Dementia can be defined as a progressive decline in cognitive function caused by damage to brain cells. Although dementia is a geriatric problem, its occurrence has to be recognized in any stage of adulthood with diminished memory, attention, language and problem solving skills. Dementia, in its advanced stages often causes disorientation in time and place. Dementia can be broadly classified as Cortical and Subcortical dementia. Cortical dementia includes Alzheimer’s disease, Vascular dementia including Binswanger's disease , Dementia with Lewy bodies , Alcohol-Induced Persisting Dementia , Korsakoff's syndrome ,Wernicke's encephalopathy , Frontotemporal lobar degenerations , including Pick's disease , Frontotemporal dementia ,Semantic dementia , Progressive non-fluent aphasia, Creutzfeldt-Jakob disease, Dementia pugilistica and Moyamoya disease. Subcortical dementia includes Dementia due to Huntington's disease , Hypothyroidism, Parkinson's disease , Vitamin B1 deficiency , Vitamin B12 deficiency , Folate deficiency , Syphilis, Subdural hematoma , Hypercalcaemia, Hypoglycemia , AIDS dementia complex , Pseudodementia often associated with clinical depression and bipolar disorder and substance-induced persisting dementia related to psychoactive use. Although nurses are familiar with the treatment and routine patient care, care for such patients and their families demands an extra dimension (Wrigley et.al, 2003). It is interesting to note that people with dementia can still maintain a normal life with family support and a nurse who can help the patient family develop an understanding of these patient’s problems can effectively help reducing the care giving family stress (Vitaliano et.al, 2003).
Smoking and Alcohol Addiction during Pregnancy
Cigarette smoking affects a pregnant women's health and the health of an unborn child. Tobacco smoking has been shown to have a carcinogenic effect on various organs. Maternal smoking and alcohol consumption during pregnancy is detrimental to both the mother and fetus, increasing the risk of intrauterine growth retardation, obstetric complications and adverse health effects. Maternal smoking during pregnancy affects foetal growth and birth weight causes spontaneous abortion, abnormal bleeding during pregnancy, premature detachment of the placenta, premature rupture of the membranes and perinatal mortality. Smoking in the second and third trimesters of the pregnancy seems to cause these complications. Babies born to smoking pregnant women are on average 200 grams lighter than babies born to non-smoking mothers because of the reduction of placental blood flow that results in a reduction in the nutrient level reaching the foetus. Reduced birth weight increases the risks of diseases and infant death. Foetal miscarriage has been found to be higher in such smoking women. Maternal smoking also induces preterm births. Breastfeeding women who smoke have been found to have lower levels of prolactin, which is essential for the breastfeeding and thus causes reduced breastfeed. Smoking in pregnancy seems to have an adverse on the physical growth and intellectual development of the child associated with a reduced height and intellectual attainments. Women who consume alcohol during pregnancy are at a high risk of having babies with fetal alcohol syndrome, which results in fetal growth deficiencies, problem in the nervous system, comparatively lowered intelligence, and facial abnormalities in the babies. It is also popularly called fetal alcohol spectrum disorder. Pregnant women who drink 10 to 15 units of alcohol a week have been found to have underweight babies. Consuming alcohol during pregnancy also affects foetal development affecting the baby at birth increasing disease susceptibility and cognitive abilities. Pregnant women who consume more than six units of alcohol per day have been shown to be at risk of having babies with foetal alcohol syndrome (FAS).
Elderly adults are a significant group of patients who need ‘specific nurse care’ and this need is the basis of geriatric nursing practice. The older adults are more prone to falls and injury than other patients due to their age and accompanying disease symptoms. Their cognitive impairments further add up to their chances of a fall and subsequent serious injuries. A fall can be defined as a sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground (Feder et.al, 2000). Several preventive strategies have proven effective to reduce the occurrence of falling and the nurse plays a preventive role by reducing the rate of falling in the elderly community. Falls and fall injuries in elderly population results in functional decline and meets all the criteria for prevention like high frequency, evidence of preventability, and high burden of morbidity (Tinetti et.al, 1998). A physical examination and focus on the patient history after a fall reveal both the immediate underlying causes of the fall and contributing risk factors. Regular evaluations also help identify high risk patients (Rubenstein et.al, 1994).
Hepatitis C refers to a blood borne viral disease caused by a hepatotropic virus called HCV or Hepatitis C virus. HCV infection causes inflammation of the liver and liver cirrhosis at later stages. HCV typically spreads by blood transmission. Nurses are occupationally exposed to HCV infection by accidental exposure to infected blood by needles and sharps. Professional precautions reduce the risk of exposure to HCV in nurses.
Evidence Based Nursing
Nurses are under increasing pressure to keep up to date and to take decisions more firmly on evidences in contrast to the anecdotal information of the past. The most important aspect of evidence-based practice is that it provides a scientifically accountable method for making best-practice decisions that ensures professional transparency. Evidence based practice provides nursing practice with a stronger application of scientific methods (Baum, 2003). Evidence based practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the case of individual patients (Sackett, 1996). Trisha Greenhalgh et.al (2003) view evidence based practice as a sequence of framing a focused question followed by a thorough Search for research derived evidence supported by the appraisal of the evidence for its validity and relevance incorporating the user's values and preferences.
In This Issue
Agency San Francisco
San Francisco, California
Charles L. Berman
Liz Di Bernardo