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.

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.

Dengue Fever Study Review

Dengue fever, a one rare tropical disease more prone to be common in Malaysia, South America, or South Sea islanders, is a spreading community health threat in settled countries. Unpoliced immigration from countries with little or no sanitation, poor innoculation records. Vaccination problems and low health standards is infiltrate more vulnerable healthcare environments every day.

These health threats are getting worse. The CDC cited in its July 2010 report that dengue fever is transmitted by mosquito bites, and where surface water cultures and agronomies are present. In time these figures and for other diseases like AIDS have grown worse. In South Africa, transmitted diseases have crossed over into population threats for travelers. Incubation can allow for re-uptake of diseased matter to likely insects, And in some (notorious) cases, rare hospital-based person-to-person transmission. .

For civilized societies, the prevalence of immigrant residents working in unsanitary health conditions near surface water with little or no medical care ensures an epidemic of a once rare tropical disease. Harking back to distant eras when medicine as it is practiced today was in a stone age of ignorance, dengue fever was also called break-bone fever for the level of pain and bone damage the dengue visited on its victims. The more serious phase of dengue fever (DHF) can cause fatal occurences of circulatory failure, shock, and multiple organ failure leading to death.

Evincing symptoms of dengue fever are back-of-the-eyes headache, an ache or pressure in the temples, arthritis flare ups, or “ghosting”, myalgia, contact rash, ecchymoses, and interior oral bleeding or nasal bleeding from mucus tissues. Clinical examination and patient history can indicate dengue fever, as well as dengue fever viral matter in the immunoglobins of IgM and IgG. An assay capture test should be run for patients exhibiting these symptoms without exclusive indications from existing conditions. Re-infection of dengue fever can occur, so patient history with respect to dengue fever is critical.

Brain damage from shock can affect the pathology of the organism as a whole, as well as exacerbate any existing medical condition. Patients in this state exhibit multiple systemic vulnerabilities. The intensity of dengue fever continues to a more serious stage, the DHF. Dengue Hemorrhagic Fever, a potential cause of death, may last two to seven days with fever, abdominal pain and vomiting throughout.

Fever can abate during the DHF phase of dengue fever without the condition being recovered from. Dengue fever wellness plans require patient assistance via nursing and leaves patients bedridden through the course of recovery.

Nursing students and community care professionals can estimate a possible case of dengue fever from lab tests showing hematocrit increase, thrombocytopenia in the blood cell count, and leukopenia. Long term complications for recovered dengue fever patients  include myocarditis, encephalopathy, and liver failure. The dengue fever has no vaccine treatment as of yet. An estimated fifty to a hundred million cases a year of dengue fever infect the known human patient population.

Patients who might experience basic symptoms of dengue fever should be questioned for recent activities such as drinking local tap water, ingestion of imported fruit, outdoor recreation near surface water areas, and foreign travel to tropical weather states (such as Florida) or Indian, South American, or Middle or Far Eastern countries where modern sanitation is compromised. Flower beds, standalone planters, pet dishes, and rain collection containers can collect mosquito infected material and spread the disease.

Mosquito repellants and double screens can increase protection from dengue fever contraction. Parents (and caregivers)should look for clothing that “holds” DEET or other mosquito repellant products well. Clothing and skin can be sprayed. Worldwide children age 15 and below represent 90% of severe shock cases of dengue fever, termed dengue shock syndrome (DSS). But American patients of dengue fever can be adult or juvenile. Astonishingly, the disease can be benign. Nurses should screen for background on foreign travel to rule out the patient being a carrier. ¬†The coagulation into the bloodstream and tissues causes the denge hemorrhagic fever. DHF patients can develop shock (DSS).

But dengue fever today exists in the United States and modern civilized countries in an outbreak that makes medical healthcare communities uneasy. Nurses must be up to date and wary of new presentation of likely symptoms. What used to be an exotic disease can now come by courtesy of a local canal or aqueduct. Water literally around the house, such as lawn irrigation or plant beds can serve as mosquito nesting grounds. Climate change, weather patterns, and activity involving egg travel in produce or lawn products, for example, can spread the disease further.