MR. ABU BAKAR

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PICNIC

Picnic is a part of Physical Medicine & Rehabilitation Hospital's program provided by social worker department of Physical Medicine & Rehabilitation Hospital for the patients. Picnic was held on November 27, 2013 in Kuwait Zoo from 10 AM to 12 Noon and attended by 7 patients ( from ward 3 and ward 5 ) , social worker, occupation therapist and nurse. The aim of picnic is to refresh and make patients happy because patients stay in the hospital for long time. A side from that the patients can learn and recognize/memorize the object specially for the patients who have cognitive impairment. Read More ..

Cognitive Impairment

What is cognitive impairment?

Cognitive impairment occurs when problems with thought processes occur. It can include loss of higher reasoning, forgetfulness, learning disabilities, concentration difficulties, decreased intelligence, and other reductions in mental functions. Cognitive impairment may be present at birth or can occur at any point in a person’s lifespan. Some early causes of cognitive impairment include chromosome abnormalities and genetic syndromes, malnutrition, prenatal drug exposure, poisoning due to lead or other heavy metals, hypoglycemia (low blood sugar), neonatal jaundice (high bilirubin levels developing after birth), hypothyroidism (underactive thyroid), complications of prematurity, trauma or child abuse such as shaken baby syndrome, or oxygen deprivation in the womb or during or after birth. Cognitive impairment that develops in childhood or adolescence can result from many conditions. Examples include side effects of cancer therapy, malnutrition, heavy metal poisoning, autism (abnormal development of communication and social skills), metabolic conditions, and systemic lupus erythematosus (disorder in which the body attacks its own healthy cells and tissues). With age, other conditions such as stroke, dementia, delirium, brain tumors, chronic alcohol use or abuse, substance abuse, some vitamin deficiencies, and some chronic diseases may cause cognitive impairment. Head injury and infection of the brain or of the covering of the brain and spinal cord (meninges) can cause cognitive impairment at any age. In some cases, cognitive impairment may be reversible if the underlying cause is identified and treated. Seek immediate medical care (call 911) for the sudden onset of cognitive impairment, especially if it is accompanied by high fever (higher than 101 degrees Fahrenheit), neck stiffness or rigidity, rash, head injury, changes in level of consciousness or alertness, flushing or dry skin, severe nausea and vomiting, fruity breath, or other symptoms that cause you concern. Seek prompt medical care for new onset of cognitive impairment or if existing impairment worsens.

What other symptoms might occur with cognitive impairment?

Cognitive impairment may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the brain may also involve other body systems or disorders. Infection symptoms that may occur along with cognitive impairment Cognitive impairment may accompany symptoms related to infection including: Fever

Headache

Malaise or lethargy

Muscle twitching, spasms or seizures

Nausea with or without vomiting

Rash

Stiff or rigid neck

Metabolic symptoms that may occur along with cognitive impairment

Cognitive impairment may accompany other symptoms related to metabolic disorders including:

Abdominal pain

Abnormal heart rhythm such as rapid heart rate (tachycardia) or slow heart rate (bradycardia)

Changes in skin

Confusion or loss of consciousness for even a brief moment

Difficulty breathing or rapid breathing Nausea with or without vomiting

Fatigue

Feeling very thirsty

Frequent urination or decrease in urine output

Fruity breath

Muscle weakness

Other symptoms that may occur along with cognitive impairment

Cognitive impairment may accompany symptoms related to other problems, such as injury, stroke or dementia. These symptoms may include:

Change in sleep patterns

Changes in mood, personality or behavior

Confusion or loss of consciousness for even a brief moment

Difficulty with memory, thinking, talking, comprehension, writing or reading

Impaired balance and coordination

Loss of vision or changes in vision

Nausea with or without vomiting

Numbness, weakness or paralysis

Seizure

Severe headache

Serious symptoms that might indicate a life-threatening condition

In some cases, cognitive impairment may be a symptom of a life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

Change in level of consciousness or alertness such as passing out or unresponsiveness

Change in mental status or sudden behavior change such as confusion, delirium, lethargy, hallucinations or delusions

Garbled or slurred speech or inability to speak

High fever (higher than 101 degrees Fahrenheit)

High-pitched, shrill cries in an infant or small child

Paralysis or inability to move a body part

Poor feeding, unusual sleepiness, or irritability in a child or infant

Seizure

Stiff or rigid neck

Sudden change in vision, loss of vision, or eye pain

Trauma to the head

Worst headache of your life

What causes cognitive impairment?

Cognitive impairment can result from conditions that occur during fetal development, at birth, shortly after birth, or at any point in life. Sometimes, the cause of cognitive impairment cannot be determined, especially in a newborn or small child. Congenital causes of cognitive impairment Cognitive impairment may be present at birth and may be genetic or chromosomal or result from complications of pregnancy. Congenital causes of cognitive impairment include:

Chromosomal abnormalities such as Down syndrome, fragile X syndrome, cri du chat syndrome, Prader-Willi syndrome, and others

Congenital hypothyroidism (underactive thyroid)

Genetic abnormalities such as phenylketonuria, Tay-Sachs disease, galactosemia, Hunter syndrome, Hurler syndrome, adrenoleukodystrophy, and others

Intrauterine growth retardation (poor growth of fetus)

Prenatal drug or alcohol exposure

Prenatal infections

Birth-related causes of cognitive impairment Cognitive impairment can also be caused by complications related to delivery including:

Infection

Lack of oxygen during labor or birth Preterm birth or its complications such as intracranial hemorrhage (uncontrolled bleeding in the brain)

Causes of cognitive impairment that occur after birth or during childhood and adolescence

Cognitive impairment can also be caused by conditions that occur after birth or during childhood and adolescence including:

Autism (abnormal development of communication and social skills)

Head injury

Heavy metal poisoning such as lead poisoning

Infection

Kidney disease (which includes any type of kidney problem such as kidney stones, kidney failure, and kidney anomalies)

Malnutrition

Metabolic conditions

Neonatal jaundice (yellowing of the skin and whites of the eyes occurring after birth)

Side effects of cancer therapy

Systemic lupus erythematosus (a disorder in which the body attacks its own healthy cells and tissues)

Causes of cognitive impairment that occur in adults

Cognitive impairment can also be caused by conditions that occur in adulthood including:

Alcohol or drug abuse

Brain or spinal cord injury

Certain vitamin deficiencies

Congestive heart failure (deterioration of the heart’s ability to pump blood)

Dementia

Infections

Kidney disease (which includes any type of kidney problem such as kidney stones, kidney failure, and kidney anomalies)

Liver disease (which includes any type of liver problem such as hepatitis, cirrhosis, and liver failure)

Medication side effects

Serious or life-threatening causes of cognitive impairment

In some cases, cognitive impairment may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

Brain tumor

Encephalitis (inflammation and swelling of the brain due to a viral infection or other causes)

Heat stroke

Kidney failure

Meningitis (infection of the membranes that cover the brain and spinal cord)

Profound dehydration

Sepsis (severe infection of the bloodstream)

Spinal cord injury or tumor

Stroke

Traumatic head injury

Questions for diagnosing the cause of cognitive impairment

To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your cognitive impairment including:

When did you first notice symptoms of cognitive impairment?

What specific symptoms have you noticed?

Did anything such as an injury or illness precede the symptoms?

Were there any prenatal complications or complications of birth?

Do you have any other medical conditions?

What medications are you taking? Are you taking any new medications?

Have you taken any street drugs?

Do you drink alcohol?

What are the potential complications of cognitive impairment?

Because cognitive impairment can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

Developmental delays and failure to thrive

Learning disability

Paralysis or inability to move a body part

Permanent cognitive impairment

Permanent loss of sensation

Personality changes

Physical disability

Reference : http://www.localhealth.com/article/cognitive-impairment Read More ..

9 PATIENT SAFETY SOLUTIONS

LOOK ALIKE SOUND ALIKE (LASA)

Separate location for placing Look Alike Sound Alike medication

Arrange Look Alike Sound Alike medication in non-alphabetical orders

Reading the label before handling and preparing Look Alike Sound Alike medication and should be placed in labeled shelves

Tall man lettering, color difference and bold face technique are used to be easily differentiate Look Alike Sound Alike medications

MEDICATION RECONCILIATION

History of current treatment should be taken by the doctor from the patient, relatives or from medical record if available

Compare the current treatment with the new added treatment and document it in the reconciliation list

CONTROLLED OF CONCENTRATED ELECTROLYTES

“MUST BE DILLUTED”

CAN KILLED……..!!!!!!

Check and verify doctors order

A proper computation of dilution is needed and asks about double checking

Note all the things you have done

Keep on monitoring patient status

Identification of patient is a must when starting the infusion

Label the prepared solution to avoid confusion

Learn doing proper handover all the time

PATIENT HANDOVER

Use SBAR

Situation : chief complaint, current status

Background : previous history

Assessment : result of assessment, vital signs, investigations and symptoms

Recommendation : suggested and anticipated changes, complications, critical monitoring

AVOIDING CATHETER & TUBING MISCONECTION

Doctor’s order must be checked and verified

Re-check all lines and tubes before and after each shift

Avoid positioning of the functionally similar tube close to each other as much as possible

Stick label on high risk catheter (e.g. arterial, epidural & intrathecal)

Encourage patient and relatives to inform the healthcare providers on duty when they notice any problems on changes on the line or tubes

Trace all lines from their origin to the connection port to verify attachment before making any connection or reconnection or to administer medications and other solutions

PATIENT I.D BRACELET

please….WEAR ME

Write complete patient information clearly

Ensure that 2 identifiers are available (e.g. full 3 names and birth date)

Apply the bracelet to an appropriate limb within one hour

Replace the bracelet if any part of the patient’s information has become not clear

Make sure that you must ask patient name rather than telling his/her name

Each time care is provided, patient identification must be done by healthcare provider

CORRECT PROCEDURE AT CORRECT BODY SITE

Identification and verification of the right person, procedure and body site should be completed before transferring the patient to the treatment area as a safety priority

A written consent should be obtained after discussion with the patient

Establish the performance of correct procedure at correct body site as a safety priority

Relevant and complete documentation is needed during and after the procedure

Check the equipment’s needed for the procedure must be checked if it correct and functioning properly

SINGLE USE OF INJECTION

Remember the ten rights when you give patient medication

Always use the single injection as safety priority

Recapping should not be done to avoid needle stick or pick

Hand hygiene and proper protection must be applied before giving the medication

Waste management procedure, rules and regulation practices should be identified and implemented in a safe way

IMPROVED HAND HYGIENE

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5 MOMENTS FOR HAND HYGIENE

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HANDS WASHING

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ISOLATION TECHNIQUE

Definition

Isolation refers to the precautions that are taken in the hospital to prevent the spread of an infectious agent from an infected or colonized patient to susceptible persons.

Purpose

Isolation practices are designed to minimize the transmission of infection in the hospital, using current understanding of the way infections can transmit. Isolation should be done in a user friendly, well-accepted, inexpensive way that interferes as little as possible with patient care, minimizes patient discomfort, and avoids unnecessary use.

Precautions

The type of precautions used should be viewed as a flexible scale that may range from the least to the most demanding methods of prevention. These methods should always take into account that differences exist in the way that diseases are spread. Recognition and understanding of these differences will avoid use of insufficient or unnecessary interventions.

Description

Isolation practices can include placement in a private room or with a select roommate, the use of protective barriers such as masks, gowns and gloves, a special emphasis on handwashing (which is always very important), and special handling of contaminated articles. Because of the differences among infectious diseases, more than one of these precautions may be necessary to prevent spread of some diseases but may not be necessary for others.
The Centers for Disease Control and Prevention (CDC) and the Hospital Infection Control Practice Advisory Committee (HICPAC) have led the way in defining the guidelines for hospital-based infection precautions. The most current system recommended for use in hospitals consists of two levels of precautions. The first level is Standard Precautions which apply to all patients at all times because signs and symptoms of infection are not always obvious and therefore may unknowingly pose a risk for a susceptible person. The second level is known as Transmission-Based Precautions which are intended for individuals who have a known or suspected infection with certain organisms.
Frequently, patients are admitted to the hospital without a definite diagnosis, but with clues to suggest an infection. These patients should be isolated with the appropriate precautions until a definite diagnosis is made.

Standard precautions

Standard Precautions define all the steps that should be taken to prevent spread of infection from person to person when there is an anticipated contact with:
• Blood
• Body fluids
• Secretions, such as phlegm
• Excretions, such as urine and feces (not including sweat) whether or not they contain visible blood
• Nonintact skin, such as an open wound
• Mucous membranes, such as the mouth cavity.
Standard Precautions includes the use of one or combinations of the following practices. The level of use will always depend on the anticipated contact with the patient:
• Handwashing, the most important infection control method
• Use of latex or other protective gloves
• Masks, eye protection and/or face shield
• Gowns
• Proper handling of soiled patient care equipment
• Proper environmental cleaning
• Minimal handling of soiled linen
• Proper disposal of needles and other sharp equipment such as scalpels
• Placement in a private room for patients who cannot maintain appropriate cleanliness or contain body fluids.

Transmission based precautions

Transmission Based Precautions may be needed in addition to Standard Precautions for selected patients who are known or suspected to harbor certain infections. These precautions are divided into three categories that reflect the differences in the way infections are transmitted. Some diseases may require more than one isolation category.

AIRBORNE PRECAUTIONS. Airborne Precautions prevent diseases that are transmitted by minute particles called droplet nuclei or contaminated dust particles. These particles, because of their size, can remain suspended in the air for long periods of time; even after the infected person has left the room. Some examples of diseases requiring these precautions are tuberculosis, measles, and chickenpox.
A patient needing Airborne Precautions should be assigned to a private room with special ventilation requirements. The door to this room must be closed at all possible times. If a patient must move from the isolation room to another area of the hospital, the patient should be wearing a mask during the transport. Anyone entering the isolation room to provide care to the patient must wear a special mask called a respirator.

DROPLET PRECAUTIONS. Droplet Precautions prevent the spread of organisms that travel on particles much larger than the droplet nuclei. These particles do not spend much time suspended in the air, and usually do not travel beyond a several foot range from the patient. These particles are produced when a patient coughs, talks, or sneezes. Examples of disease requiring droplet precautions are meningococcal meningitis (a serious bacterial infection of the lining of the brain), influenza, mumps, and German measles (rubella).
Patients who require Droplet Precautions should be placed in a private room or with a roommate who is infected with the same organism. The door to the room may remain open. Health care workers will need to wear masks within 3 ft of the patient. Patients moving about the hospital away from the isolation room should wear a mask.

CONTACT PRECAUTIONS. Contact Precautions prevent spread of organisms from an infected patient through direct (touching the patient) or indirect (touching surfaces or objects that that been in contact with the patient) contact. Examples of patients who might be placed in Contact Precautions are those infected with:
• Antibiotic-resistant bacteria
• Hepatitis A
• Scabies
• Impetigo
• Lice.
This type of precaution requires the patient to be placed in a private room or with a roommate who has the same infection. Health care workers should wear gloves when entering the room. They should change their gloves if they touch material that contains large volumes of organisms such as soiled dressings. Prior to leaving the room, health care workers should remove the gloves and wash their hands with medicated soap. In addition, they may need to wear protective gowns if there is a chance of contact with potentially infective materials such as diarrhea or wound drainage that cannot be contained or if there is likely to be extensive contact with the patient or environment.
Patient care items, such as a stethoscope, that are used for a patient in Contact Precautions should not be shared with other patients unless they are properly cleaned and disinfected before reuse. Patients should leave the isolation room infrequently.

Types of Isolation :
 Strict isolation.
 Contact isolation.
 Respiratory isolation
 Tuberculosis or acid-fast bacillus (AFB) isolation.
 Enteric precautions
 Drainage/secretion precautions
1. Strict Isolation
 Designed for highly contagious infections that are spread by both airborne droplet nuclei and contact transmission.
 Examples include:
 varicella,
 Disseminated herpes zoster,
 Viral hemorrhagic fevers.
Technique
 Private room.
 With negative airflow.
 The use of masks, gowns, and gloves for all persons entering the room.
2. Contact isolation
 designed for highly transmissible infections that are not spread by airborne droplet nuclei but are transmitted primarily by close and direct contact.
 Examples
 viral respiratory infections in children, such as respiratory syncytial virus (RSV)
 Patients with large draining wounds require contact precautions.
Technique
 Technique includes :
 Private room,
 Masks for those personnel providing close direct care to the patient,
 Gowns if soiling is likely,
 Gloves for touching infective material.
3. Respiratory Isolation
 designed to prevent transmission of diseases spread over short distances through the air (droplet transmission).
Examples include :
 children with Haemophilus influenza,
 epiglottitis,
 meningitis,
 pneumonia.
 patients with serious meningococcal disease;
 mumps and pertussis.
Technique
 Technique includes.
 Private room.
 Or cohering patients with the same organism.
 And masks for those personnel providing close direct care to the patient.
4. Tuberculosis or Acid-fast Bacillus (AFB)
 isolation—designed for patients suspected or known to have pulmonary or laryngeal tuberculosis.
 technique includes a private room with negative airflow
 and the use of appropriate respiratory protection (see tuberculosis).
5. Enteric precautions
 designed to prevent infections that are transmitted by direct or indirect contact with fecal material,
 such as Salmonella gastroenteritis.
Technique
 private room only if the patient has poor hygiene and is likely to contaminate the environment,
 gowns if soiling is likely,
 and gloves for touching infective material.
Drainage/secretion precautions
 designed to prevent infections transmitted by direct or indirect contact with purulent material or other drainage from an infected body site.
 Technique includes :
 gowns if soiling is likely
 and gloves for touching infective material.



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