A to Z for Nurses

A nurse is caring for a client with chronic obstructive pulmonary disease (COPD). Which intervention is most appropriate?
A. Encourage fluid intake of 3–4 liters/day unless contraindicated
B. Provide oxygen at 6 L/min via nasal cannula
C. Place the client in a supine position to promote oxygenation
D. Advise the client to avoid pursed-lip breathing exercises

NORKA to recruit nurses to Germany

Qualified nurses who wish to work abroad may apply now for the Triple Win programme sponsored jointly by the state-run overseas recruitment agency NORKA Roots and the Federal Employment Agency (Bundesagentur für Arbeit or BA) of the German Government. Nursing graduates or diploma holders, who have an experience of at least a year, may submit applications.

Selected candidates would be trained in German language (up to B1 level) and recruited. Male and female candidates who are not above 45 years can apply for this programme. Language training and recruitment are totally free of cost.

Preference would be given to those who are already working and has an experience of over 3 years, those who are fluent in German language, experienced home care/nursing professionals and those who are experienced in intensive care/geriatric/cardiology/general ward/surgical–medical ward/neonatology/orthopaedics and related areas/operation theatre/psychiatry departments.

NORKA ROOTS
NORKA to recruit nurses to Germany, MoU to be signed today Interested candidates should apply at www.norkaroots.org within 10 March. Those who have applied earlier need not apply again. Call toll-free number 1800–425–3939 for more information. Email: [email protected].

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Vaccines can’t stop COVID-19 alone, but by doing it all we can make a difference.

Know about COVID-19
• Coronavirus (COVID-19) is an illness caused by a virus that can spread from person
to person.
• The virus that causes COVID-19 is a new coronavirus that has spread throughout the world.
• COVID-19 symptoms can range from mild (or no symptoms) to severe illness.
Know how COVID-19 is spread
• You can become infected by coming into close contact (about 6 feet or two
arm lengths) with a person who has COVID-19. COVID-19 is primarily spread from person to person.
• You can become infected from respiratory droplets when an infected person coughs, sneezes, or talks.
• You may also be able to get it by touching a surface or object that has the virus on it, and then by touching your mouth, nose, or eyes.
Protect yourself and others from COVID-19
• There is currently no vaccine to protect against COVID-19. The best way to protect yourself is to avoid being exposed to the virus that causes COVID-19.
• Stay home as much as possible and avoid close contact with others.
• Wear a cloth face covering that covers your nose and mouth in public settings.
• Clean and disinfect frequently touched surfaces.
• Wash your hands often with soap and water for at least 20 seconds, or use an alcohol- based hand sanitizer that contains at least 60% alcohol.
milk Practice social distancing
• Buy groceries and medicine, go to the doctor, and complete banking activities online when possible.
• If you must go in person,
stay at least 6 feet away from others and disinfect items you must touch.
• Get deliveries and takeout, and limit in-person contact as much as possible.
Prevent the spread of COVID-19 if you are sick
• Stay home if you are sick, except to get medical care.
• Avoid public transportation, ride-sharing, or taxis.
• Separate yourself from other people and pets in your home.
• There is no specific treatment for COVID-19, but you can seek medical care to help relieve your symptoms.
• If you need medical attention, call ahead.
Know your risk for severe illness
• Everyone is at risk of getting COVID-19.
• Older adults and people of any age who have serious underlying medical conditions may be at higher risk for more

Wound Types: Pressure Injuries and Ulcerations

Pressure injuries may never heal if the patient is failing to consume adequate food and fluids to maintain body functions and assist tissue growth.

An additional complication could be underlying involvement of the bone (known as osteomyelitis) in deep pressure injuries.

If osteomyelitis is not managed appropriately by a qualified physician, it may result in serious sequelae and the possibility of the wound never healing.

There are now six classifications of pressure injury.

Pressure Injury Staging

♦️Stage One

Intact skin with non-blanchable redness of a localised area, usually over a boney prominence.

A stage one pressure injury is an intact area of damage, so protection of the tissue and providing an environment for recovery is the aim.

♦️Stage Two

Partial thickness loss of dermis presenting as a shallow, open- wound with a red/pink wound bed, without slough or bruising. May also present as an intact or ruptured serum-filled blister. Shiny or dry.

Stage two pressure injuries are relatively clean, superficial, partial-thickness injuries. Once again, protection is important, however due to the break in the integument, the chosen dressing must also have some absorbent capabilities.

♦️Stage Three

Full thickness tissue loss, subcutaneous fat may be visible, slough may be present.

Stage three injuries involve damage through to the subcutaneous tissue, with the presence of slough and soft, tenacious necrotic tissue, which will require debridement.

Debridement can be as previously mentioned: managed by a surgeon, a skilled clinician, or using dressings to aid autolytic processes.

♦️Stage Four

Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present.

Stage Four implies that the area of damage extends down through muscle and bone may be exposed or palpable. These injuries are generally necrotic and malodourous. Managing odour becomes the priority.

♦️Unstageable (Depth Unknown)

Unstageable pressure injury (depth unknown): full thickness tissue loss, base is covered by slough and/or eschar (yellow / brown/ black) in the injury bed.

The aim here is to remove the necrotic tissue until viable tissue is reached and the wound can begin to heal from the base up.

Debriding products previously mentioned can be used on this category.

♦️Suspected Deep Tissue Injury* (Depth Unknown)

Suspected deep tissue injury (depth unknown): purple/maroon localised area of discoloration of intact skin or blood-filled blister. May develop thin blister or eschar over dark wound bed.

The aim here is to preserve the tissue intact for as long as possible and await what the body can do if the pressure is removed. Most clinicians take a -watch and wait approach. Dressings that seal the area off can sometimes create more moisture and heat making the tissue more vulnerable to further damage.

♦️Leg Ulceration

Although there are many types of leg ulcers, the most common are venous, followed by arterial, and then mixed venous arterial.

Ulceration of lower legs is often complex as the diagnosis may not have been made.

Venous ulcers can heal with compression therapy, however conversely some arterial ulcers may deteriorate if compression is used.

Therefore having a knowledge of the characteristics of venous and arterial ulcers is imperative to ensure appropriate decision-making regarding management of these wounds.

♦️Venous Ulceration

Venous ulcers are located in the lower third of the lower-leg and generally are superficial and weeping.

The priority of care is managing the oedema and encouraging the epithelium to grow across the superficial break.

Zinc paste bandages and compression bandages are the mainstay of treatment to achieve these goals. The zinc paste bandages may include products like Viscopaste or Varicex.

Compression therapy selection is complex and must be tailored to the patient. A safe and effective system from which to start, however, is the use of straight, elasticated tubular bandages

These must be applied from toes to knee after selecting the appropriate size according to the manufacturers guide. Commence with one layer, if tolerated then add another second layer but extending to only 2/3 of the lower leg and finally if tolerance is maintained then add another 1/3. This is known as 3 layers straight elasticated tubular bandage-allowing removal of the upper layers for sleeping then re-apply next morning.

♦️Arterial Ulceration

When it comes to managing arterial ulceration, a vascular surgeon is best to consult as ideally some surgery can be performed to restore perfusion to the limb. It then becomes the attending clinician’s role to prevent infection.

Generally the rule is: if the tissue is dry and ischaemic, then keep it dry. So Betadine™ lotion is used to achieve this and keep the eschar dry.

If the tissue in the arterial wound is offensive, infected or malodourous, then a silver or cadexomer iodine may be used, such as Aquacel Ag or Iodosorb ointment/powder.

PCR Testing for COVID -19