long after the flesh and other damaged or diseased areas have been repaired. The axons of neurons keep firing and “informing” the brain of pain that in fact is no longer being inflicted. The patient feels pressure and the slightest sensation with a magnification that few nurses initially can credit. Just getting dressed, driving, and/or working activities can be physically and mentally impossible for some patients with chronic pain syndrome.
This can affect patients recovering from a long disease, suffering from other conditions at the same time, or suffering from chronic pain as a complication of other conditions, wounds, or diseases of the body. The physical treatment of the chronic pain syndrome also involves attention paid to the creative fulfillment, intellectual stimulation, connection to nature and energetic physical endeavors of the patient to put balance back into their routine. But many patients suffering from chronic pain syndrome are not ready for these interventions yet.
Not by medication alone can chronic pain syndrome be treated. And in some cases, patients will report as few as a two to three hours a day or even in one week when they can handle activities such as writing, reading, reviewing accounts, discussing business affairs, or even concentrating on complex ideas or complicated matters. The patient recognizes this loss even as they battle it being lost. The mental attitude of a chronic pain syndrome patient cannot convert chronic pain into nothingness, but a sharpened perspective and a better-motivated alertness to the positive side of things can assist in keeping the chronic pain from controlling and ruining one’s life.
Nurses taking care of patients with chronic pain syndrome will have some difficulty moving them out of a mode of lethargy and into a spirit of motivated exercise. Movement is a key way to change the ingrained tendencies toward “moping” and dwelling on the pain that chronic pain syndrome involves. Patients such as this need to be urged to get out once in a while, make lists of things they like to do and schedule them. Sufferers of chronic pain syndrome must take an active role in combating the wear and tear of the disease. The behavioral aspect of their choices can overtake their neurobiological symptoms.
Chronic pain patients, especially the elderly, develop patterns of coping with their pain that may not seem helpful to outsiders. But survivors of wounds, attacks, diseases, and other complicated life events will nurse problematic chronic pain conditions for the rest of their lives. This is in contrast to the acute care approach to many painful issues in the otherwise straightforward assistance that urgent care patients receive. But long-term care and elderly patients will usually have an onset of chronic pain syndrome with the severely worsening of arthritis, osteoarthritis, sciatica, and back pain.
Unfortunately, not a lot of physicians train or prepare their patients on how to deal with chronic pain syndrome psychologically. Pharmaceutically the plan of care can treat the pain as it occurs or worsens. But the ongoing struggle with the challenges of chronic pain syndrome, complex and long standing, are unique to the individual patient in many cases. Because many chronic pain sufferers avoid public places, noise, chaotic events like concerts or music clubs, and unpredictable and physically demanding environments, they develop a coping system of this avoidance and they become viewed as “shut-ins”. The outsider observes the behavior of avoidance and misses the fact that there is reason and a pattern of behavior behind it. The patient is just trying to avoiding trigger situations where their chronic pain can be set off.
Nurses can keep an eye on their chronic pain syndrome patients and counsel them about their health. Nurses and case managers can provide helpful advice about how to spend their free time as well as enhance the attention paid to details other than their vital statistics and medication schedules. Such patients may be suffering from depression because of their inability to deal with their chronic pain syndrome. Nurses spend a good deal of time talking with patients. They hear how the patients speak of themselves. These patients may need to learn to interrupt negative belief systems, they may need encouragement and praise, and they may need to find ways to reward themselves and learn new ways of spending their time.
Sufferers of chronic pain may give out signals that friends and relatives do not understand. And chronic pain sufferers do not like to advertise how much pain they are in. They can mask their problems with overeating, Internet surfing, “quick-hit fixes” like smoking, video games, light movies or soft drinks. These activities can hijack feelings of serious ongoing pain in extremities, the temples , in the lower back or neck, et cetera. Sufferers of chronic pain may not understand that they have a serious problem, and may simply put their issues down to emotional problems or being unsuccessful at functioning to a higher standard.
Patients dealing with chronic pain syndrome will plot ways to avoid dealings with their pain by avoiding exercise or going out, to compare themselves unfavorably with others. They know their health is in decline, they just may not understand why. Chronic pain victims will isolate themselves and often appear erratic and eccentric. Chronic pain sufferers can cope with sudden and uncontrollable pain by stomping their feet,(to displace nerve pain) drinking, (to numb the nerve pain) watching TV, (for distraction), playing music (to give the pain white noise to play against) , and/or driving too fast, (because they can’t control the pain in their limbs and leg nerves). Or, when suffering from unpredictable intensities of chronic pain patients may cancel appointments and social engagements because they can’t anticipate when the pain will peak.
The solution to a problem with chronic pain is to concoct a care plan with many moving parts . This plan then becomes the patient’s responsibility to keep those moving parts improving and going, growing and becoming better. These are significant goals that can alter the quality of life for sufferers of chronic pain syndrome. The many motifs in a successful care plan for chronic pain syndrome are simply a roadmap to access all the information involved and plot a best case scenario. A nurse can assist any patient in the parts of the care plan they feel most comfortable with. Sometimes just visualizing a better frame of mind or achieving small goals can be helpful to the health of the patient. Nurses should refer their patients showing symptoms to chronic nerve pain specialists, or care plan managers.

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