Foods like yogurt, miso, kimchi, sauerkraut, kombucha, and tempeh are rich in “good” bacteria called probiotics. They may help ulcers by fighting an H. pylori infection or by helping treatments work better.Oct 12, 2018
Thursday, November 26, 2020
Omeprazole
Conclusions: Omeprazole is a well studied and well tolerated agent effective in adults or children as a component in regimens aimed at eradicating H. pylori infections or as monotherapy in the treatment and prophylaxis of GORD with or without oesophagitis or NSAID-induced gastrointestinal damage.
H Pylori test
Diagnosis
Tests and procedures used to determine whether you have an H. pylori infection include:
- Blood test. Analysis of a blood sample may reveal evidence of an active or previous H. pylori infection in your body. However, breath and stool tests are better at detecting active H. pylori infections than is a blood test.
-
Breath test. During a breath test, you swallow a pill, liquid or pudding that contains tagged carbon molecules. If you have an H. pylori infection, carbon is released when the solution is broken down in your stomach.
Your body absorbs the carbon and expels it when you exhale. You exhale into a bag, and your doctor uses a special device to detect the carbon molecules.
Acid-suppressing drugs known as proton pump inhibitors (PPIs), bismuth subsalicylate (Pepto-Bismol) and antibiotics can interfere with the accuracy of this test. Your doctor will ask you to stop taking those medications for a week or two before you have the test. This test is available for adults and children.
- Stool test. A laboratory test called a stool antigen test looks for foreign proteins (antigens) associated with H. pylori infection in your stool. As with the breath test, PPIs and bismuth subsalicylate can affect the results of this test, so your doctor will ask you to stop taking them for two weeks before the test.
-
Scope test. You'll be sedated for this test, known as an upper endoscopy exam. During the exam, your doctor threads a long flexible tube equipped with a tiny camera (endoscope) down your throat and esophagus and into your stomach and duodenum. This instrument allows your doctor to view any irregularities in your upper digestive tract and remove tissue samples (biopsy).
These samples are analyzed for H. pylori infection. This test isn't generally recommended solely to diagnose an H. pylori infection because it's more invasive than a breath or stool test, but it may be used to diagnose H. pylori ulcers or if it's needed to rule out other digestive conditions.
More Information
Treatment
H. pylori infections are usually treated with at least two different antibiotics at once, to help prevent the bacteria from developing a resistance to one particular antibiotic. Your doctor also will prescribe or recommend an acid-suppressing drug, to help your stomach lining heal.
Drugs that can suppress acid include:
- Proton pump inhibitors (PPIs). These drugs stop acid from being produced in the stomach. Some examples of PPIs are omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid) and pantoprazole (Protonix).
- Histamine (H-2) blockers. These medications block a substance called histamine, which triggers acid production. One example is cimetidine (Tagamet HB).
- Bismuth subsalicylate. More commonly known by the brand name Pepto-Bismol, this drug works by coating the ulcer and protecting it from stomach acid.
Your doctor may recommend that you undergo testing for H. pylori at least four weeks after your treatment. If the tests show the treatment was unsuccessful, you may undergo another round of treatment with a different combination of antibiotic medications.
Preparing for your appointment
See your primary care doctor if you have signs or symptoms that indicate a complication of H. pylori infection. Your doctor may test and treat you for H. pylori infection, or refer you to a specialist who treats diseases of the digestive system (gastroenterologist).
Because appointments can be brief, and because there's often a lot to discuss, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. Before your appointment, you might want to write a list that answers the following questions:
- When did your symptoms begin?
- Does anything make them better or worse?
- Have your parents or siblings ever experienced similar problems?
- What medications or supplements do you take regularly?
Your time with your doctor is limited. Preparing a list of questions to ask may help you make the most of your time together. For H. pylori infection, some basic questions to ask your doctor include:
- How did H. pylori infection cause the complications I'm experiencing?
- Can H. pylori cause other complications?
- What kinds of tests do I need?
- Do these tests require any special preparation?
- What treatments are available?
- How will I know if the treatment worked?
As you talk, ask additional questions that occur to you during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover other points you want to address. Your doctor may ask:
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- Do you take any over-the-counter pain relievers such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve)?
April 08, 2020
Related
Associated Procedures
Products & Services
Helicobacter pylori (H. pylori) infection
Friday, November 20, 2020
negligent
negligent behavior often used terms such as failure to, lack of, incomplete, ineffective, and improper.
The categories of negligence are: failure to follow standards of care, failure to use equipment in a responsible manner, failure to communicate, failure to document, failure to assess and monitor, and failure to act as a patient advocate
2 The nurse failed to seek such a review and ordered the Orthoblock for use in the patient's ACF.
Failing To Act Is Not An Option
2. Read the article "Failing To Act Is Not An Option"
3. Discuss the following points:
- Identify the contributing factors that lead to the event.
- Describe appropriate nursing actions that should have occurred, if any.
- Connect the ETHICAL PRINCIPLES demonstrated by and/or lacking from the behavior of the nurse.
- Connect the STANDARDS OF CARE demonstrated by and/or lacking from the behavior of the nurse.
- Identify any negligence, if any.
4. You will earn between 1 and 5 bonus points for doing this activity, depending on the completeness of your answers.
https://www.nursingcenter.com/journalarticle?Article_ID=5265830&Journal_ID=54016&Issue_ID=5265824
Authors
- Oyeleye, Omobola Awosika EdD, JD, RN-BC, CNE
Article Content
NURSES HAVE AN obligation to communicate changes in a patient's condition to the healthcare provider in a timely fashion. When a patient's condition deteriorates, a nurse's failure to act violates this fundamental responsibility, undermines patient safety, and has potentially severe consequences for the patient and nurse alike. The following court case summary and discussion illustrate the peril of failing to act.
Facts of the case
Mary Long* was admitted to the hospital with cholelithiasis and common bile duct dilation and evidence of a bowel obstruction, leading to a diagnosis of acute cholecystitis. After undergoing a procedure to remove the gallstones, a nasogastric (NG) tube was inserted as prescribed by the physician. No further orders were written regarding what actions to take if the NG tube was dislodged or removed.1
Hospital records indicated that Ms. Long removed the NG tube within 2 days after insertion and refused to let the nurses reinsert it. The nurses did not replace the NG tube or inform the prescribing physician that the tube had been removed and not replaced. Ms. Long subsequently underwent surgery for a bowel obstruction. At the time of discharge, she had been diagnosed with 12 different medical conditions and experienced many post-op complications.1
Ms. Long (plaintiff) sued the hospital, hospital system, and two RNs (defendants) for failing to comply with the physician's order for an NG tube and for "failure to properly treat...diagnose...and monitor" the patient.1,2 The plaintiff alleged that after the tube was removed, she "aspirated and significantly deteriorated," and that her post-op complications resulted from the nurses' failure to comply with the NG tube order. The plaintiff also alleged that the nurses failed in their duty to care for the plaintiff, including a failure to follow policies and procedures.1 Whether the plaintiff was partly liable because she removed the tube herself was not addressed in this lawsuit.
Case dismissed, then appealed
The defendants asked the trial court to dismiss the lawsuit because the plaintiffs failed to provide an Affidavit of Merit. In New Jersey, the hospital's location, the Affidavit of Merit statute requires that any malpractice or negligence action against a licensed person in his or her professional capacity must be supported with an affidavit by another appropriate licensed person. The affidavit should state that it is reasonably probable that the actions leading to the lawsuit did not comply with acceptable professional standards or treatment practices.3 In other words, the plaintiff would need to have an expert's affidavit to support the claim of professional misconduct.
As requested by the defendants, the court dismissed the case on the grounds that the plaintiff had not submitted an expert's affidavit. The plaintiff appealed this ruling.
Plaintiff prevails upon appeal
At the appellate level, the plaintiff's lawyers argued that the trial court was wrong in dismissing their case for lack of an affidavit. They based this argument on the "common knowledge" exception to New Jersey's Affidavit of Merit statute. Under this exception, an expert is not needed if jurors and other laypersons could reasonably use their common knowledge, understanding, and experience to determine whether the defendants were negligent in their duties. The plaintiff argued that the nurses' failure to reinsert the NG tube fell under the common knowledge exception.
The appellate court agreed, ruling that in this case, a layperson could use "ordinary understanding and experience to determine a defendant's negligence, without the benefit of the specialized knowledge of an expert."1 The Court reasoned that even though the general requirement is to have an expert establish the standard of care and the breach of care in a professional negligence claim, that requirement is not absolute. In cases where individuals of average intelligence can assess the carelessness of a defendant, an expert is not required.
The court drew another distinction between this case and other cases where experts are required. Most cases requiring an Affidavit of Merit concern situations in which a professional defendant had taken some action requiring an expert's professional opinion. In contrast, Ms. Long's case involved an "act of omission," or a failure to act.
The appellate court determined that the nurses' alleged failure to take action by not alerting the physician that the NG tube was no longer in place was obvious enough that a layperson would not need an expert's assistance to determine the significance of the nurses' inaction, especially given that a physician had ordered its insertion. The court concluded that "common sense dictates that some action should have been taken when the nurses were confronted with the sudden termination of [the patient's] medical treatment that was required by the physician charged with her care."1 The case was returned to the lower court for future trial or settlement.
The appellate court's decision expresses no opinion about whether the nurses were negligent or whether they should be found negligent when the case goes to trial in the lower court. It means only that the plaintiff's case against the defendants should not have been dismissed because of the absence of expert testimony. The plaintiff will still have to prove the merits of the case when she goes before the trial court.
Discussion
Once an NG tube is inserted, the RN's major responsibilities involve monitoring the patient and managing the NG tube. The results of this monitoring will likely indicate when the tube should be removed.4
It is not uncommon for a patient to experience some discomfort during and after NG tube insertion. It is also not unusual for patients to pull out the NG tube before completion of the therapy, usually due to discomfort.5
The details and merits of the Long case will not be discussed here because they were not litigated in the trial court. Instead, because the hospital's records indicate that the patient removed the NG tube and refused to permit reinsertion, this discussion will revolve around the question of what constitutes a nurse's duty of care when a patient refuses treatment.
For nurses, the obligation to care begins once they accept the assignment to care for a patient. Many of these obligations are regulated by the various state Nurse Practice Acts and the laws of medical malpractice encompassing the duty of care. That duty of care includes carrying out the healthcare provider's prescriptions for the patient's therapy and communicating the patient's condition to the multidisciplinary team, especially the prescribing healthcare provider.6 Until a healthcare provider's prescription for a patient is terminated, it remains in effect. If the plaintiff can establish that a breach of duty led to patient injury, the professional will be found to be negligent.7
To be successful at trial, the plaintiff needs to prove all the elements of negligence: that there was a duty of care by the defendants, that the defendants breached that duty, that there was injury, and that the breach was what caused the injury. In this case, the plaintiff needs to prove that the nurses' failure to notify the physician led to the plaintiff's injury and that the outcome would have been different if the nurses had informed the physician.8
In view of a competent adult's right to refuse treatment and the nurse's duty to provide care, what should a nurse do when a patient has refused treatment?
Follow the nursing process
Many facts of this case were not discussed in court, so it is unclear whether the nurses recognized the dangers of their alleged inaction or why they took no action over several shifts and days. One must then view the case from the perspective of what is common knowledge to nurses and how that could have helped them resolve the issue. That common knowledge is the nursing process.
Used consistently, the nursing process is a tool that helps nurses provide appropriate patient care. The five steps of the nursing process: assessment, nursing diagnosis, planning, intervention, and evaluation (ADPIE) provide an organized method of patient care that, if followed, would guide a nurse along a path that gets the patient the right care even when the nurse is not completely certain about what to do.
If the nurses in this case had utilized the nursing process, they could have found a solution with minimal delay. An assessment would have shown that the tube had been removed. Further assessment, through questioning the patient, would have revealed the reasons why the patient removed the NG tube and why she did not want it back in. Those reasons would have led them to a nursingdiagnosis, such as pain. Planning would have given them a chance to determine how to address the diagnosis so that the patient could accept the reinsertion as an intervention. Evaluation would include assessing the patient's comfort level following tube reinsertion.
If the patient continued to refuse an NG tube, or if the reinsertion was not successful or acceptable to the patient, then the next intervention would have been to communicate the issue to other members of the team and escalate it up the chain of command, documenting along the way who was notified, when they were notified, and what actions were taken by those up the command chain. This process should continue until the issue is resolved.9
Communication problems account for approximately one-third of malpractice cases against nurses, with more than 75% resulting in serious injury or death.10 As in this case, any failure to communicate a patient's condition is potentially harmful.
Fundamental nursing responsibilities
Regardless of whether the nurses are found to be negligent at trial, the big takeaway from the appellate court's ruling is that the nurses' obligation to communicate a patient's condition to a healthcare provider, such as a physician, is so fundamental and simple to understand that no expert affidavit is necessary. In other words, it is common sense. As members of a multidisciplinary team, nurses must share information. There is no "do nothing" option.
In this case, the nurses may or may not win in court. But doing nothing is what took them to court in the first place.
REFERENCES
1. Cowley v. Virtua Health System, 193 A.3d 330 (2018). [Context Link]
2. Law.com. Justices to take up "common knowledge" exception, duty to warn for outsourced parts. ALM Media. January 24, 2019. [Context Link]
3. N.J.S.A. 2A:53A-27. [Context Link]
4. Price G, Shuss S. The ins and outs of NG tubes. Nurs Made Incredibly Easy. 2016;14(5):52-54. [Context Link]
5. Feil M. Dislodged gastrostomy tubes: preventing a potentially fatal complication. Penn Pat Saf Advisory. 2017;14(1):9-16. [Context Link]
6. Shannon SE. The nurse as the patient's advocate: a contrarian view. Hastings Cent Rep. 2016;46(suppl 1):S43-S47. [Context Link]
7. Negligence. In: Batten D, ed. Gale Encyclopedia of Everyday Law. 3rd ed. Detroit, MI: Gale; 2013: 1425-1429. [Context Link]
8. Kidney v. Eastside Med. Ctr., LLC, 806 S.E. 2d 849 (2017). [Context Link]
9. Using the chain of command effectively. AORN J. 2019;109(3):367-369. [Context Link]
10. CRICO Strategies. Malpractice risks in communication failures. 2015 CRICO Strategies national CBS report. 2015. http://www.rmf.harvard.edu/Malpractice-Data/Annual-Benchmark-Reports/Risks-in-Co. [Context Link]
* The patient's name has been changed to protect her privacy. [Context Link]
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WHY HEALTH CARE IS EXPENSIVE
TECHNOLOGY IS IMPORTANT
hospital -when u go to the hospital ( tylenol one pill will cost 10 dollar )
where health care
pharmaceutical is expensive
what other country
surgery
everybody need to get access of health care
what is the challenge
healthcare with technology costing more and more money
you have a patient
patient that you have said i have been feeling
task and physician work flow
to get the same out come for the patient
in the rural area there may not be a
if you enter a rehab center
you can learn how
what level of chare tertiary
four profit agency
urgent clinic
valley medical center VA reginal hospital elcamino ( federal agency )
state agency ( Valley med medical center )
Nurse role on the healthcare team
they started asked me
medication
RN
people think that you know everything
Friday, November 13, 2020
LEGAL PRACTICE IN NURSING
If a nurse forces a treatment on a patient without their consent, the nurse can be charged with battery.
Correct!
law is something that we need to follow
nursing law ( protecting the patient )
what we can do what we cannot do
- constitution
- statues
- administrative law (authoritiy -BRN given authority to NPA)
- common law
- regulation with nursing home
criminal law
prohibit conduct harmful to society
nurses can get trouble into civil law
practice medicine without license =criminal law
reasonable doubt
its mean that
tells that you are guilty
unreasonable
confusing
what happen if you break a law ( could be fine , jail , can be both )
sue you at the court
civil law ( your dog broke my fence )
liability ( 51 percent you did do it or you did not do it penality is monitoring )
intentional tortorts
assult and battery
false imprisonment
any unlawful confinment within fixed boundaries
false imprisonment
AMA ( they can sign the form ) Against medical advicement ( let them sign the form and let them go )
autonomy
Do i have a good doctor ( do you want information on other things ? )
invasion of privacy
you need to insert the urinary cathether ( you need to create a privacy )
you should ask for the permission ( if you need to teach your student nurse for doing catheterization)
better than not asking the question
i will allow enough student to get in
not the whole team
battery
assult
threat
you don't have to touch them
somefearful of you
contact this requirement
might happen
little lady dress
people are not happy
ICU ( their love one is not doing they are out of control )
charge with battery
she was charge with it
they was accusing her
here what she did
the patient was not doing well
my formal student
gentally guided
guiding them her body language,
can get into trouble
reasonable
better clam without touching
produre on someone ( inform consent ) can prevent some disturb
sometime the situation cannot prevent
matter of my routine ( they misinterpret)
when draw blood ( they saw can misinterpret too )
do not recuscitate ( the family tend to be not happy )
paramedic
implied concent ( i am going to take blood pressure)
explicit ( formal process for taking consent for surgery)
dementia patient
battery ( don't do it )
ER psy ward ( there are people patient tried to kill you )
its under standable ( ER taking care the psy background patient , patient decided stocking that he would call the unit ) she had to get restraining order )
almost victim of assult
group therapy session
witness the signature ( if the patient is not fully understand )
in emergency ( consent is presumed )
you have to get consent ( the patient is prenarcotic ) can you take consent ?
go something
the procedure is ready to do
the consent is missing
what you going to do first
you cannot give medication until consent have been giving
they have the ability to give consent
communication might not be always verbal ( speak english ) not in medical term
make the patient fully understanding ( basic understanding )
we need to keep information confidential
can you get access
tried to
grant access ( to student nurse )
you practice on your own license
you will not practice under anyother license
you are in elevator
not to gossip
confidential is regulated by fedral
we are mandatory report
what is you wrong
you have to report withing 24 hours
you are okay as long as you are in good faith
reported to authority
don't social media
getting caught up in the internet
deanza
found it entry pop up
she said finish my first sesmenster
not respecting the dignity of patient
a lot of company
really want the profile picture
she is in colorado
nursing school
football game
be mindful that
someplaces could disapline
no photograph in the unit ward
mal practice
under civil right ( not criminal )
legally responsible by the law
the patient sue you also doctor and hospital
joint liability (e.g , doctor accuse , you can challange and dr accuse you ,
you are not doing the right job )
bonus point
hospital fellout the window and die
safety mechanism ( hospital )
nurse ( responsible )
CNA ( RN is delegate , and responsible )
on the other hand
when you delegating your CNA
you still have to ---
negligence
professional part
mal practice
resonable and prudent
similar situation
resonable
prudent is careful
six component
(1) Duty to act
(2) breach ( you did not do it )
(3 ) harm ( something that happen )
(4) causation ( you breach )
wrong side of mal practice
to defense your self
look at those four words
standard of care
actually its causation
suppose somebody
suppose you are on break
suppose you went on your break you went break too long
yes it was damage
tipical lawyer defence
she was gone too long
preventing negligence and malpractice
the best way stay out of malpractice ( you know what you doing)
include the setting
it just seems like
crazy
so unsafe
if you feel like your license is risking you need to quit
you need to follow on unsafe situation ( quit from that job )
goal ( long term care )
identified the situation and work
rule of law
what is the best story
communication
patient family and other
it is been shown
there is alot of people could sue and some are don't
they concerned on nurses and sue
bad thing that happen
alot of people sue out of frastration becuse of being not listened
its very important
70 dollar a year ( insurance ) for patient sue in case
if you break policy
in adequate charting
case study
you need to document
two year later it went to the court
failure to communicate
read the legal case
this patient confuse
thats fine you do your job
doctor has to review patient medication
inaccurate counting of instument in surgery
you have to always
never ask yes no question
always identified
however , you have known this patient very well
time to get new one
that will be the case
acute care hospital
this is the part
this is something
medical
not guilty
that is clear
there is criminal behind this
make a mistake ( all the evidence )
cms report
here is a story
patient ( was order this drug for sedation ) versed but she was given vercuronium
float nurse
pyxis mechine ( ATM for drug )
for sedation
versed =midazolam
look at vial
take 10cc
small drug 2 ml
she gave the worng medication
she did not read the name
she did the wrong drug
it is criminal
that is mal practice
in history ( they did not do any thing bad , mal practice )
it was water soluble medication
including your breating
not for CT scan
they have to be on vantilator ( must be O2 ) quiet whole body down before intubation they give that medication
but she give the wrong medication
the medcation effect is they cannot open the eye
she could not even call for help
this is the case you are practice
your license
make a mistake and go to jail
you have to careful
reasonable and prudent
she was ICU nurse she was float nurse
even if the right drug she should have to monitor the patient respiratory
the original cause of death
malpractice -
criminally
group of nurse
the primary purpose is to protect public health and safety
a law that defines and controls nursing
state boards of nursing
California BRN
we are allow to do
it defines
sometimes they approched many programmed
thats why
get in trouble for that
AND ( allow natural death)
DNR ( do not resuscitate)
what they want
how aggressively they want to be treated
durable power ( daughter , spouse , family member )
you need to careful assessment ( need to evaluate the patient)
LTC ( they need to ensure compliance of law ,educate the staff )
information of patient ( you need to make sure the patient is allow his sister to know about his condition )
decline
non compliance
combactive
make the reader
don't use label
how can you lose your license
AKA
obtaining license by fraud
felony
somebody had DUI
seems to the board
they can
you might not get your license
VA
they don't let you in
background check
what are you doing
scare they don't get that license
not reporting ( you can be the one for lunch break )
falsely portraying self to public or any HCP as a nurse
they can give u license immediately ( after evaluate )
whistle blower act
good samaritan act
you saw a you tube video
if you do reasonable and prudent you won't get mal practice charge
you are in the air
what law would apply ( Aviation )
joint comission keep in safe
here is national safety
always wonder
what happen
obviously
improve
reduce healthcare reduce risk of fall
joint comission
pretty similar
what hte joint commision does
you have to ask if you don't want this
know your power point for sure
you you get there though
flight nurse
star student
ER master
https://kristenfmartins.wordpress.com/2020/04/21/running-out-of-outlets/?fbclid=IwAR0Wx3VmOHsnM2tC29Zuwszy-Pa3FMTNH-RzpNtSwwI9U0qm6OimOUeNBSs
https://kristenfmartins.wordpress.com/2020/04/21/running-out-of-outlets/?fbclid=IwAR0Wx3VmOHsnM2tC29Zuwszy-Pa3FMTNH-RzpNtSwwI9U0qm6OimOUeNBSs
Sunday, November 1, 2020
NURSING 50 CLASS QUIZ ( MID TERM )
Which of the following is true of Maslow's basic of self actualization
ans (1) People use their abilities to the fullest extent possible and are true to their nature.
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