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Also the experimentalsubjects werehighly statistically significant increase in satisfaction level than the controls (p=<0 discount precose 50 mg overnight delivery managing diabetes through good nutrition. Conclusion: changing patients position and using supportive devices after diagnostic cardiac catheterization are associated with decrease back pain intensity and increasing the satisfaction level without increasing vascular complications discount 25 mg precose mastercard diabetes mellitus in dogs prevention. Keywords:Position buy generic precose 25mg line diabetes type 1 update, Back pain order precose 50mg line diabetes 88, Coronary arterydisease, Cardiac catheterization,Satisfaction level,Vascular complications (bleeding &hematoma). It is considered one [2,3] of the master reasons of disease burden in developing and developed countries. Several methods are utilized for diagnosis and treatment of heart diseases, such as:chest X-ray, exercise [5] stress test, echocardiograph,cardiac catheterization, andelectrocardiogram. Although many noninvasive diagnostic techniques have been commonly used, cardiac catheterization still remains the most definitive procedure and currently is the golden standard for the examination of various types of coronary and structural [5,6] heart diseases. A heart catheterization is excessively used for diagnostic evaluations in patients with cardiovascular diseases. Generally,In 1929, "Werner Forssmann" was the first to propela catheter into the heart. These days, [7] cardiac catheterization is performed routinely in clinical regions all around the globe. Per year, around 3 millioncardiac catheterizations are performed in the United States. To dodiagnostic cardiac catheterization, the entrance to heart is set up through a catheter, which in over 90% of casesexecuted through the percutaneous [8,9] femoral artery. It includes theinsertion of a catheter into a cardiovascular vessel"coronary catheterization" or chamber by method for a reasonable vascular access, usually a femoral artery. There are twomajor categories of cardiac catheterization, right heart catheterization and left heart catheterization. At the point, when the catheter is embedded throughthe femoral vein and then advanced to the right ventricle and the pulmonary artery, the technique is called right heart catheterization. This is used to assess tricuspid and pulmonary valve function, in addition to, measure the pressure levels in the right ventricle and the pulmonary artery. If the catheter is advanced through the femoral artery and into the left ventricle to testthe blood flow in the coronary arteries, as well as the level of function of the aorta, mitral valves and left ventricle. In spite of the fact that,transfemoral cardiac catheterizations are accomplished by skin perforation [14] under local anesthesia. In addition,perforation of cardiac chamber, air embolism, cerebrovascular accident, allergic reactions to the contrast andacute renal failure might be encountered. Vascular complications are considered the most common adverse events after diagnostic cardiac catheterization. After cardiac catheterization, to limit potential vascular complications,the nurse must apply direct pressure either manual or mechanical to the femoral artery for 10-20 minutes, until hemostasis is achieved. Additionally, the patients are instructedto strict immobilization and complete bed rest in the supine position for at least six hours immediately after the test, the head of the bed no higher than 30 degrees during period of bed [16,17] rest,as well asthe affected limbshould be keptstraightand immobilized. Such a position, while lessening the vascular complications of the procedure, often leads to patient discomfort, dissatisfaction, and increase the risk of developing back pain. Increased costs, health system resources used, length of hospital stay and also an [8,18,19] increase in nursing task load are all expected. Haghshenaset al (2013) and Heravi et al (2015) illustrated that,back pain is commonly reported after transfemoral cardiac catheterization due to aprolonged period of bed rest in the supine position. Accordingly, the [18,19] patients wish to change their position inorder to lessenthe backache and discomfort. Pain leads to various unsafe impacts through activating the biological stress response. These events may increase blood pressure,heart rate, myocardial workload, oxygen utilization, and finally myocardial infarction. Therefore, the nurses require a safe protocol based on research and evidence base to promote patients satisfaction and comfortafter cardiac catheterization without increasing the [19,20] risk of vascular complications, and also decrease costs and period of hospitalization. Aim of the study: this study aimed to investigate the effect of changing position on patient outcomesof back pain, vascular complications "bleeding and hematoma" and patient satisfaction after transfemoral diagnostic cardiac catheterization. Research hypothesis: Hypothesis1: Patients who receive changing position after transfemoral diagnostic cardiac catheterization exhibit less back pain intensity than those who don?t receive it. Hypothesis2: Both studied groups who receive and not receive changing position after transfemoral diagnostic cardiac catheterization had a similar and no effect on the incidence of vascular complications. Hypothesis 3:Patients who receive changing position after transfemoral diagnostic cardiac catheterization exhibit more satisfaction level than those who don?t receive it. Material And Methods Material Research design: A quasi experimental research design was used for the aim of the study. Setting:The study was conducted at the Cardiac Catheterization Unit in theCardiology Department of Alexandria Main (Smouha) University Hospital, Alexandria, Egypt. Subjects:A convenience sample of 40 adult male and female patients who were admitted the previous mentioned setting for performing diagnostic cardiac catheterization through the femoral artery, were divided randomly by using (computer generated rondmization) into two equal groups (control and experimental), twenty patients each. All studied patients were selected according to the following criteria: 1 Adult male and female patients undergoing transfemoral diagnostic cardiac catheterization. Toolsfordata collection:In order to fulfill the objective of the study, two tools were used for data collection. Tool I:Biosociodemographic data structured questionnaire: this was questionnaire developed by the researchers based on review of the literature to obtain information about biosociodemographic data of the [7,8,20,21] studied patients. It consisted of two parts as the following: Part I :Sociodemographic dataas gender, age,marital status, area of residence,educational level, occupation, and economic status.

Keep oxygenation levels high (100%) administer oxygen by non rebreather mask d buy precose 50mg mastercard blood sugar dogs. Unique Anatomy buy 25mg precose diabetic ketoacidosis icd 9, Physiology discount precose 50 mg diabetes signs in young adults, and Pathophysiology Considerations of Injured Pediatric Patients 1 buy generic precose 50 mg on-line diabetes mellitus nursing diagnosis. Heavy head with weak neck muscles in children increases risk of cervical spine injury 2. Unique Assessment Considerations for a Pediatric Patient Who Has Sustained Trauma 1. Pad beneath child from shoulders to hips during cervical immobilization to prevent flexion of the neck 6. Unique Anatomy, Physiology, and Pathophysiology Considerations of Injured Geriatric Patients 1. Changes in pulmonary, cardiovascular, neurologic, and musculoskeletal systems make older patients susceptible to trauma 2. Circulation changes lead to inability to maintain normal vital signs during hemorrhage, blood pressure drops sooner 3. Brain shrinks leading to higher risk of cerebral bleeding following head trauma 5. Skeletal changes cause curvature of the upper spine that may require padding during spinal immobilization 6. Loss of strength, sensory impairment, and medical illness increase risk of falls C. Mechanism of injury cognitively impaired patients are more susceptible to trauma B. Unique Anatomy, Physiology, and Pathophysiology Considerations for Injured Cognitively Impaired Patients 1. Unique Assessment Consideration for Cognitive Impaired Patients Involved in Trauma 1. Unique Management Consideration for Cognitively Impaired Patients Involved in Trauma 1. Little difference in patient lungs regardless of what type of water submersion occurred 2. Oxygen saturation may be difficult to obtain if patient is cold Page 164 of 212 b. Use spinal precautions when opening airway to assess if risk of spinal trauma is possible c. If cardiac arrest is present, refer to current American Heart Association guidelines b. Little or no perspiration in exertional heat stroke the skin may be sweaty and hot b. Compressed air in blood at depth expands upon ascent, turning into bubbles in blood which obstruct blood flow C. Occur after the patient raises to the surface too fast following dive at depths 2. Looking at a trauma scene and attempting to predict what injuries might have resulted based on an evaluation of the motion involved 2. Kinetic energy function of weight of an item and its speed speed is the most import variable 3. Unbelted drivers and front seat passengers suffer multi-system trauma due to multiple collisions of the body and organs c. Typically a patient considered to have multi-system trauma has more than one major system or organ involved a. This may include specialists such as neurosurgeons, thoracic surgeons, and orthopedic surgeons 4. Support ventilation and oxygenation oxygen saturation greater than 95 percent 7. Adequate ventilation must occur patients with low minute volume need assisted ventilation c. Consider use of tourniquets if severe extremity bleeding cannot be controlled with direct pressure 3. The definitive care for multi-system trauma may be surgery which cannot be done in the field b. Use of advanced life support intercept and air medical resources in a multi-trauma patient should be highly considered. Transport to the appropriate facility is critical know your local trauma system capabilities 5. Backboards serve as entire body splints when patients are appropriately secure in unstable patients 6. Do not develop tunnel vision by focusing on patients who complain of pain and are screaming for your help while other quiet patients who may be hypoxic or bleeding internally can not call out for help because of decreases in level of consciousness b. Blast waves cause disruption of major blood vessels, rupture of major organs, and lethal cardiac disturbances when the victim is close to the blast b. Hypertensive Disorders: Pathophysiology, Assessment, Complications, and Management 1. High-Risk Pregnancy: Pathophysiology, Assessment, Complications, and Management A. Complications of Labor: Pathophysiology, Assessment, Complications, and Management A. Complications of Delivery: Pathophysiology, Assessment, Complications, and Management A.

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Then wrap the person in dry blankets and plastic sheeting cheap precose 25mg diabetes mellitus type 2 histology, if available discount precose 50 mg mastercard diabetes prevention worker job description, to generic 50 mg precose fast delivery diabetes diet nutrition guide hold in body heat purchase 25mg precose with mastercard diabetes insipidus glycosuria. If you are far from medical care, position the person near a heat source or apply heating pads or hot water bottles filled with warm water to the body. If you have positioned the person near a heat source, carefully monitor the heat source to avoid burning the person. If the person is alert and able to swallow, you can give the person small sips of a warm, non-caffeinated liquid such as broth or warm water. Myth: Giving a person with hypothermia an alcoholic drink can help the person to warm up. Although alcohol may temporarily make the person feel warmer, it actually increases loss of body heat. You should also avoid giving a person who has hypothermia beverages containing caffeine, because caffeine promotes fluid loss and can lead to dehydration. Frostbite Frostbite is an injury caused by freezing of the skin and underlying tissues as a result of prolonged exposure to freezing or subfreezing temperatures. Signs and Symptoms of Frostbite the frostbitten area is numb, and the skin is cold to the touch and appears waxy. First Aid Care for Frostbite If the frostbite is severe or the person is also showing signs and symptoms of hypothermia, call 9-1-1 or the designated emergency number. Never rub the frostbitten area, because this can cause additional damage to the tissue. Remove wet clothing and jewelry (if possible) from the affected area and care for hypothermia, if necessary. Do not attempt to rewarm the frostbitten area if there is a chance that the body part could refreeze before the person receives medical attention. Once the rewarming process is started, the tissue cannot be allowed to refreeze because refreezing can lead to tissue necrosis (death). Skin-to-skin contact (for example, cupping the affected area in your hands) may be sufficient to rewarm the frostbitten body part if the frostbite is mild. Alternatively, you can rewarm the affected body part by soaking it in warm water until normal color and warmth returns (about 20 to 30 minutes). If the fingers or toes were affected, place cotton or gauze between them before bandaging the area (Figure 7-1). To care for frostbite, rewarm the body part by immersing it in warm water (A) and then loosely bandage it (B). Poisoning A poison is any substance that causes injury, illness or death if it enters the body. Poisons can be ingested (swallowed), inhaled, absorbed through the skin or eyes, or injected. Practically anything can be a poison if it is not meant to be taken into the body. Even some substances that are meant to be taken into the body, such as medications, can be poisonous if they are taken by the wrong person, or if the person takes too much. Children younger than 5 years, especially toddlers, are at the highest risk for poisoning. Children may be attracted to pretty liquids in bottles, sweet-smelling powders, berries on plants that look like they are edible, or medications or vitamins that look like candy. Additionally, very young children explore their world by touching and tasting things around them, so even substances that do not look or smell attractive are poisoning hazards among this age group. Older adults who have medical conditions that cause confusion (such as dementia) or who have impaired vision are also at high risk for unintentional poisoning. Box 7-2 lists common household poisons, and Box 7-3 describes strategies for reducing the risk for unintentional poisoning at home. Common causes of death as a result of poisoning include drug overdose (of over-the counter, prescription and illicit or street drugs), alcohol poisoning and carbon monoxide poisoning (Box 7-4). The person may experience: Gastrointestinal signs and symptoms, such as abdominal pain, nausea, vomiting or diarrhea. If you think that a person has been poisoned, try to find out: the type of poison. First Aid Care for Poisoning If the person is showing signs and symptoms of a life-threatening condition (for example, loss of consciousness, difficulty breathing) or if multiple people are affected, call 9-1-1 or the designated emergency number. If the person is responsive and alert, call the national Poison Help hotline at 1-800-222-1222. When you dial this number, your call is routed to the regional poison control center that serves your area, based on the area code and exchange of the phone number you are calling from (Box 7-5). General first aid care steps for poisoning include the following: Remove the source of the poison if you can do If you do not know what the poison was so without endangering yourself. Myth: If a person has been poisoned, you should make the person vomit to get rid of the poison. Inducing vomiting in a person who has been poisoned often causes additional harm and is not recommended. Sometimes the person may vomit on his or her own, but you should never give the person anything to make him or her vomit unless you are specifically instructed to do so by the poison center staff member. When a person is bitten or stung, proper first aid care can help to limit complications and speed healing, and may even be lifesaving. Signs and Symptoms of Animal Bites Animal bites may result in bruising, breaks in the skin or both.

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Scrubs in on all procedures under the supervision of a competent staff member using appropriate sterile technique buy precose 25mg mastercard vision loss in diabetes in dogs. Caring for a patient after all procedures purchase 50mg precose visa diabetes insipidus differential diagnosis, observing for complications buy cheap precose 50 mg blood glucose kit, assisting in access site compression trusted 25mg precose diabetes signs feet, and giving a proper handover to the transferring ward. After completion of these tasks the advanced beginner shows confidence and comprehension. For the competent trainee, a plan establishes a perspective, based on considerable conscious, abstract and analytic contemplation of the problem. The competent trainee has been encountering similar situations in the cath lab and have the ability to master and manage but still lack the speed and efficiency (6,12). They develop their skills and awareness of complications that may occur and have the knowledge to assist and intervene when necessary. They develop their skills and awareness of complications that may occur and have the knowledge to assist and intervene when necessary. They are proficient in knowledge of guidelines and make sure they are followed during practice by all staff members. Expert the expert professional has an intuitive grasp of each situation and identifies the problem without time delay. Highly skilled analytic ability is necessary for situations of no previous experience (6,12). After completion the expert professional demonstrates skills and prepares, circulates, scrubs in, and cares for patients after a procedure without supervision. They are able to operate with ease and always have a grasp on complex situations using intuition and analytical approaches to provide the best care. Assessment Methods Assessment for the procedure and technique oriented specialty of Interventional Cardiology involves self-evaluation, reflection, and assessment by competent higher level local trainers. Competence assessment should focus on performance in caring for a patient in the cath lab. It includes the education and ongoing review as well as demonstrating documenting and integrating knowledge through skills, using the standards of care and established policies and procedures in your training institution. The competencies matrix provided in the appendix can be used as a tool kit to assess the trainees changing level of competence through repeated task oriented training. Parallel to the competencies training the trainee should be evaluated to see not only how they are functioning within the technical aspects of their training, but also in patient care, team work and all parts of the core curriculum. This is an important step for the trainee to evaluate the trainees understanding beyond basics. A discussion should take place on what has happened and what could maybe have been done better or differently to prevent the complication from happening in the future. The trainee should also be assessed for working safety and providing a safe environment for patients and fellow colleagues. The competencies matrix log book must maintain a continuous record of their participation and what their level of participation is in all areas of training. The trainees will be evaluated to see at which level of experience they are currently in. The trainer is responsible for assessment of the trainee to ascertain that they are ready to advance to the next level of experience. The local trainer should be directly involved in observing the trainee, they should come from the same institution, and have at least achieved the level of competent. There should be regular intervals of assessment and all assessment should be documented in the competencies matrix. The records of training should be kept at the institution and all procedures done and documented in the matrix should be signed by trainee and trainer. It is recommended that the candidate be recognized by a National Society for Cardiology. It is recommended that the training centre should have an independent interventional cardiology unit, allowing the trainee to follow the patient from the admission to the completion of Interventional treatment and during follow-up. The presence of a programme of peripheral interventions, treatment of adult congenital heart disease, performance of septal ablation for hypertrophic cardiomyopathy and valvuloplasty are useful adjuncts to the centre qualification. An electronic database of diagnostic and interventional procedures regularly audited by the National Cardiology Society is desirable to ensure that the number and types of interventions required according to the training scheme are met. It is recommended that the interventional cardiology programme should perform at least 800 coronary angioplasties per year including acute coronary syndromes and primary angioplasty. It is recommended that the training institutions have a library and internet facilities offering access to the current world scientific literature, specifically major international journals relating to cardiology and internal medicine, and should provide the necessary physical infrastructure for training including conference rooms and allocated office space for trainees. The trainee should be provided with the opportunity to participate in basic scientific or clinical research. If basic science research facilities are not available in the training institution, collaboration with centres that offer this option should be made available for the trainee. Ideally the number of trainees should not exceed the number of local trainers (full-time equivalent). Delivery of the curriculum may be facilitated by a structure that includes a national training director, a local training director (or educational supervisor), and multiple local trainers. The trainer of the core curriculum should separately indicate whether the trainee has achieved enough experience and proficiency to perform them. Mitral, aortic and pulmonary valvuloplasty and percutaneous valve repair & Prosthetic paravalvular leak closure B.