Few weeks ago, I looked after a very sick patient who was treated for a rare disease condition. Oh! Well, rare because I’ve never heard or come across the condition till that very day.
Bullours pemphigoid is a harsh skin condition whereby the sufferer gets blisters all over their body. As the blisters get bigger and bursts newer ones develops. I haven’t seen anything like that before. In the picture above, the skin looks dry but Vera’s were mostly weeping blisters and the almost constant cream application made her skin moist most of the time.
Causes
It is triggered by a disorder of the autoimmune system which attacks the inner layer of the skin
Signs and symptoms
Appearance of blisters
Burning skin
itchiness
Red skin around blisters
Nose bleeding.
The appearance of the skin can be quiet similar to the skin of a burns patient. Looking at Vera lying on her sick bed, I recalled a few years back when I had visited a schoolmate that had suffered severe burns which made her wound dressing takes more than half of the shift to complete.
Vera was nursed in a theatre gown as the usual cotton hospital gown would stick onto her skin.
Her care regime included cream application every two hours. You heard me right every two hours and Dermovate for areas without burst blisters.
Dermovate: this is a steroid cream tha that is used in severe skin conditions medication used to treat skin conditions that have not responded well to other corticosteroids, including severe psoriasis and eczematous dermatitis.
Vera was very unwell as she had sepsis; which was the main reason for admission to our unit.
There are different kinds of pemphigoid. Have you looked after someone with this condition? I will like to know your experience.
P.S.
Confidentiality was maintained through this post.
For my new readers, I’m a nurse by profession and do blog about health and health conditions too. Other health related post can be found in the health category.
Hello Friends, I’m posting a health related post today. Hope you had a great weekend?
I will be taking about HIV and our perception of sufferers.
I cared for a man who was in his late fifties last week. He was diagnosed with HIV about eight years ago but over time deteriorated as he wasn’t taking his medications judiciously as required of him.
“Vivien you always treat me very differently” he said to me. “People are always in a hurry to leave my room but you take your time”
I told him I was only doing what was required of me. This gentleman was so frail and needed lots of persuasion. In my opinion, it was quite draining especially emotionally, as he at times declined most nursing acts and I could see he was weak. He would tell me he wanted to be left alone.
Genuinely, I think anybody ill will want to get better and would comply with medical advice but when I come across patients like this I tend to believe that they are fighting a battle with their condition and even the tiniest acts can upset them. My first day with him was challenging but days went by and I had him again.
He was happy to see me this time, like old friends, we stayed friends all through that day. I felt fulfilled and better compared to the first day.
As a health personnel, we all become very protective and extremely cautious when we know patients have certain conditions. Please don’t blame us because no one would want to jeopardise their health in the course of saving the lives of others.
Nevertheless, I will urge my fellow nurses, doctors and other health staff to show love and affection to HIV/AIDS patients. With standard precaution measures; which ought to be part of our everyday practice, one should be able to practise safely.
The condition alone is a cross for them, let’s not make it any worse. They know what they have, they wake up every day and the condition is still same, any act to take their mind of it is much needed.
I don’t want to stress much in this post about the stigmatisation associated with HIV, it still exists regardless of the numerous awareness programmes. Unfortunately.
I have previously discussed HIV/AIDS in details. The post outlined what HIV/AIDS is, it’s symptoms, prevention and stigmatisation. It can be found here.
I will like you to read that too.
I have a soft spot for this condition, I’m happy to discuss and answer questions. Do leave a comment or contact me if you are affected by this post.
Other health posts can be found in the health category.
P.S: Confidentiality was strictly maintained throughout this post.
My message for you today is DO NOT allow yourself to be angered unnecessarily. Anger is a strong feeling of displeasure, annoyance or hostility. Friends, please do control your temperament. I know most of us might think it’s that easy, I must tell you it’s easier said than done but it is definitely achievable.
Do not be angered and feel you must react straight away, instead take a deep breath and look at the situation differently. There are lots of myths about anger and how you must vent, which is not true. There are ways of managing anger.
We are humans and definitely, someone would hurt or provoke us but that shouldn’t be the reason to act irresponsibly. Do not forget that anger and stress trigger certain health conditions.
There are lots of terrible stories that surround us, whether it’s our neighbours, relations or colleagues who have taken a drastic action as a result of being provoked, which they later regretted.
I had an ugly encounter the other day. It happened that a young man had an argument with his girlfriend, he hit her and she fainted. He panicked and hung himself. Minutes later the girlfriend woke up, saw him hanging helplessly and rang the ambulance.
There is so much to that story. I feel so sad and hurt that this actually happened. So many questions ran through my mind:
Why hit someone over something you can talk about?
Hitting your loved one to the point of leaving them unconscious? Seriously?
Why commit suicide when you think you’ve accidentally killed a person?
Was he that caring or an emotional person to actually want to take his own life realizing the consequences of his action?
Anger Management
Source: Positivemed.com
Similarly, there are biblical verses that preach about anger control. I found a link that comprises of biblical passages on how why we all can overcome anger.
One of them says: Refrain from anger and turn from wrath;
do not fret—it leads only to evil – Psalm 37. 9. Others can be seen here.
Unfortunately, sad events occur due to anger but we all should be abreast with effective ways of controlling our temper.
Do leave a comment below if you like this post or the story affects you.
If you have asthma do endeavour to carry your inhaler regardless of the last time you had an attack. Some people say that the attack feels like one being strangulated or suffocated.
What is Asthma
National Institutes of Health (2014) defined asthma as a chronic lung disease which causes the inflammation and narrowing of the airways and presents with recurrent episodes of wheezing sound, chest tightness and coughing (mainly at night and early in the morning).
A popular definition by Global Initiative for Asthma (GINA, 2016) states that “Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation”.
There are different definitions of asthma which incorporate other subtle signs and symptoms, therefore it is important that nurses and other health professionals are proficient in their knowledge of asthma and its management.
Pathophysiology
Asthma is marked by characteristic episodes of symptoms and variable obstruction of the airway which can occur spontaneously or triggered by environmental factors. Exposure to allergens or viruses causes increased inflammation and exacerbation of symptoms such as cough, wheezing, chest tightness and dyspnoea (difficulty in breathing).
The main characteristic of asthma is inflammation of the bronchi and bronchioles which is marked by the release of various cells and chemical mediators which consequently leads to bronchoconstriction, airway oedema, airway hyperresponsiveness and airway remodelling. Airway remodelling leads to hyperplasia of submucosal and goblet cells and cause hypersecretion of mucus. Mucus plugging of the alveoli is a key cause of asthma death.
Majority of deaths from acute asthma takes place outside the hospital. Asthma patients whose symptoms did not improve either at the emergency department or in the ward should be admitted to intensive care unit.
Therefore, it is paramount that the asthmatics are equipped with the necessary knowledge and support to enable them to manage themselves.
Some patients are known to have triggers such as viral infections and cold air.
Diagnosis
A well detailed history taking and good knowledge of differential diagnosis will ensure that asthma is diagnosed appropriately.
In the view of BTS/SIGN (2016), asthma diagnosis is based on the identification of the characteristic pattern of signs and symptoms and the lack of a different explanation for them.
Once asthma is diagnosed, the physician assesses the patient for the level of severity. The presence of intense symptoms indicates an asthma attack.
Management
The significance of treating asthma symptoms once they are detected cannot be overemphasized as it prevents the symptoms from worsening.
Pharmacological management of Asthma:
Inflammation of the airways is central to the pathogenesis of asthma, hence systemic corticosteroid forms part of the first-line treatments for acute asthma.
Intravenous hydrocortisone 200mcg and Prednisone 4g should be given in accordance with BTS/SIGN (2016) guidelines. Other sources advocates the usage of oral and intravenous steroids in the management of severe asthma.
Ipratropium nebulizer 500mcg to be given every 20 minutes for 1 hr and later reduced to Qds. It is a bronchodilator that eases breathing by relaxing the air passages.
Salbutamol nebulizer 5mg Qds. β2-adrenergic agonists are the first-line treatment for smooth-muscle mediated bronchoconstriction and are most reliable for dilating the bronchioles (GINA, 2016).
Iv Magnesium sulphate 2g in cases of hypomagnesia. Studies showed that the administration of 2g of Magnesium sulphate increases the dilation of the bronchioles in patients with severe asthma regardless of normal magnesium levels.
Health education is vital in the management of Asthma as it ensure asthmatics are able to self-manage, monitor symptoms, adhere to written asthma care plan and attend review appointments as recommended by GINA (2016) to avoid hospital admissions.
The BTS/SIGN (2016) reported evidence in which self-management was considered to reduce emergency use of healthcare resources and improve markers of asthma control.
Ideally, there is an asthma care plan for all sufferers which should adhered to. Asthma UK (2016) stressed on the importance of patients adhering to their written asthma care and added that asthma patients are four times less likely to present in the hospital if they utilize their asthma care plan.
Conclusion
It is paramount that asthma patients are supported by healthcare professionals to make sure they confidently self-managed, experience lesser symptom and thus, require less hospital visits.
P.S.
I am a registered volunteer of Asthma UK. Detailed information about asthma, its management and events are on the website.
This post is adapted from an Asthma case study, to access the full study do not hesitate to contact me.
For a very long time, I’ve heard so much about Jehovah withnesses inability to receive blood transfusion based on their religious belief. Other sources have it that they are best known for it.
Recently, I had a genuine encounter. It happened that I was looking after a man in his late sixties who was severely ill and had underwent a bloody surgery. As a result, so much blood was lost.
On going through his theatre paperwork, he had agreed that there will be no blood transfusion of any sort even if it results to death. Mere reading those lines gave me chills. That kind of faith is powerful.
Families were present and made sure the request of their loved one was acted upon regardless of the circumstances. Interesting, one of the children was of different religion but still supported the rest of the family.
It was then I got to know that as a Jehovah withness, you ought to have a passport that clearly states your inability to receive blood transfusion and present it Doctors.
My patient had lost his passport recently and it was a bit of an issue because the consultant I had worked with demanded to see it. As far as he was concerned, the verbal communication and nursing documentations showing the obvious was not just enough to act upon.
“Where’s the passport” He asked.
The situation became more challenging as his haemoglobin (Hb) level dropped further to the lowest level I have ever come across.
As the situation worsened, tension built up. However, almost the time when the Drs had decided to try iron alternatives, one of the relatives coincidentally asked why other alternatives can not be tried. After a multidisciplinary meeting, it was agreed that iron dextran and other supplements will be used instead.
Next time I checked on him, Hb level had slightly gone up; just a little bit.
This makes me wonder how religion significantly affects our health. The look on the relatives faces each time they ask for HB value will always remain with me. It was a difficult situation and extremely challenging as they fought that battle of faith at that very critical time.
Hello Friends, I hope you are doing well? Let talk about health. I will be sharing with you today my encounter with SN-OD’s. Do you wonder what that is? No worries, I thought same the very first time I heard it. It is simply specialist nurses-organ donation. Their role is to support potential families of a patient donating organ(s) throughout the entire processes of organ donation.
So, I had to look after Patient X who was critically ill and was attached to invasive ventilator. She was confirmed dead awaiting organ donation but requires full care right from the beginning of my shift. Observations were done hourly as usual and nasogastric feed was ran through.
Normally, once such patients are identified, referral to the SNOD is done. Death is confirmed based on neurological criteria, brain stem testing and confirmation of cardiac death.
The specialist nurse nicely partitioned Miss X’s hairs, knotted it with ribbon and gently cut it off . She got her hand-prints too as keepsake for families. It was so lovely to watch and I can imagine the look on the faces of her relatives when they receive their precious keepsakes. It was a beautiful experience.
In line with the plan for the day, this specialist team was with me off and on. They took more than 20 samples of blood. They would come and brief me about the status of X’s various organs and if they have found a compatible recipient which I found very interesting. At a point, kidneys and liver has gotten the all clear pending the heart.
Source: Financialtribune.com
They liaised with the team from the other hospital where there is someone awaiting an organ transplant. Apparently, that patient was in theatre while X was prepared and taken to the theatre for Harvest.
At the theatre, I handed over and watched carefully and observed the initial processes of organ retrieval from X. I didn’t stay till the last minute though as I have to go back to my ward. Duty calls.
Finally, Organ donation is the highest gift man can give to another. Miss X was able to give life to others which made me more aware of how amazing people can truly be to others even to the point of death.
I would recommend that many of us register as donor to enable us give this incredible gift of life to other people; who are very desperate to live while we no longer need them.
More detailed information about organ donation can be found here. For similar health related posts, please click here.
Do you have concerns? I will like to know your views.
Disclaimer: This cannot be substituted for a medical advice.
There are lots of cradle cap remedies online but I will tell you what worked for me. By the way, what does cradle cap look like?
Photo credit: Wikipedia
It is oily yellowish patches that appears on the scalp of babies. It is mostly common within 3 months of life and can last up to 1 year. It is not contagious and does not harm the baby.
In my experience, my little one had it and I was really worried but the GP said not to worry that it goes away before most babies one year birthday. However, that was not enough for me. I simply wanted it to go away as soon as possible.
I read a lot online, watched YouTube videos and was not happy with my findings. None seemed to be say what I wanted to hear.
Many sources recommended the usage of olive oil and combing it out after 15 mins. Meanwhile, that was my baby’s hair oil. Strangely, the front part of the scalp where I cover with lots of oil was coated with cradle cap.
I was convinced that ‘Olive oil’ was the culprit and cannot be my solution. This was further confirmed by an article I read too. The link to the article is available at the end of this post.
I searched for shampoos but was worried trying those chemicals on my little ones scalp. Then, a friend told me she had same issue but theirs was very little and gradually disappeared. She said her GP prescribed Capasal therapeutic shampoo for her baby but she never used it.
It was as if that was all I needed – something prescribed by a professional! I used it on my little one and it worked like magic. The first time, I was really careful both on application and on combing of the hair. It worked and I was happy. The second day, I was more confident in using it and most of it came off. On the third day, my baby’s scalp was neat, no traces of cradle cap.
I could not believe the past few weeks and all the time I had spent online reading lots of stuffs that amounted to nothing.
I hope this post gets to someone who needs remedy that I needed or to someone that knows someone. However, every baby is different. What worked for mine might not be suitable for yours.
Below are sites for further reading on the topic. I found them very informative.
Acute respiratory distress syndrome commonly known as ARDS is a life-threatening medical condition whereby the lungs cannot provide sufficient oxygen for the body. Causes This condition develops when the lungs has become infected or sustained an injury leading to inflammation. The inflammation causes fluid from nearby blood vessels to leak into the tiny air sacs in the lungs, making breathing increasingly difficult.
Inflammation can be caused by:
Sepsis
Pneumonia
Severe chest injury
Accidental inhalation of vomit, smoke or toxic chemicals
Acute pancreatitis
Blood transfusion reaction
Clinical Features Theses can occur within 24 to 48hrs of illness and can include:
Severe shortness of breath
Rapid, shallow breathing
Low blood pressure
Tiredness, drowsiness or confusion
Feeling faint
Organ failure
Normally, these patients are so sick that they cannot complain of symptoms.
Diagnosis
A full assessment is carried out and include the following:
Physical examination
Blood test to ascertain oxygen saturation and check for signs of infection
Arterial blood gases(ABG) for continous monitoring of respiratory state, blood volume and electrolytes.
Blood and urine culture
Pulse oximetry test for continuous monitoring of oxygen saturation
Chest X-ray and a computerised tomography (CT) scan – to look for evidence of ARDS
Echocardiogram to picture the heart ; to rule out heart failure.
Sputum culture and analysis
Broncoscopy can be carried out in certain cases.
Treatment -Admission into intensive care unit for breathing support via Ventilator. -Antibiotic administration to fight infection.
*Prone position have been found to be appropriate in the management of ARDS.
My Encounter with ARDS patient I had to look after after a Mr. X diagnosed with ARDS and Intracranial hyperosmolar. It turned out to be a very busy and interesting shift.
Cardiovascular: Blood pressure was initially high but was supported with Noradrenaline infusion and it was managed. –
Respiratory: Was intubated and ventilated. Settings include: pressure control mode of 24, peep 14, FiO2 70%, respiratory rate 15, peak 38. The above high settings were changed slightly throughout the day. ABG revealed; high PCO2, low O2, high hydrogenbicarbonate, high base excess, high sodium, low potassium and high glucose. All electrolytes were replaced and a slidiing scale was in place to control his blood glucose level.
Neurologically, he was sedated and paralysed using Propofol and Actracurium infusions. Fentanyl was given for pain. Pupils were 2 and nonreactive. Richmond sedation agitation score was -5(deeply sedated and unarousable)
Nutrition: on nasogastric feed- Nutrison and ng water at 40ml and 30ml respectively
Elimination: Good bowel movement and urine output. However, furosemide was given to push more fluid out of the lungs.
I hope you are getting the gist? I am not going to bore you with my nursing care bits. So, let me wrap it up by telling you the issues and plan for that day. Problems:
ARD
Septic shock
Neutral fluid balance(off target)
Electrolyte abnormalities
Permissive hypercapnia
Plan:
PC Ventilator settings – sedated and paralysis
Manual recruitment post sunctioning
No nebs – Suction 6hrly
Ng water @ 30ml/hr
Furosemide infusion Urine output greater than 100ml/hr
Continue antibiotics Meropenem and Teicoplanin
Discuss with microbiology daily.
Lastly, ARDS is a killer illness. I was practically on my feet throughout the shift as Mr. X was unstable and I had lots of infusions that were running out at different times amongst other tasks. Suctioning was quite scary that day as Mr. X could desaturate within secs. Oh! I ended up staying 45mins extra to do my documentations.
References NHS Choices (2015)
P.S. Thanks for reading. Sorry for the medical jargons- I tried to minimse them. When your loved ones or friends are sick or look unwell, please encourage them to go the hospital to get a medical assistance.Ours lives are so precious.
Disclaimer: This cannot substitute for a professional medical advice and treatment.
I have come across lots of articles and case studies on liver diseases and the rapid health decline of most sufferers. So, I will like to share some of my knowledge of the liver and liver diseases. I will tell it like a story and cite where necessary.
Before I start, what melted my heart the other day was when I met a very young girl who has undergone two liver transplants. In this girl’s case, her former transplant failed because her body system rejected the organ. The later transplant is pretty new and she complained of so much pain and discomfort. As I write this, my heart reaches to her, I wish her a speedy recovery and hope this is her last organ transplant.
The liveris the second largest organ in the body and the biggest reservoir for blood. It serves as the body factory and plays lots of significant roles that are vital to life. The liver islocated in the upper right side of the abdomen, beneath the diaphragm and on the top of the right kidney.
The mainfunctions of the liver include;
Filtration and cleansing of the blood
Fights against infections and diseases
Production of proteins that makes blood clot( i.e when you bleed)
Aids in digestion
Destroys and deals with poisons and drugs
Excretion of wastes.
There are lots of other roles the liver play in the body. It is a very powerful organ than we think.
Onset of liver disease:- Acute- Whereby it happens over a short period of time
-Chronic- Here, the disease manifests after couple of years e.g 5-8 years
Main causes: -Heavy alcohol consumption or alcohol misuse (the commonest)
-Undiagnosed hepatitis
-Obesity
Typesof Liver diseases
-Alcohol related liver diseases- Liver damage occurs due to years of heavy alcohol consumption.
-Non-alcoholic fatty liver diseases-
-Hepatitis- Inflammation of the liver
-Haemochromatosis i.e an inherited disorder whereby there is iron overload in the body
-Primary biliary cirrhosis
All these types of liver diseases can cause scarring of the liver, which is called Cirrhosis (www.nhs.uk)
Pathophysiology
Photo credit: Youtube images
The liver responds to injury by becoming inflamed. Any form of inflammation of the liver is known as hepatitis. This can happen suddenly (acute) or over a long period of time (chronic). Repeated injuries cause the liver cell not to regenerate any more,fibrosis gradually forms.
When the fibrosis spreads out due to persistent harm not been addressed, the liver shape and function is disrupted.and is known ascompensated cirrhosis. As damage progresses, the liver is unable to function effectively (decompensated) and begins to fail. This stage is termedend stage liver diseasethis allows toxic chemicals and wastes to build up in the body causing jaundice, ascites and hepatic encephalopathy (i.e. a brain disorder due to toxins in the brain). Further deterioration may lead to multiple organ failure anddeath.
Signs and Symptoms: It is important to know that liver diseases can go on for a long time before the clinical manifestations sets in. They include:
Loss of appetite
Weight loss or sudden weight gain
Jaundice i.e yellowing of the skin
Itchy skin and bruises
Fluid retention (oedema)
Brownish or orange tint in the urine
Light coloured stools
Confusion, disorientation, personality changes
Treatment and Management This can achieved mainly the use of drugs or surgery –Diet control; Avoiding too much or little protein. –Drugs:-Lactulose;This works by changing the stool acidity which prevents bacterial growth and reduces ammonia production. -Neomycin; An antibiotic which kills intestinal bacteria and minimises ammonia production. -Rifaxiimin; An antibiotic used in reducing the recurrence of hepatic encephalopathy. –Surgery: –Paracentesis: This is the removal of fluid that has accumulated in the liver due to ascites –Liver transplant: This occurs in cases where liver transplant is inevitable.
Prevention
The commonest type of liver diseases is the Alcohol liver disease, which means we can make liver diseases unpopular.
Avoidance or minimal alcohol intake (you need to know your limit: Ask)
Diet: reduced protein intake is advised to minimise ammonia(waste) production
Exercise- This is good for you to stay fit. Being overweight or obese can affect the progress or treatment your liver condition. Thus, avoid sendatary lifestyles.
Get vaccinated against hepatitis B.
Health education about liver and causes of liver disease: Equip yourself by reading or watching videos or discussing with health professional about the liver.
Having been already informed about his condition, I knew I was going to be very careful and most times repeat myself to him.
On reaching there, he was dressed in an outing attire and was so full of life. Few minutes later, whistling by a bird at the corner drew our attention. One of my colleagues who seem to know more about birds went closer and I followed her just for curiosity sake. She was asking him for the species, who gave it to him, how long he has had it and what he had named the little creature.
We all got chatty. .He said, it was a Christmas present from his son and he can’t think of a name yet and simply calls it baby. Mmm… How am I supposed to know a mere bird can be called baby as well. We all laughed. I admired his sense of humour.
It struck me that it was a present. I thought to myself, won’t he be doing some more cleaning because of this bird, so much noise and distractions but then I viewed it in a more positive and healthy perspective and concluded that his brilliant son has bought that to make him more attentive, keep him busy and also keep him company or for some other reasons.
He was pleased to have us around. He talked about his housing issues and how he called an ambulance three days ago when he felt so unwell. He looked much stronger and said he felt much better. If my guess was right, he enjoyed our company and wanted us to come more often. I can tell because loneliness is friend of no man.
When we were about leaving, we mentioned our names to him once more and made sure he locked the door before we headed for the stairs.
The next day, I ran into him in an event and he recognised me, I was impressed though he didn’t remember my name, which I reminded him of.
At this juncture, I want to get us acquainted with the condition.
Photo credit: Daily mail.
Dementia is a syndrome associated with an ongoing decline of the brain and its abilities. This includes problems with:memory loss,thinking speed,mental agility, language,understanding and judgement.
It usually affect people above the age of 65, though on fewer occasions could have an early onset.
Symptoms include:
Increasing difficulties with tasks and activities that require concentration and planning
Depression
Changes in personality and mood
Periods of mental confusion
Difficulty finding the right words
Hallucinations i.e they may see or hear things that other people do not or they may make false claims or statements.
A catastrophic reaction i.e when put in circumstances beyond their abilities, there may be a sudden change to tears or anger .A common symptom of dementia is for dementia sufferers to deny that relatives, even relatives in their immediate family, are their own relatives.
Disorientation- this occurs in the later stages of the condition, whereby subjects may be disoriented in time (not knowing the day, week, or even year), in place (not knowing where they are), and in person (not knowing who they and/or others around them are).
On the contrary, with appropriate management and care, they lead an active and fulfilled live.
Photo credit: NL Group
Conclusion Aging do come with certain conditions and dementia seems to be very popular among them. Do try and treat the elderly with much care and concern, you never can tell what condition(s) they are battling with.
