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Nursing Safety: Antibiotic Reistance to Bacteria

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The Centers for Disease Control and Prevention recently released a study noting that more American deaths occur each year due to MRSA, an antibiotic-resistant bacterium, than due to the AIDS virus.  The Committee to Reduce Infection Deaths calculates that more than 100,000 Americans die annually due to hospital acquired infections.  Statistical reporting does vary.  The National Institutes of Health (NIH) estimates that 90,000 people in the US die annually due to hospital acquired infections.  This statistic was noted in an an April 2006 report from the NIH division, The National Institute of Allergy and Infectious Diseases. The NIH also notes in this report that this number rose from 13,300 deaths annually in 1992 to 90,000 in 2006.  The NIH also notes that approximately 2,000,000 patients in the US get an infection in hospitals annually.  Tracking suggests that this number is rising.  Experts note that hospitals provide more procedures such as joint replacements and transplants which increase the risk of infections and push the trend upward.  Also, an increasing amount of hospital patients suffer from immunosuppression due to cancer and AIDS which also contribute to the increased risk of cross infection.  For 2008, the Centers for Medicare and Medicaid Service  has stated that Medicare will no longer reimburse hospital bills for care relating to hospital acquired infections.  It is expected that this will cause hospitals to fund greater resources towards improved staffing and equipment for disinfection, MSRA screening, and isolation rooms.

Another challenge is the natural process of bacterial antibiotic resistance.  Bacteria acquire genes conferring antibiotic resistance by spontaneous DNA mutation, transformation, and a DNA transfer process carried by a plasmid (a small circle of DNA that can jump from one bacteria to another).  The FDA notes that there are many factors involved in the increasing use of antibiotics which, in turn, promote the natural process of bacterial resistance to antibiotics.  For example, the FDA cites that an increased use of day-care facilities for children corresponds to a doubling of the amount of doctor visits for ear infections (and antibiotic use) between 1975 and 1990.  The FDA notes that the antibiotic resistance trend is also partially due to immunocompromised patients living longer, increased chemotherapy and transplant recipients, routine antibiotic prescriptions, and homelessness.  Interestingly, the FDA notes that doctors are pressured by patients to prescribe antibiotics in cases where they may not be necessary.  The FDA is also investigating whether or not the use of antibiotics in food animals can lead to human diseases.

Nursing Continuing Education Peptic Ulcers

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Nursing Continuing Education Courses Online

Foucs: Peptic Ulcers

 

HealthCMI brings special FYI information on common questions in nursing continuing education and medicine.


Peptic ulcers are circumscribed breaks in the continuity of mucosa, extending below the epithelium. Strictly speaking, breaks in the mucosa not extending below are called erosions, although they are often referred to as ulcers. Chronic ulcers have scar tissue at the base. Peptic ulcers can be located in any part of the gastrointestinal tract exposed to the acid-pepsin gastric juice, including the esophagus, stomach, duodenum and after gastroenterostomy, the jejunum. Although the peptic digestive activity of the gastric juice is an important etiologic factor, there is evidence that this is only one of many factors in its pathogenesis. Both cortisone and aspirin produce qualitative changes in the gastric mucus which may facilitate its degradation by pepsin.

Aspirin, alcohol, bile salts, and other substances injurious to the gastric mucosa alter the permeability of the epithelial barrier, which allows back diffusion of hydrochloric acid with resultant injury to underlying tissues, especially blood vessels. Histamine is liberated, which stimulates further acid and pepsin secretion and increased capillary permeability to proteins. The mucosa becomes edematous, and large amounts of plasma proteins may be lost. The mucosal capillaries may be damaged, resulting in interstitial hemorrhage and bleeding. Severe stress, especially chronic, is another major cause of gastric ulcers. Overall, acidity is the major pathogenic factor, so that a malfunction of Brunner's glands, which produce a mucoid secretion that neutralizes the acid chyme, would lead to ulceration. If normal tissue resistance defense systems like this are overwhelmed- ulcer. Also important to tissue resistance is vascular supply, proper epithelial regeneration - normally replaced every 3 days. HealthCMI will feature food cures for nursing continuing education online courses on this topic- coming soon!

Other causes: Indomethacin, phenylbutazone, and corticosteroids, also- caffeine. Associated diseases: Liver cirrhosis, chronic pancreatitis, chronic lung dz, hyperparathyroidism, and Zollinger-Ellison syndrome. In addition, bile reflux from abnormal pyloric sphincter function disrupts the mucosal barrier.

CLINIC: upper abdominal pain usually 2 hours after a meal and is relieved by foods and antacids; sometimes pain in the middle of the night (duodenal ulcer), and weight loss (gastric ulcer).

COMPLICATIONS: intractability, hemorrhage, perforation, and pyloric obstruction. Some ulcers are malignant, others may lead to iron-deficiency anemia, shock in the case of bleeding. Perforation may lead to chemical peritonitis and therefore intense pain, a fear of moving and breathing, and a rigid abdomen. If the pancreas is involved, pain may radiate to the back. Obstruction may lead to anorexia, nausea, and bloating after eating and weight loss; also, sever pain and vomiting.

STRESS ULCER: Brain injury, shock, sepsis, burns and drugs

Nursing job burnout

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Nursing Continuing Education Courses

Nurse to Patient Ratio Issues

Job Burnout and Quality Patient Care

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HealthCMI will feature important nursing continuing education courses on quality of life factors for nurses. Nursing continuing education will focus on important roles that nurses can empower themselves with in the working environment. Look forward to nursing continuing education online at HealthCMI!

In one of the most interesting studies concerning the nursing profession (JAMA. 2002 Oct 23-30;288(16):1987-93), important results were tabulated concerning nurse to patient ratios. Research articles are often dry. Not this one. The opening description of the abstract notes, “The worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-to-nurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice.” The research was conducted by the Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania. The results showed, “each additional patient per nurse was associated with a 7% increase in the likelihood of dying within 30 days of admission and a 7% increase in the odds of failure-to-rescue. After adjusting for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% increase in the odds of burnout and a 15% increase in the odds of job dissatisfaction.” The study was conclusive that the mortality rate for surgical patients is higher with fewer nurses per patient and job burnout for nurses increases as well.

California Nurses and Nursing Education

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The University of California, San Francisco's Center for California Health Workforce Studies, notes that nursing school graduates have increased 73 percent during the last five years.  In California, nurses average a 9.6 hour workday and 45 percent of nurses in California are over 50 years old according to the Board of Registered Nurses.  The average nurse in California is estimated at a salary of approximately $73,500.

Nursing Continuing Education Colitis

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Nursing Continuing Education FYI

Focus: Ulcertative Colitis and Crohn's Disease

 

Chronic inflammatory disease of the large bowel is divided into two major entities-nonspecific ulcerative colitis & Crohn's disease  of the large bowel (regional enteritis, granulomatous colitis).  Both involve abdominal pain, diarrhea, and rectal bleeding.  Crohn’s disease is  one-fifth as common as ulcerative colitis in the US.

Crohn's disease is a nonspecific chronic transmural inflammatory dz that most commonly affects the distal ileum and colon but may also occur in any part of the GI tract from the mouth to the anus and perianal area.  Chemicals and low-fiber diets of industrialized nations facilitate this onset of this disease.  It occurs more commonly in Jewish people of Eastern European descdent and has familial tendencies.  Most cases begin before age 40 and have peak incidence in the 20's.

The earliest macroscopic lesions of Crohn’s disease appear to be tiny focal "aphthoid" ulcerations of the mucosa, usually with underlying nodules of lymphoid tissue.  The inflammation may regress or progress to involve all layers of the intestinal wall.

The transmural inflammation, deep ulcerations, edema, and fibrosis are responsible for obstruction, deep sinus tracts and fistulas and mesenteric abscesses.  Chronic diarrhea associated with abdominal pain, fever, anorexia, weight loss, and a right lower quadrant mass or fullness are the most common presenting features.  However, many patients are first seen with an "acute abdomen" simulating acute appendicitis or intestinal obstruction.

Ulcerative colitis, however, is usually a series of attacks of bloody diarrhea varying in intensity and duration interspersed with asymptomatic intervals.  Onset of an attack may be acute and fulminant with  sudden violent diarrhea, high fever, signs of peritonitis and profound toxemia.

Psychological aspects of ulcerative colitis play a secondary role in attack onset.  The initial pathologic lesion is confined to the mucosal layer and consists of abscess formation in the crypts, as opposed to Crohn’s disease, which involves the entire thickness of the bowel wall.  Ulcerative colitis reveals a friable and intensely inflamed mucosa with exudate. Usually, the rectosigmoid area of the colon is involved.  The disease may extend from this area but always in a continuous fashion, in contrast with Crohn’s disease, which tends to skip.  Ulcerative colitis patients  may have narrowing of the bowel lumen as a result of fibrosis, which is generally mild compared to Crohn’s disase.  Age onset differs.  Ulcerative colitis peaks at 15-30 years and also 50-70 years of age.

Hospital Nutrition Nursing

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Nursing Continuing Education and Nutrition

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Highlight on Food

 

Food delivers the staple nutrition required to maintain health and a proper diet also speeds recovery from illness.  It follows that hospitals need to focus on quality foods for patients, staff, and for the public.  Under a holistic model of health, the hospital setting is an opportunity to provide quality food for its health benefits and to set an example to the community for healthy eating.  One strong example of a quality food delivery system in the hospital setting is Sutter Maternity and Surgery Center in Santa Cruz, California.  This 30 bed not-for-profit hospital serves fresh locally grown and certified organic foods.  Patients can order meals in a similar fashion to food service in quality hotels.  In addition, the fresh organic foods are available in the food cafeteria for the general public and staff.  The process is accomplished with Sutter’s model of purchasing food directly from a farm.  By contrast, the food courts in many hospitals provide fast-foods that provide profits but miss the mark in terms of healthy eating.

For a link to the US FDA Click Here .

Nursing Continuing Education Employment

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Nursing Employment Figures

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Registered nurses represent the largest number of healthcare providers in the United States.  There are 2.5 million nurses and over 50 percent of them work in the hospital setting.  The educational preparation for a career in nursing may include a bachelor’s degree, an associate degree, or a diploma from a dedicated nursing program.  There is an increasing demand for nurses in the US and over a 500,000 new nursing positions are expected to be created by the year 2015. 

Registered nurses (RN’s) work with both patients and the general public in an effort to educate people about treatment paths for medical conditions.  Nurses treat patients, perform and analyze diagnostic tests, and administer medications.  Nurses also perform record keeping responsibilities and work with patient rehabilitation.  Very importantly, nurses provide emotional support to patients and their families. 

Nurses are essentially on the “front lines” of medicine.  They may be responsible for reviewing and explaining issues concerning post-operative recovery, dietetics, and for helping patients to understand their responsibilities regarding recovery from illness and also how to maintain wellness.  Many nurses operate in a public health capacity in an effort to education the public concerning the signs and symptoms regarding disease processes.  Other efforts include working at immunization clinics, physical therapy centers, blood drives, and the operation of important medical equipment for diagnostic, analytic, and treatment purposes. 

Nurses provide an important role in monitoring and administering medications including the checking of dosages.  Other nurses may be charged with administering intravenous (IV) fluids including pharmacological agents and blood.  Nurses may also oversee and manage nursing aids.  Nurses with advanced certifications may have the power to prescribe medications.

Specialization in nursing takes several directions.  Many nurses perform perioperative procedures for work in operating rooms and act as assistants to surgeons.  Other nurses manage long term cases of illness involving the careful monitoring of lifestyle, medications, and follow-up visits.  Nursing specialties can be quite specific to a particular demographic, organ, or disease type.  There are several major categories of nursing specialties.  They include perioperative nurses, rehabilitation nurses, long-term care nurses, ambulatory care nurses, emergency nurses, hospice care nurses, infusion nurses, home health care nurses, transport nurses, critical care nurses, palliative care nurses, radiology nurses, perianesthesia nurses, mental healthcare nurses, transplant nurses, and more.  The income for nurses ranges from approximately $40,000 to over $80,000.

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