...Evidence-Based Fever Management Teaching Intervention for Emergency Room Nurses Alonya Elgrably Dominican University of California E-MAIL: ERSPRSTAR@gmail.com March 04, 2010 Signature Page This capstone project is assembled under the direction of the candidate’s program advisor and approved by the Director of the Master’s program and the Chair of the Nursing Department. It has been presented to and accepted by the Faculty of the School of Nursing, Dominican University of California, in partial fulfillment of the requirements for the degree of Masters of Science, Nursing. ______________________________________________ __________________ Candidate Date ______________________________________________ __________________ Advisor or Director Date ______________________________________________ __________________ Department Chair Date ______________________________________________ __________________ Dean of the School of Health Sciences Date Evidence-Based Fever Management Teaching Intervention for Emergency Room Nurses Fever has long been a common childhood illness faced by parents, physicians, and nurses. In fact, 30 percent of visits to the emergency room included fever as the main complaint (Watts, Robertson, & Thomas, 2003). Over the decades the research has shown fever to be an adaptive physiological mechanism and shown to improve survival rates and shorten the duration of the disease...
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...Clinical guidelines Diagnosis and treatment manual for curative programmes in hospitals and dispensaries guidance for prescribing 2010 EDITION © Médecins Sans Frontières – January 2010 All rights reserved for all countries. No reproduction, translation and adaptation may be done without the prior permission of the Copyright owner. ISBN 2-906498-81-5 Clinical guidelines Diagnosis and treatment manual Editorial Committee: I. Broek (MD), N. Harris (MD), M. Henkens (MD), H. Mekaoui (MD), P.P. Palma (MD), E. Szumilin (MD) and V. Grouzard (N, general editor) Contributors: P. Albajar (MD), S. Balkan (MD), P. Barel (MD), E. Baron (MD), M. Biot (MD), F. Boillot (S), L. Bonte (L), M.C. Bottineau (MD), M.E. Burny (N), M. Cereceda (MD), F. Charles (MD), M.J de Chazelles (MD), D. Chédorge (N), A.S. Coutin (MD), C. Danet (MD), B. Dehaye (S), K. Dilworth (MD), F. Fermon (N), B. Graz (MD), B. Guyard-Boileau (MD), G. Hanquet (MD), G. Harczi (N), M. van Herp (MD), C. Hook (MD), K. de Jong (P), S. Lagrange (MD), X. Lassalle (AA), D. Laureillard (MD), M. Lekkerkerker (MD), J. Maritoux (Ph), J. Menschik (MD), D. Mesia (MD), A. Minetti (MD), R. Murphy (MD), J. Pinel (Ph), J. Rigal (MD), M. de Smet (MD), S. Seyfert (MD), F. Varaine (MD), B. Vasset (MD) (S) Surgeon, (L) Laboratory technician, (MD) Medical Doctor, (N) Nurse, (AA) Anaesthetist-assistant, (Ph) Pharmacist, (P) Psychologist We would like to thank the following doctors for their invaluable help:...
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...Pediatric Fever Problem-Based Curriculum for the Chief Complaint of Pediatric Fever Curriculum Goals: 1. Gather accurate, essential information in a timely manner specific to the chief complaint of pediatric fever. 2. Learn the bacteriology, virology, pathophysiology, presentation, and management of common conditions that cause the pediatric fever. 3. Develop skill in the performance of a screening and detailed clinical evaluation for patients with pediatric fever. 4. Competently perform specific diagnostic and therapeutic procedures for patients with pediatric fever. 5. Effectively utilize diagnostic imaging modalities available for the evaluation of pediatric fever. 6. Integrate diagnostic information and generate an appropriate differential diagnosis for the chief complaint pediatric fever. 7. Stabilize and provide initial treatment for diseases and injuries that cause pediatric fever. 8. Implement an effective patient management plan, including therapy, appropriate consultation, disposition, and patient education for patients with pediatric fever. 9. Locate, appraise, and utilize current scientific evidence related to pediatric fever. 10. Practice cost-effective health care and resource allocation that does not compromise quality of care for patients with pediatric fever. Curriculum Objectives: Upon completion of an emergency medicine residency, the resident will be able to: 1. Demonstrate both a targeted, and a complete, physical examination on...
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...treatment regimen. The patient should understand the need to avoid persons with infection, especially upper respiratory tract infection, and to report cold, flu, and cough symptoms. The importance of avoiding excessive fatigue and the need to plan rest periods before and after activity should be carefully explained to the patient. Good oral hygiene, including daily care and regular dental visits, is also important. The patient must also inform all health care providers performing dental, medical, or surgical procedures of the history of IE. The patient should also be taught the significance of the prescribed prophylactic antibiotics therapy before any invasive procedure. 3. A patient with IE has many problems that require nursing management. IE generally requires treatment with antibiotics for 4 to 6 weeks. After initial treatment in the hospital, the patient may continue treatment at home. Patients who receive outpatient IV antibiotics will require vigilant home nursing care. The patient and or the family also need instruction by the nurse about the importance of monitoring body temperature because a persistent and prolonged body temperature may indicate that the drug therapy is ineffective. The nurse should also teach the possible complications (stroke, pulmonary emboli, and heart failure) and its signs and symptoms such as change in mental status, dyspnea, and chest pain. A patient may also encounter exposure to...
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...acute and self limiting virus which is usually has no lasting side effects (Morris and Edmunds, 2002). However in some uncommon cases, infectious mononucleosis has caused neurologic and malignant complications (Marshall and Foxworth, 2012). Description of Mononucleosis Infectious mononucleosis, also known as the “kissing disease” is a highly infectious viral disease that most commonly occurs in adolescents and young adults in North America (Ilardi, 2009). Mononucleosis is transmitted by oral secretions and blood from one person to another. This is the reason for the nickname “kissing disease”. Symptoms of mononucleosis usually appear four to seven weeks after an individual has been infected. The symptoms include: constant fatigue, fever, sore throat, loss of appetite, swollen lymph nodes, headaches, sore muscles, swollen liver or spleen, skin rash and abdominal pain. Patients can present with all or a combination of these symptoms and the severity varies from no symptoms at all to debilitating (Ilardi, 2009). Because these symptoms are general, it is best to see a physician in order to be diagnosed. In order for a physician to diagnose infectious mononucleosis, a blood test is performed in order to look for the presence of heterophile antibodies, known as the monospot test (Marshall and Foxworth, 2012). Even with a diagnosis, there is no treatment for this viral infection....
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...poisonous. This plant describe to be a slender-stemmed, annual hairy plant with many branches from the base to the top, the branches simple or forked and ascending or spreading, up to 40 centimeters tall, reddish or purplish in color. Leaves are opposite, elliptic-oblong to oblong-lanceolate, 1 to 2.5 centimeters long, usually blotched with purple in the middle, toothed at the margin. Involucres are numerous, purplish to greenish in color, borne in dense, axillary, stalkless or short-stalked clusters or crowded cymes, about 1 millimeter in length. Capsules are broadly ovoid, hairy, three-angled, about 1.5 millimeters long. This is plant considered in the Philippines that is to be a folkloric herbal medicine that can cure illnesses like dengue fever and other respiratory illnesses. But for instance the government still doesn’t recommend it as a cure for any diseases in the cause of their unfinished studies about the effectivity of the plant. for the treatment of many ailments has been validated, and that the plant is reasonably safe to use, this plant has not received sufficient promotion for use as herbal medicine. Its development will be important in the improved delivery of primary health...
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...Review of Related Literature and Studies 1. Antipyretic An antipyretic is a type of medication that will prevent or reduce fever by lowering body temperature from a raised state. They will not affect normal body temperature if the patient does not have a fever. Generally, most non-steroidal anti-inflammatory drugs (NSAIDs) work by inhibiting prostaglandin synthesize within the hypothalamus. Fever, or pyrexia, occurs when the body reaches a temperature above what is considered "average". Bear in mind, however, that this "average" temperature can vary from person to person within certain parameters. It is generally accepted fever exists at a temperature above 37 degrees Celsius (98.6 degrees Fahrenheit) when the thermometer is placed under the armpit, or over 37.5 degrees Celsius (99.5 degrees Fahrenheit) when measured orally or rectally. Fever usually results from microbes such as bacteria or viruses triggering the body's defense mechanisms. This activates certain types of cells, some of which release the substance interleukin. Prostaglandin is another chemical released by the body that plays a part in this process. Prostaglandin is induced by bacterial pyrogens and is produced in the Central Nervous System (CNS). Interleukin affects the hypothalamus, which is the part of the brain that regulates body temperature, signaling it to raise the temperature by a few degrees. The hypothalamus works like a thermostat while the interleukin that is released serves to raise its preset...
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...| ANTHRAX | IONIZING RADIATION | SARIN GAS | Pathophysiologicactions | Caused by Bacillus Centhracis bacteria. 3 ways of contact, cutaneous, ingesting, inhalation. Inhalation is the most deadly. Inhaled spores produce toxins within the lungs and lymph system. | Causes | Inhibits the breakdown of the enzyme acetylcholinesterace. It over stimulates the parasympathetic nerves in smooth muscle | | | | | Signs and Symptoms | Cutaneous- bumps, blisters with black centersGI- nausea, vomiting, loss of appetite, fever, bloody diarrheaInhalation- sore throat, mild fever, fatigue, muscle aches, high fever, trouble breathing, shock, meningitis, coma, death.Resembles flu like symptoms. | Radiation sickness- nausea, vomiting, diarrhea, fatigue, skin erythema, necrosis, sterility, damage to DNA, low birth weight babies, mental retardation, developmental delays, cataracts, cancers. | Runny nose, blurred vision, sweating, muscle twitching, tightness of the chest, headache, cramps, nausea, vomiting, involuntary defecation and urination, convulsions, coma, respitory arrest. | | | | | Treatments | Treat skin lesions, Oral antibiotics like PCN, Tetracycline, Ethromycin, and Cirpo. | Treat symptoms as they appear. Many symptoms will not appear for days, weeks even years.Blood transfusions stem cell transplant, and cytokine therapy. | Treat symptoms as they appear. Give Atropine and Pralidozine (PAM) | Bioterrorism is a constant concern today. As seen in the news, bioterrorism...
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...SCIENCE A N D HUMAN WELFARE’ I BIOLOGY AND MEDICINE M Y SUBJECT this afternoon is “Biology and Medicine,” but I think a more accurate wording would be “Medi- cine and Other Phases of Biology,” for to my mind Medicine is a branch of Biology. Webster’s Dictionary defines medicine as the science and art dealing with the prevention, cure, or alleviation of disease. Biology is the science of life, Disease might well be defined as life out of balance, and is in a strict sense a biological process. Whether it be an attack by microorganisms, or improper functioning of glands, or congenital misformation or maladjustment, or injury by poison or bullets, disease processes are in the last analysis nothing more than cells, tissues, or organs that have suffered injury and so not only fail to perform their normal functions but in most cases interfere with the normal functions of other parts, more often than not of the entire body. Of the two great divisions of medicine dealing respectively with treatment and with prevention, the former is much the older. It is far easier to observe the effects of treatment on a person suffering from a malady than it is t o understand why someone else escaped it. Some knowledge of curative or alleviative medicine was possessed by our cave-dwelling ancestors; in fact, it is instinctive in many lower animals. It gradually grew up as a sort of folklore from a slow process ‘Public lectures delivered a t the Rice Institute on Sunday afternoons in the spring...
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...FOOD-BORNE OUTBREAK Fresno County has recently experienced a major outbreak in food-borne illnesses. Most of the county residents have been hospitalized with severe flu like symptoms. These residents have been complaining about severe stomach pains, vomiting, diarrhea, confusion, blurred vision, difficulty swallowing, and muscle weakness. Some had a very high fever that caused them to become hospitalized. The hospital is advising everyone to take the proper food safety, handling, and purchasing steps to prevent any more cases from arising. These steps would include keeping up on the latest safety recalls, washing hands before and after handling any meats, and washing all utensils right away after they have been used. Residents can check for local recalls by going online or checking the local newspapers daily. Sometimes a recall only impacts a small amount of food. Inspecting your meat for the proper coloring and looking for visible signs of dirt are another way of prevention, as well as washing all fresh vegetables and cooking them thoroughly before consumption. Avoid sharing utensils, knives, and cutting boards when you are cooking with meats and vegetables. You must thoroughly wash each item before using it on something different or use a different utensil all together. According to the California Department of Health 48 million people get sick, 128,000 people end up hospitalized, and 3,000 people die from food-borne diseases in the United States every year. They say that...
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...Heat Stroke and Heat Exhaustion University of Phoenix Susie Hughes HCS 245 August 29, 2011 Mr. Carmon Heat Stroke and Heat Exhaustion In Dallas of this year, a football coach with a heart condition from a heat stroke. He was practicing with his team in heat that was more than 100 degrees. Two days later, two South Georgia football players, died from heat exhaustion, both were 16 years of age. For the past two months, the country has been under the threat of hot and humid temperatures. Heat advisors in most countries across the United States, are broadcast publicly to ensure that people are taking serious precautions during the months of extreme humid temperatures. In this essay, the writer will discuss: (1) definition and short history of heat strokes and heat exhaustion conditions, (2) the symptoms and the signs of each illness, (3) how is heat strokes/heat exhaustion acquired, (4) the diagnosis and treatments, (5) alternative treatments, and (6) the statistics. Definition and Short History of Heat Strokes and heat exhaustion Heat stokes and heat exhaustion are heat-related illnesses. The Center of Disease Control and Prevention (2011) states that, “historically from 1979-2003, excessive heat exposure caused 8,015 deaths in the United Stated, which 300 deaths were accounted for during 2001.” Heat exhaustion, is an insignificant nature of heat-related illnesses, and occurs when a person is working, children are...
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...systems also increased congestion and created new safety hazards for pedestrians (Armitage, Buhle, Czitrom, & Faragher, 2009). Elevated trains were created, but still left the population under the shadow of noisy, rickety wooden platforms, and air pollution increased by unrestricted burning of coal to fuel railroads. Modern water and sewer systems which brought indoor plumbing to most homes were created but they did not eliminate serious environmental or health issues. Cities would continue to dump sewage into nearby bodies of water even after governments established separate clean-water systems. Rivers and streams would still be polluted. Overcrowded conditions and inadequate sanitary facilities bred tuberculosis, smallpox, and scarlet fever, among other contagious diseases. Children’s diseases like whooping cough and measles spread rapidly through poor neighborhoods (Armitage et al., 2009). Many people including immigrants and African Americans would flood major cities looking for a better life. Without much choice of place of residence because of racial or ethnic lines these groups would be compelled to live in the dingiest, most crime ridden, and dangerous sections of town. The more inequality and social lines drawn in the rapid growth of the major cities in the 19th century the more problems they would later be faced with. Despite many technological advances, the quality of life in the nation’s cities did not necessarily...
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...log cabin. Once it was occupied by a young couple who wanted to distance themselves from the chaos of this modern world. Here they were miles away from the nearest town. Bob, the husband, made the occasional trip into town to buy supplies whereas Jan, his wife, spent her free time by the fire, sewing. Their life was simply idyllic. Then, one midwinter's day, Jan woke up from bed with a strange ache in her bones. Putting it down to overwork, Bob shooed her to bed and made sure she rested. Though Jan was impatient to get to her chores, Bob soothed her, "Relax, Sugar. You're overdoing things. All these chores will be here when you recover." However, Jan seemed to be getting worse instead of recovering. By evening, she was running a high fever and in greater pain. In spite of his best efforts, Bob could not manage to ease her suffering. And then suddenly, she started to lapse into unconsciousness. It was then obvious that she was seriously ill. What could Bob do? He had no experience in treating the sick and Jan was getting worse by the minute. He knew that there was an old doctor in town but he lived three miles away, downhill. Pot-bellied and obese, there was no way the doctor could make it up to their cabin. Something had to be done quickly! Bob racked his brains but to no avail. The only thing left to do was to go to the doctor. In Jan's condition, she could never walk that far in the waist-deep snow. Bob would have to carry her! Bob searched his mind for a way to...
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...pins and joined a “registry,” allowing them to practice as private duty nurses in patients’ homes. Nurse registries, operated by hospitals, professional organizations, or private businesses, provided sites where the public could acquire the services of these private duty nurses. Families could contract for the services of a nurse for a day or a few hours to care for their loved ones either at home or in the hospital (Whelan, 2005). Although physicians’ orders were required, private duty in the home provided graduate nurses with the venue and the opportunity to break away from the rigid hospital routine and allowed for a more autonomous practice. These nurses provided care to patients with contagious diseases such as pneumonia and typhoid fever, aided women in childbirth, and supported those with fractures, infected wounds, strokes, and mental diseases. Private duty nurses lived with and worked for their patients, providing 24-hour care, often for weeks at a time (Stoney, 1919). (Creasia 5-6) Creasia, Joan L., Elizabeth Friberg. Conceptual Foundations: The Bridge to Professional Nursing Practice, 5th Edition. Mosby, 2011. VitalBook file. The citation provided is a guideline. Please check each citation for accuracy before...
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...Septic Shock Medical Careers Institute NUR 255 November 19, 2014 Instructor Y. Rogers Introduction Septic shock is the most common type of circulatory shock. Sepsis or septic shock is systemic inflammatory response syndrome (SIRS) secondary to a documented infection. This response is a state of acute circulatory failure characterized by persistent arterial hypotension despite adequate fluid resuscitation or by tissue hypoperfusion (manifested by a lactate concentration >4 mg/dL) unexplained by other causes. Sepsis can occur in stages that may progress from uncomplicated sepsis, to severe sepsis, to shock. Despite efforts to decrease shock with the use of antibiotics, the incidences continue. Septic shock is the leading cause of death in noncoronary ICU patients. More than 18 million cases of severe sepsis occur each year, this results in 1,400 deaths worldwide every day (Hinkle, 2014). Background In the past, the terms sepsis and septicemia have referred to several ill-defined clinical conditions present in a patient with bacteremia. These 2 terms have often been used interchangeably; however, only about half of patients with signs and symptoms of sepsis have positive results on blood culture. Serious bacterial infections at any site in the body, with or without bacteremia, are usually associated with important changes in the function of every organ system in the body. These changes are mediated mostly by elements of the host immune system against infection...
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