Research Articles Base: Smoking Habits

Chronic Pulmonary Disease

Introduction The condition of chronic obstructive pulmonary disease (COPD), nothing like a good number of other illnesses, is growing in incidence globally. This boost, at least to some extent, is probably as a result of the population surviving much longer generally and increasing cigarette use in developing nations. Moreover, even though contact to cigarette fumes is by a long way, it is the foremost identifiable origin of COPD. Similarly, contact to specific occupational dirt and chemicals have also been deemed to be another cause of COPD. On the other hand, exposures at home in smoke used for cooking and heating are also liable causes. Furthermore, one could not discount the genetic predisposition which might have triggered the illness among the casualties. This paper will look into the condition of a geriatric patient admitted for COPD exacerbation in which complications have taken place before his release. For clarity and coherence of the paper, the discussions and assessment on the stated case will be divided into several parts. One part will be discussing the probable questions that could help the assessment on making out the complications that the patient has acquired. The subsequent part will be discussing the body systems that will be involved in the assessment of the case. It is in this part where the respiratory system and the heart are to be discussed. Specifically, the parts in which the complications might have been involved in the case of the patient are to be taken into consideration. The third part is going to look into the factors in which the patient might encounter risk with regards to the treatment. And finally, after the discussions regarding the situation, a conclusion will be provided with regards to the condition of the patient and concerns with COPD in general. Questions Providing Essential Information In the case study, the patient is admitted in the hospital for exacerbated COPD with complications like pneumonia. An exacerbation of COPD is described by a boost in cough, with an alteration in color or amount of sputum or a worse condition of dyspnea. (Shelley and Salpeter, 2003) Before the patient is discharged, he complained of a pain in the left part of his chest and shortness of breath.    o       Does the patient have a family history of heart problems? o       Does he have a hypertension and high cholesterol in his medical history? o       Has the patient totally stopped smoking tobacco? o       Does the patient feel emotionally strained? o       Is the pain felt underneath the breastbone? o       Is the pain characterized by a prickly, intense, or constricting feeling? o       Does the pain start after a walk or if he leaves his bed? o       Is the pain relieved when the patient gets enough rest? In looking at the response of the patient based on the case, one could suspect that the patient is experiencing an episode of angina. Moreover, if the medical history of the patient is taken into account, one could also presume the existence of a case of chronic heart failure.  Body Systems Included in the Assessment The condition of the elderly patient with COPD is actually possible in terms of acquiring heart diseases. Patients with COPD are at bigger danger of acquiring heart illnesses as compared to asthmatics. (Shelley and Salpeter, 2003) Nevertheless, they similarly possess more severe airway impediments such that they may possibly be more susceptible to small alterations in forced expiratory volume of 1 second. (FEV1) In a study of Shelley and Salpeter (2003), they noted that these patients would make the most from the employment of ß blockers. In a study of Cilli, Uslu, Ozdemir (2004), they noted that patients with chronic obstructive pulmonary disease (COPD) have a bigger possibility of fatality from reasons other than COPD. The most frequent comorbid illnesses include hypertension (22%), coronary heart disease (8.9%), diabetes mellitus (7.4%), cancer (6.4%), heart failure (4.9%) and cerebrovascular disease (2%). Whereas  most  said that sicknesses were stated to be the most frequent comorbid factor, FEV1, heart failure and cancer were related components with bigger threat of death from COPD. On the other hand, it was stated that the case may possibly be complicated by a heart condition on the part of the patient, thus, it is important to take a look at the possibility of the patient having a chronic heart failure. Left-sided chronic heart failure (CHF) takes place in patients with COPD for the reason of a concurrent cardiac disorder like coronary artery disease or hypertension. (Wilbert and Aronow, 2003) This is apparently present in the case of the elderly patient considering he had a history of hypercholesterolemia and poorly controlled hypertension. It should be treated in concurrence with the COPD, however, on grounds of financial problems with the patient, it was ceased. Moreover, according to the work of Wilbert and Aronow (2003) it is important to establish whether the patient has really stopped smoking. If he did stop, it must be established whether he has been constantly exposed to other probable sources of COPD, like secondary cigarette smoke or chemical dusts. Another system to be checked is the respiratory tract. (Wilbert and Aronow, 2003) It should be checked if it is infected. If it is infected, it might lead to RV failure. This means that it should be treated quickly. To look if the tract is indeed infected,   the secretions of the sputum should be monitored to establish whether there is a need to employ mucolytic agents to address this condition. Risk Factors in the Patient’s Condition This part will be discussing the risk factors involved in the condition of the patient. Particularly, those related to the lifestyle choices, medications, and conditions are going to be pointed out in this context.    Conditions The patient might have exacerbated his condition because of his being bed-ridden for several days caused by his COPD exacerbation. This might have triggered the heart condition that has been caused by his previous illnesses GERD, hypercholesterolemia, and hypertension over and above his exposure to smoking. His old age has also added the risk of the heart condition. Having a geriatric patient lessens the capability and speed of recovery because of the slower metabolism of the patient. Similarly, the inactivity of the patient might have also triggered the disease since he has been confined for several days already. This inactivity might have slowed down his already slow metabolism rate and might have triggered the illness along with the help of the COPD.  Lifestyle choices There are two lifestyle choices that should be looked into in taking into account of the risk factors present in the patient’s condition. First is the existence of alcohol abuse or withdrawal. Alcohol consumption is associated with a favorable lipid profile. (Mozaffarian et al, 2004) On the other hand, greater intake is associated to brain atrophy. Another lifestyle choice is smoking. Cigarette smoking is a well recognized risk factor for illnesses among adolescent and grown-up populations. Older adults who have ceased smoking have inferior risk than those who carry on smoking. (Mozaffarian et al, 2004) However, continuous exposure to cigarette smokes such that of second hand smoke may still trigger the risk factor. Medications Early methods for the management of COPD are in a lot of aspects considerably unlike from current recommendations. At first, the amount of pharmacologic agents accessible to take care of COPD was inadequate. Antibiotics, mucolytics, and nonselective sympathomimetics were the key agents provided for COPD management. (Petty, 2002) Paradoxically, oxygen and working out a couple of the most common elements of treatment today were deemed harmful. Antibiotics have been accessible to take care of patients with COPD for years and frequently were controlled consistently in patients with obstructive lung disease. Even though patients with COPD are more vulnerable to pulmonary illnesses than those patients with no COPD and management of these agents is an essential element of the management of infection connected with COPD, antibiotic treatment must be employed more prudently nowadays than it was in the past. Antibiotic resistance formerly was recognized in the 1970s and has been growing progressively in commonness. (Faulkner and Hilleman, 2002) On account of this occurrence, patients nowadays are monitored more cautiously for antibiotic requirement. (Saint et al, 2001) On the other hand, mucolytic drugs are deemed to boost the expectoration of sputum by lessening its thickness. (Faulkner and Hilleman, 2002) More than a few years ago, mucolytic treatment with an oral mixture of potassium iodide was provided to dilute the mucus of patients with COPD. (Petty, 2002) Nowadays, it would be atypical to see this agent employed in such ability to view its possibly harmful implications in individuals with thyroid disease, and for the reason that other mucolytic agents are readily obtainable. In addition, the effectiveness of mucolytic agents for a good number of patients with COPD has been challenged. Merely lessening the thickness of mucus may possibly be useless with no general reduction in the quantity of mucus emitted. (Rogers, 2002) Conclusion Patients who are indicative with constant COPD have need of a range of interventions to optimize their way of life and continued existence. Conditional on their individual conditions, they may possibly take advantage from making the most of airflow, lessening and clearance of secretions, physical treatment, averting infections, and guaranteeing sufficient oxygenation. The different components can be brought in eventually with cautious inspection to establish which intercession has constructive (or adverse) consequences. Responsiveness of other disorders that are frequent among those with COPD will assist in early detection, cure, or prevention. Punctual acknowledgment and efficient administration of acute exacerbations of COPD are necessary. Moreover, facts from this study advocates that diet, physical activity, and smoking habits in the later part of a person’s life may have an effect with health risk. Corresponding to medical or surgical intercessions, such lifestyle alterations are comparatively low risk, low rate, and extensively pertinent. Consequently, even small alterations in risk because of these elements may possibly be important on a population level. Credit:ivythesis.typepad.com

Chronic Pulmonary Disease

Introduction The condition of chronic obstructive pulmonary disease (COPD), nothing like a good number of other illnesses, is growing...

Smoking in United Kingdom

Cigarette smokers are known to be more frequently involved in driving accidents; it has been found that extraverts tend to be more frequently involved in driving accidents than are introverts. It has been found that divorced people tend to smoke more whereas single people tend not to smoke; we have already noted that introverts tend to marry less and extraverts to be more frequently involved in a change of marital partner. It has been found that people who change jobs frequently tend to smoke more; again extraverts are known to change jobs more frequently. Several studies have tended to show that people who are relatively unsuccessful academically, both at school and university, tend to smoke more; it has also been found that introverts are more successful at school and at university. People who smoke a lot have been found to be ‘chance oriented’; this agrees well with the findings that extraverts tend to be impulsive. Many European studies have also been concerned with neuroticism or emotionality, and it must be said that here agreement is much less obvious. Most of the European studies have found a positive relationship between smoking and neuroticism. Admittedly many of these studies were carried out on relatively small groups, and in most cases groups chosen were quite unrepresentative. Nevertheless, the amount of agreement reported must make one cautious of dismissing these results. The European report summarizes the findings in the following sentence: ‘Despite the individual deficiencies of many of the studies, despite the great diversity in conceptualization and research methods used and despite discrepancies in reported findings the presence of some comparability between them and the relative consistency of findings lend support to the existence of a relationship between the smoking habit and a personality configuration that is vaguely described as “neurotic”.’ The tortured structure and syntax of this sentence adequately indicate the difficulty which the authors had in coming to a conclusion on this point; it must be left to further research to say whether the difference between our findings and those mentioned are due to national differences between England and America or whether there is some other cause for the discrepancy. Smoking Cessation The 1990 U.K. Surgeon General’s Report ( U.K. Department of Health and Human Services, 1990) stated that smoking during pregnancy is related with premature birth, increased respiratory problems among infants and young children, and sudden infant death syndrome (SIDS). Maternal smoking also increases the risk of abruptio placentae, placenta previa, and bleeding early or late in pregnancy, all of which increase the risk for perinatal loss Finally, efforts to help women end or lessen smoking during pregnancy become a main concern of obstetric providers. Smoking cessation programs, the committee found that one-on-one sessions with a counselor or a physician are among the most effective prenatal smoking cessation strategies. They also found that although group counseling appears to be less effective, social support seems to be critical to reducing or eliminating pregnant women’s smoking. Given the enormous toll cigarette smoking is taking on pregnancy outcomes and child health, prenatal and postpartum smoking cessation is a critical priority. Unfortunately, few institutionalized smoking cessation initiatives exist within prenatal care programs. In October 1994, with the prenatal smoking cessation program (PSCP) aimed first and foremost at providers working in inner-city communities and serving diverse populations (Chaloupka:1991). The project seeks to help prenatal care providers implement smoking cessation programs in their facilities. Smoking is a serious health concern among college students today. There is a large portion of the smoking public and could have a unique chance to stop smoking through college smoking cessation program (Jason and Malone:1990). The smoking cessation will give a two-credit college smoking cessation course. The sessions will train the student about the impact of smoking to their health. Student mentors, who were previous smokers, will provide support for students outside of the classroom and at the end of the semester students who were successful in quitting smoking will have the opportunity to become smoking cessation mentors themselves. Many smokers want to quit, but few succeed in it. Integrating this cessation program in a college course could aid student smokers in their quitting efforts. Another study attempted to utilize these components in a comprehensive worksite program (Winstanley, Woodward and Walker:1995). There was a significant difference in quit rates between individuals in the group (G) condition (42%) versus those in the nongroup (NG) condition (15%). At the 6-month data point, 29% of G participants and 20% of NG participants were abstinent. A year after the program’s onset, 26% of G participants were abstinent as compared with 16% of NG participants. In addition, significantly more participants in G (12%) reported continuous cessation than did those in NG (5%). As these figures indicate, higher smoking cessation rates were found in companies that were provided 12 monthly booster sessions plus incentives. The present study presents the data collected 24 months following the beginning of the project. This program suggests several important components for assisting smokers at worksites in quitting and maintaining a smoke-free life-style. Several limitations of this study include the reliance on self-report measures without biochemical verification and the combined use of both support groups and incentives in one condition. Future research should attempt to isolate the specific influences of the support groups, self-help materials, and incentives. The present data identify several areas that might be altered to increase cessation rates. These include follow-up support groups after initial cessation efforts, provision of regular incentives for continued abstinence, and use of the media as a method of reinforcing utilization of cessation strategies (Jason, Salina, et al., 1991). Given the health risks of smoking and the costs to firms and society, we endorse the need for smoking bans. Currently, there is a wave of legislative efforts to mandate nonsmoking areas. In a recent survey of 280 private California corporations with more than 500 employees, 87% had adopted formal worksite smoking policies (Schauffler, 1993). These efforts may improve the effectiveness of worksite cessation programs, as well as diminish smoking rates in public areas. Worksite smoking cessation programs appear capable of assisting many smokers to quit and enjoy healthier, more productive life-styles while maintaining cost efficiency and reaching many individuals. Media interventions represent a cost-effective method of reaching many more individuals than traditional smoking cessation programs, and their efficacy in cessation efforts should continue to be explored. In addition, the role of incentives and support groups need to be delineated more clearly to ascertain under what circumstances incentives are most effective (Malone & Jason, 1990). Worksites offer many unique characteristics that make them excellent environments for smoking cessation programs including organizational norms and group identity. Researchers should continue to investigate how to design effective smoking cessation programs that can be accommodated to worksites. References Chaloupka, F. (1991), ‘Rational Addictive Behaviour and Cigarette Smoking,’ Journal of Political Economy 99, August, 722-42. Jason, L. A., Salina, D. D., Hedeker, D., Kimball, P., Kaufman, J., Bennett, P., Bernstein, R., & Lesondak, L. (1991). Designing an effective worksite smoking cessation program using self-help manuals, incentives, groups and media. Journal of Business and Psychology, 6(1), 155-166. Malone, S. W., & Jason, L. A. (1990). Using incentives, lotteries, and competitions in worksite smoking cessation interventions. In R. R. Watson (Ed.), Drug and alcohol abuse prevention. (pp. 313-327). London: Routledge. Schauffler, H. H. (1993). Integrating smoking control policies into employee benefits: A survey of large California corporations. Journal of Public Health, 83, 1226-1230. Winstanley, M., Woodward, S. and Walker, N. (1995), Tobacco in United Kingdom: Facts and Issues, Victorian Smoking and Health Program. Ear Wax Removal: Drops or Syringing? Ear wax is a common creation of the ear which keeps the skin of the ear from water and infection. Ear wax is produced in wax glands in the outer ear canal as well as other sections such as dead skin, sweat, and oil. The main element of ear wax is keratin (derived from dead skin). Ear wax therefore is slightly different from cerumen which is the secretory product of the ceruminous glands in the outer auditory canal (Hawke, 2002). While ear wax is usually purely felt to be a irritation, in medieval times, ear wax was utilized as a part of coloring for lighting of manuscripts (Petrakis, 2000). Different individuals differ significantly in the quantity and regularity of their ear wax. There are two kinds illustrated, wet and dry, which are innate. Dry wax is widespread in Asia, while wet wax is frequent in Western Europe. Dry wax, also known as “rice-bran wax”, have 20% lipid. Extraordinarily, rice-bran wax is related with a lower occurrence of breast cancer (Hawke, 2002). Wet wax contains 50% lipid (Burkhart et al, 2000). Wet wax can be both soft or hard, the hard wax being more probably to be impacted. Too little ear wax raise the risk of infection (Fairey et al, 1985). Too much wax also increases the occurrence of infection and impairment of hearing. A study of this, some individuals is “wax producers”, and others stay wax free without much maintenance (Bankaitis and Kelso. 2005). <li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">Wax can block up the ear, resulting to reduce hearing, and a full feeling in the ear. This is called an “impaction”. There are about 2.6% of patients has an ear wax impaction at any time. </li> <li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">Wax can entrap bacteria in the ear, this may lead to infection. This is frequently painful or at least itchy. </li> <li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">Ear wax damage vision when the doctor looks in your ears, possibly hiding a dangerous process. </li> According to a medical study, ear wax can be removed by using water jets or drops that sucks the hard wax (Burkart:2000). A doctor can also use instruments. If a person has chronic ear disease, a damage of the ear drum, or has wax in their only hearing ear, it is suggested to have wax eradicated by an otolaryngology doctor under direct vision. If there is a puncture in the ear drum, or a sound possibility of a perforation, wax should be removed by instruments and/or suction, and not by irrigation. Syringing is a normal method of wax removal and just about 150,000 ears are irrigated each week in the United Kingdom (Grossan, 1998). To shun inducing dizziness, body temperature water is preferred. While syringing is a traditional and acknowledged method of ear wax removal, it has many weaknesses contrasted to removal than drops. For example, in the unusual occasions when there is a puncture under the wax, syrnging may force water and wax into the middle ear, causing a nidus for infection. Syringing also puts the ear to threat for bacterial infection. Some medical practitioners suggest placing 1 or 2 drops of Domeboro, Vosol or Cortisporin otic in the irrigated canal to stop infection. Syringing should not be used in ears with puntures. Another study stated that there are some instances wax is hardened and impossible to remove with syringing. In this condition one may put an effort to soften the wax with oil and return in one week for another attempt. Suction may be helpful in this situation. Current research proved that counter drops is more effective in removing hard wax using water, oil and peroxide solutions like Debrox. Other solutions can be tap water, 10% sodium bicarbonate, 3% hydrogen peroxide, 2% acetic acid and a combination of 0.5% aluminum acetate and .03% benzethonium chloride. Hydrogen peroxide commonly melts ear wax because of its mechanical effect. When it comes to oil-based organic solutions are olive oil, glycerin, propylene glycol, and others. Warm solutions must be used for wax removal is more advantageous. According to Hawke, oil based solutions essentially do nothing but lubricate (Hawke, 2002). Some solutions used for ear wax removal are enzyme based. However, this may cause allergies to the patient.  Some patients, a wax plug blocks the ear so one cannot know for sure if a puncture is present. Though in this case, it is usually achievable to make an educated guess with a reasonable degree of reliability (Hawke, 2002). There are also preparations intended to dissolve ear wax — for example, Cerumenex Ear Drops and Murine Ear drops. A recent study suggested that neither of these preparations are any better than salt water (placebo). (Roland , 2004). Credit:ivythesis.typepad.com

Smoking in United Kingdom

Cigarette smokers are known to be more frequently involved in driving accidents; it has been found that extraverts tend to be more fre...

Mucoactive drugs for asthma and COPD

Introduction The condition of chronic obstructive pulmonary disease (COPD), nothing like a good number other illnesses, is growing in incidence globally. This boost, at least to some extent, is probably as a result of the population surviving much longer generally and increasing cigarette use in developing nations. Moreover, even though contact to cigarette fumes is by a long way the foremost identifiable origin of COPD. Similarly contact to specific occupational dirt and chemicals have also been deemed to be another cause of COPD. On the other hand, exposures in the home like being exposed to the smoke used for cooking and heating are also liable causes. Furthermore, one could not discount the genetic predisposition which might have triggered the illness among the casualties. This paper will look into the condition of a geriatric patient admitted for COPD exacerbation in which complications have taken place before his release. For clarity and coherence of the paper, the discussions and assessment on the stated case will be divided into several parts. One part will be discussing the probable questions that could help the assessment on making out the complications that the patient has acquired. The subsequent part will be discussing the body systems that will be involved in the assessment of the case. It is in this part where the respiratory system and the heart are to be discussed. Specifically, the parts in which the complications might have been involved in the case of the patient is to be taken into consideration. The third part is going to look into the factors in which the patient might encounter risk with regards to the treatment. And finally, after the discussions regarding the situation, a conclusion will be provided with regards to the condition of the patient and concerns with COPD in general.   Questions Providing Essential Information In the case study, the patient is admitted in the hospital for exacerbated COPD with complications like pneumonia. An exacerbation of COPD is described by a boost in cough, with an alteration in color or amount of sputum or a worse condition of dyspnea.  Before the patient is discharged, he complained of a pain in the left part of his chest and shortness of breath.    o       Does the patient have a family history of heart problems? o       Does he have a hypertension and high cholesterol in his medical history? o       Has the patient totally stopped smoking tobacco? o       Does the patient feel emotionally strained? o       Is the pain felt underneath the breastbone? o       Is the pain characterized by a prickly, intense, or constricting feeling? o       Does the pain start after a walk or if he leaves his bed? o       Is the pain relieved when the patient gets enough rest? In looking in the response of the patient based on the case, one could suspect that the patient is experiencing an episode of angina. Moreover, if the medical history of the patient is taken into account, one could also presume the existence of a case of chronic heart failure.     Body Systems Included in the Assessment   The condition of the elderly patient with COPD is actually possible in terms of acquiring heart diseases. Patients with COPD are at bigger danger of acquiring heart illnesses as compared to asthmatics. Nevertheless, they similarly possess more severe airway impediments such that they may possibly be more susceptible to small alterations in forced expiratory volume at 1 second. (FEV1) They noted that these patients would make the most from the employment of ß blockers.   They noted that patients with chronic obstructive pulmonary disease (COPD) have a bigger possibility of fatality from reasons other than COPD. The most frequent comorbid illnesses include hypertension (22%), coronary heart disease (8.9%), diabetes mellitus (7.4%), cancer (6.4%), heart failure (4.9%) and cerebrovascular disease (2%). Whereas the most the said sicknesses were stated to be the most frequent comorbid factor, FEV1, heart failure and cancer were related components with bigger threat of death from COPD.   On the other hand, it was stated that the case may possibly be complicated by a heart condition on the part of the patient, it is important to take a look at the possibility of the patient having a chronic heart failure. Left-sided chronic heart failure (CHF) takes place in patients with COPD for the reason of a concurrent cardiac disorder like coronary artery disease or hypertension. This is apparently present in the case of the elderly patient considering he had a history of hypercholesterolemia and poorly controlled hypertension. It should be treated in concurrence with the COPD, however, on grounds of financial problems with the patient, it was ceased. Moreover, according to the work of it is important to establish whether the patient really has stopped smoking. If he did stop, it must be established whether he has been constantly exposed to other probable sources of COPD, like secondary cigarette smoke or chemical dusts.   Another system to be checked is the respiratory tract. It should be checked if it is infected. If it is infected, it might lead to RV failure. This means that it should be treated quickly. To look if the tract is indeed infected,   the secretions of the sputum should be monitored to establish whether there is a need to employ mucolytic agents to address this condition.   Risk Factors in the Patient’s Condition This part will be discussing the risk factors involved in the condition of the patient. Particularly, those related to the lifestyle choices, medications, and conditions are going to be pointed out in this context.     Conditions The patient might have exacerbated his condition because of his being bed-ridden for several days caused by his COPD exacerbation. This might have triggered the heart condition that has been caused by his previous illnesses GERD, hypercholesterolemia, and hypertension over and above his exposure to smoking. His old age has also added the risk of the heart condition. Having a geriatric patient lessens the capability and speed of recovery because of the slower metabolism of the patient. Similarly, the inactivity of the patient might have also triggered the disease since he has been confined for several days already. This inactivity might have slowed down his already slow metabolism rate and might have triggered the illness along with the help of the COPD.   Lifestyle choices There are two lifestyle choices that should be looked into in taking into account the risk factors present in the patient’s condition. First is the existence of alcohol abuse or withdrawal. Alcohol consumption is associated with a favorable lipid profile.  On the other hand, greater intake is associated with brain atrophy. Another lifestyle choice is smoking. Cigarette smoking is a well recognized risk factor for illnesses among adolescent and grown-up populations. Older adults who have ceased smoking have inferior risk than those who carry on smoking. However, continuous exposure to cigarette smokes such that of second hand smoke may still trigger the risk factor. Medications Early methods for the management of COPD are in a lot of aspects considerably unlike from current recommendations. At first, the amount of pharmacologic agents accessible to take care of COPD was inadequate. Antibiotics, mucolytics, and nonselective sympathomimetics were the key agents provided for COPD management. Paradoxically, oxygen and working out, a couple of the most common elements of treatment today were deemed harmful.   Antibiotics have been accessible to take care of patients with COPD for years and frequently were controlled consistently in patients with obstructive lung disease. Even though patients with COPD are more vulnerable to pulmonary illnesses than are patients with no COPD and management of these agents is an essential element of the management of infection connected with COPD, antibiotic treatment must be employed more prudently nowadays than it was in the past. Antibiotic resistance formerly was recognized in the 1970s and has been growing progressively in commonness. (Faulkner and Hilleman, 2002) On account of this occurrence, patients nowadays are monitored more cautiously for antibiotic requirement.   On the other hand, mucolytic drugs are deemed to boost the expectoration of sputum by lessening its thickness. More than a few years ago, mucolytic treatment with an oral mixture of potassium iodide was provided to dilute the mucus of patients with COPD. Nowadays, it would be atypical to see this agent employed in such ability in view of its possibly harmful implications in individuals with thyroid disease, and for the reason that other mucolytic agents are readily obtainable. In addition, the effectiveness of mucolytic agents for a good number of patients with COPD has been challenged. Merely lessening the thickness of mucus may possibly be useless with no general reduction in the quantity of mucus emitted.   Conclusion   Patients who are indicative with constant COPD have need of a range of interventions to optimize their way of life and continued existence. Conditional on their individual conditions, they may possibly take advantage from making the most of airflow, lessening and clearance of secretions, physical treatment, averting infections, and guaranteeing sufficient oxygenation. The different components can be brought in eventually with cautious inspection to establish which intercession has constructive (or adverse) consequences. Responsiveness of other disorders that are frequent among those with COPD will assist in early detection, cure, or prevention. Punctual acknowledgment and efficient administration of acute exacerbations of COPD are necessary. Moreover, facts from this study advocates that diet, physical activity, and smoking habits in the later part of a person’s life may have an effect with health risk. Corresponding to medical or surgical intercessions, such lifestyle alterations are comparatively low risk, low rate, and extensively pertinent. Consequently, even small alterations in risk because of these elements may possibly be important on a population level.     Credit:ivythesis.typepad.com

Mucoactive drugs for asthma and COPD

Introduction The condition of chronic obstructive pulmonary disease (COPD), nothing like a good number other illnesses, is growing ...

Nursing Care Plan

Introduction             The patient is Keri’s father, Mr. Joshua Vertigo, who is 82 years old and is living at the back of Keri’s house in a self-contained granny apartment for almost six years since his wife died. Mr. Vertigo does his own activities of daily living or ADL’s like taking a bath, going to the toilet and cleaning the apartment. However, the patient sometimes needs supervision and assistance in order to get the work done properly. To ensure a healthy diet for the patient, the couple (Keri and his husband) prepares his meals. The patient himself prepares his snacks.             Mr. Vertigo’s only means of transport is Keri and her husband. The patient requires some assistance to aid him with his shopping, banking and his weekly trip to the Returned Services League or RSL to catch up with some friends who are his only social contacts.             Mr. Vertigo is suffering from several medical complaints which have considerably complicated his capability to carry out his ADL’s. In 1985, Mr. Vertigo had had a heart attack and after a number of tests, he was found to have atrial fibrillation – an abnormality in the rhythm of the heart (also known as cardiac arrhythmia) which involves two small, upper heart chambers or the atria (Benjamin, et al., 1998). In a normal heart, heartbeats begin after the electricity which is produced in the atria by the sinoatrial node spread through the heart and causes the heart muscle to contract and the blood to pump whereas in atrial fibrillation, the electrical impulses of the sinoatrial node are replaced by disorganized, rapid electrical impulses which causes the irregularity of heartbeats (Greenlee and Vidaillet, 2005). Even though both the heart problems of the patient have no long-term effects, the patient as to take lifetime medication such as Warfarin – to reduce the rate of stroke – and Digoxin, Slow K and Lasix – to assist his cardiac problems.             Aside from the patient’s heart problems, he is also suffering from diabetes. Mr. Vertigo has to inject himself with insulin everyday. Twice a day, the patient takes his blood sugar to adjust the degree of his insulin intake, as well as his dietary necessities. The patient has had diabetes for already thirty years; nevertheless, his diabetes has brought about some problems that have affected his vision. The patient has been diagnosed to have diabetic retinopathy – damage to the retina caused by complications of diabetes mellitus which could eventually lead to blindness (Bradford, 1999). The patient’s diabetic retinopathy has greatly affected his carrying out of his ADL’s as well as his reading – his other only activity. In addition, his dramatic deterioration of his eyesight has also caused him an increased difficulty in his administration of insulin. Moreover, the patient is also suffering from leg ulceration which has also been brought about by his diabetes. Leg ulceration is actually a common chronic recurring condition and a major cause of morbidity and suffering (Callam, et al., 1988; Roe and Cullum, 1995). Leg ulcers are areas of “loss of skin below the knee on the leg or foot which take more than six weeks to heal” (Dale, et al., 1983). It is important to note that other cases of leg ulcers do not even heal at all.             In addition to the patient’s medical complaints is his osteoarthritis of the spine and upper limbs. It is a common condition where the joints are affected by degeneration wherein the joints are red, hot, swollen and painful (Horstman, 1999). As for the patient’s case, a district nurse visits him every other day in order to dress his small leg ulcer. The complication that the patient’s osteoarthritis has brought about is his restricted range of movements. His osteoarthritis has greatly affected his balance and because of this, he his already unsteady when he walks. Therefore, the patient needs a walking stick. However, due to his visual problems, the patient has a high probability of falling and, in turn, may break some bones. Furthermore, the patient is also suffering from chronic lower back pain.             Keri reports that the main problem of Mr. Vertigo is his increasing inability to undertake his ADL’s as well as his drug administration. This paper will be providing a detailed nursing care plan for Mr. Joshua Vertigo. The Resident Classification Scale or the RCS will be used as a tool and the outcomes for the patients will be analyzed as to whether the patient needs to be placed in residential care or may only stay at home. After which, a detailed nursing care plan will be made for the patient. At the end of the paper will be a conclusion which will summarize the major points and themes of the paper.   Application of the Resident Classification Scale (RCS)             The Resident Classification Scale (RCS) is used in Australian residential aged care as a relative resource allocation instrument. It is applied to all individuals entering residential care and is reviewed at least once a year. Since 1997, the RCS has been the grounds for Commonwealth Funding in all residential care facilities (Stepien, et al, 2006). The RCS constitutes of twenty items which contribute most to the differences in the cost of care with each item given a weighted score depending on the cost of providing the level of care necessitated (Please refer to table 1). Each of the questions in the RCS has a choice of four ratings which may be A, B, C or D. It is important to note that the elements in the RCS have been selected as those elements of care that best discriminate between relative care needs. Hence, the RCS provides a ranking which ranges from the patients with the highest care needs to those with the lowest care needs.             The RCS has been designed for the residential care setting. In this paper, the RCS has been used as a tool to determine the degree of dependence of Mr. Vertigo, taking into consideration the physical function, family and social functioning, supervision and the time required by the staff to encourage independence where possible. in order to determine the subsidy level of Mr. Vertigo, each RCS item is scored using the corresponding weights given in table 1 and are then summed up to give a total between 0 to 140. The higher scores represent higher degree of dependence and must be placed in residential care. Questions A B C D Communications 0.00 0.28 0.36 0.83 Mobility 0.00 1.19 1.54 1.82 Meals and Drinks 0.00 0.67 0.75 2.65 Personal Hygiene 0.00 5.34 14.17 14.61 Toileting 0.00 5.98 10.65 13.70 Bladder Management 0.00 2.22 3.82 4.19 Bowel Management 0.00 3.32 5.72 6.30 Understanding and Undertaking Living Activities 0.00 0.79 1.11 3.40 Problem Wandering or Intrusive Behavior 0.00 0.80 1.58 4.00 Verbally Disruptive or Noisy 0.00 1.19 1.75 4.60 Physically Aggressive 0.00 2.34 2.69 3.05 Emotional Dependence 0.00 0.28 1.50 3.84 Danger to Self and Others 0.00 1.11 1.54 1.98 Other Behavior 0.00 0.91 1.82 2.61 Social and Human Needs – Care Recipient 0.00 0.95 1.98 3.01 Social and Human Needs – Families and Friends 0.00 0.28 0.55 0.91 Medication 0.00 0.79 8.55 11.40 Technical and Complex Nursing Problems 0.00 1.54 5.54 11.16 Therapy 0.00 3.64 6.10 7.01 Other Services 0.00 0.71 1.46 2.93 Table 1. The RCS and their Corresponding Weights Source: Stepien, et al., 2006             In the proceeding part of this paper, the researcher will explore the questions in the RCS and will rate the patient basing on the guidelines from the Documentation and Accountability Manual of the Department of Health and Ageing of the Australian Government <www.health.gov.au>.             In the first question which is communications, this refers to the degree of assistance that the patient needs in communicating with staff, relatives, and friends for whatever reason. For this question, the researcher has rated Mr. Vertigo with an A, which means that the patient does not require any assistance in communication. The researcher has assessed this because the case study does not mention that Mr. Vertigo has any problem with regards to communication. Although his vision has rapidly deteriorated, he still capable of communicating effectively.             The second question is mobility. This refers to the degree of assistance that the patient needs in association to his mobility. This basically includes: (1) assistance in walking, on a one-on-one basis which includes provision of supervision, encouragement or physical support; (2) assistance in the use of mobility aids like wheelchairs and walking frames; and (3) assistance with moving to and from chairs, wheelchairs or toilets. For this question, the researcher has rated Mr. Vertigo with a B, meaning he needs some assistance in order to be mobile. This has been evaluated based on the findings that the patient needs a walking stick due to his osteoarthritis of the spine and upper limbs and his chronic back pain. The patient needs some assistance because of his unsteadiness as he walks. In addition, the patient has visual problems which further complicate his mobility. He needs someone to assist him walking to prevent tripping and falling and breaking of bones.             The third question is meals and drinks. Here, Mr. Vertigo has been rated by a B because he does not prepare his meal by himself. His meals are prepared by the couple, Keri and her husband, to ensure a healthy diet. However, his snacks are prepared by himself in his small kitchenette. He, therefore only needs little assistance – only in the preparation of his meals. In addition, he is also capable of eating and drinking by himself.             For the patient’s personal hygiene, he has been rated by a B which means that he needs some assistance in his activities for his personal hygiene. Because of his poor eyesight and his unsteadiness in walking, he will need assistance in showering because there is a relatively high likelihood that he might fall and break his bones because of the wet floor.             Similar to the patient’s hygiene, the researcher has assessed that the patient also needs some assistance in going and using the toilet, which is the next question. For the same reasons as cited above (poor eyesight and unsteadiness in walking), Mr. Vertigo is rated a B.             The next two questions are bladder and bowel management which refers to the continence of urine and feces and its maintenance, as well as its reduction. However, the researcher has assessed that Mr. Vertigo does not need any assistance in his bladder and bowel management, thus rating the patient A.             The eighth question has something to do with the patient’s understanding and undertaking his daily activities. This question refers to the capability of the patient in remembering, understanding, planning for, initiating and performing general activities and reacting accordingly to information provided. For this question, the researcher has recorded a B for the patient. As noted earlier, due to the medical complaints of the patient, the patient is less able to carry out his daily activities. He needs some assistance and supervision in order for the jobs to be done properly.             The next six questions all associate to the needs of the patient which have been caused by the patient’s behavior. The ratings for these questions are associated to the frequency of observations and interventions which has been designed to: (1) avoid recurrence of the behavior itself or the triggers for the certain behaviors; (2) minimize the frequency or duration of the behavior; or (3) minimize the impact of the behavior on the patient or others. Questions nine to fourteen are: (a) problem wandering or intrusive behavior – patient’s wandering, absconding or interfering with other people and their properties; (b) verbally disruptive or noisy behavior – includes abusive language and verbalized threats  directed at another person, may be family or friends or strangers; (c) physically aggressive behavior – covers any physical conduct which threatens and has the potential to harm another person, may be family or friends or strangers, including (but not limited to) hitting, pushing, kicking or biting; (d) emotional dependence – one-on-one interventions needed by the staff to respond to, manage and alleviate behaviors resulting from a patient with strong attachment or reliance on another person, may include active/passive resistance other than physical aggression, attention seeking, manipulative behavior and withdrawal; (e) danger to self and others – covers high-risk behavior  necessitating observation or intervention and strategies to prevent, minimize or manage the behavior such as unsafe smoking habits, walking without required aids, leaning out of windows, self-mutilation and suicidal tendencies; and (f) other behavior – behaviors not covered in questions nine to thirteen which necessitates the staff to spend time and effort and to support for daily activities.             For all of the behavioral questions, the patient has been rated an A except for emotional dependence. Even though, Keri notes that her father is very independent, on the contrary, this may represent that the patient is emotionally dependent. His stubbornness and unwillingness to admit that he needs outside help may be signs of emotional dependence; hence, for this question, the researcher has rated Mr. Vertigo with a C.             The next two questions relate to the patient’s social and human needs, the former referring to the patient himself, the latter to his families and friends. For these two questions the researcher has rated Mr. Vertigo with a B because the patient needs some support other than physical care and needs the support less frequently than weekly. Although, he meets with his friends weekly in the Returned Services League, they are his only social contact. He will need some degree of support from other people as well.             The next question has something to do with the patient’s medication. This question refers to the degree of assistance that Mr. Vertigo needs in administering his medications. As mentioned in the case study, Mr. Vertigo has difficulties in administering his insulin because of his visual problems. He needs someone to assist him. Thus, the researcher has rated a C for this question. In addition, the patient is also on Warfarin, Slow K, Digoxin and Lasix for his cardiac problems. He also needs someone to remind him and make him take these medications.             The eighteenth question is technical and complex nursing procedures that the patient needs. For this, the researcher has rated Mr. Vertigo with a B which means that Mr. Vertigo needs some assistance in technical and complex procedure. This has been evaluated on the basis of the fact that the district nurse comes every other day to dress his small leg ulcer, meaning he is not capable of doing it himself.             Last two questions refer to therapy and other services that the patient needs. For both questions, the researcher has rated Mr. Vertigo with an A.     Nursing Care Plan             The general problem for the patient is his increasing inability to undertake his ADL’s and administer his medications. With this problem, the nurse is to know the underlying causes of his less capability to undertake his ADL’s and administer his medications. Basing from the findings from the RCS which is summarized in the table below (Please refer to table 2), the researcher has decided that it is not yet necessary for the patient to be placed in residential care since he has scored only 25.77.     Questions Rating Weight Communications A 0.00 Mobility B 1.19 Meals and Drinks B 0.67 Personal Hygiene B 5.54 Toileting B 5.98 Bladder Management A 0.00 Bowel Management A 0.00 Understanding and Undertaking Daily Activities B 0.79 Problem Wandering or Intrusive Behavior A 0.00 Verbally Disruptive or Noisy A 0.00 Physically Aggressive A 0.00 Emotional Dependence C 0.28 Danger to Self and Others A 0.00 Other Behavior A 0.00 Social and Human Needs – Care Recipient B 0.95 Social and Human Needs – Families and Friends B 0.28 Medication C 8.55 Technical and Complex Nursing Procedures B 1.54 Therapy A 0.00 Other Services A 0.00 Total     ……………………………………………………………………….        25.77   Table 2. Mr. Vertigo’s RCS and their Corresponding Weight             The patient may stay at home and be given community care such as the Home and Community Care or (HACC) Program. It is a central element of the Australian Government’s aged care policy which provides community care services to frail aged and younger people with disabilities and their carers. The type of services funded through the HACC Program include (but not limited to) nursing care, allied health care, meals and other food services, domestic services, personal care, home modification and maintenance, transport, respite care, counseling, support, information and advocacy and assessment <www.health.gov.au>.            Conclusion             To sum up, this paper provides a nursing care for Mr. Joshua Vertigo which bases from the findings of the RCS. From the findings, the researcher has concluded that Mr. Vertigo stay at home and get community services – Home and Community Care – which is provided by the Australian government. Reference: Benjamin, E.J., Wolf, P.A., D’Agostino, R.B., Silbershatz, H., Kannel, W.B. & Levy, D. (1998). Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation, 98 (10), pp. 946-952. Greenlee, R.T. & Vidaillet, H. (2005). Recent progress in the epidemiology of atrial fibrillation. Curr Opin Cardiol, 20 (1), pp. 7-14. Bradford, C. (1999). Basic ophthalmology for medical students and primary care residents. 7th edition. San Francisco, California: American Academy of Ophthalmology. Horstman, J. (1999). The Arthritis Foundation’s Guide to Alternative Therapies. Atlanta, GA: Arthritis Foundation. Dale, J.J., Callam, M.J., Ruckley, C.V., Harper, D.R. & Berrey, P.N. (1983). Chronic ulcers of the leg: a study of prevalence in a Scottish community. Health Bull (Edinb), 41, pp. 310–314. Callam, M.J., Harper, D.R., Dale, J.J. and Ruckley, C.V. (1988). Chronic leg ulceration: socio-economic aspects. Scott Med J, 33, pp. 358–360. Roe, B. and Cullum, N. (1995). The management of leg ulcers: current nursing practice. In Cullum, N. and Roe, B. (Eds.). Leg Ulcers: nursing management. (pp. 113-124) Harrow: Scutari Press. Stepien, J.M, White, H., Wundke, R., Giles, L.C., Whitehead, C.H. and Crotty, M. (2006, March). The Resident Classification Scale: Is it a valid measure of functional dependence? Australasian Journal on Aging, 25(1), pp. 42-45. Documentation and Accountability Manual, Electronically retrieved from the official website of the Australian Government, Department of Health and Ageing, May 11, 2006, from <www.health.gov.au>. Credit:ivythesis.typepad.com

Nursing Care Plan

Introduction The patient is Keri’s father, Mr. Joshua Vertigo, who is 82 years old and is living at the back of Keri’s house ...