Wednesday, July 23, 2008

Sports Related Concussions, Part 2

By Jean M. Walsh, RN
Trauma Coordinator

As I wrote last time, a concussion, also known as a mild traumatic brain injury (MTBI), is caused by a bump, blow, or jolt to the head or body that causes the brain to move rapidly inside the skull. Quite simply, a concussion alters how the brain normally functions. Concussions can have serious long term health effects and even a subtle “ding” or “bump” can be serious.

According to the Center for Disease Control, it is estimated that nearly 1.6 to 3.8 million sports and recreation concussions occur in the United States each year. Youth 5-18 years of age account for over 2 million sports related emergency room visits per year. Of these visits, nearly 6% or 135,000 involve concussions. Football accounts for nearly 60% of these concussions while bicycling, basketball, soccer and other playground activities round out the top five causes.
If you are a parent or a coach and you believe one of your children or players has suffered a concussion you should:

· Remove the player from the competition immediately.
· Never leave the player alone.
· Get a professional medical evaluation.
· Avoid contact or collision sports for at least 3 weeks.
The 911 system should be activated in the following situations:
· Severe head trauma
· A fall from a height greater than the height of the person
· Prolonged loss of consciousness (greater than 2 minutes)
· Unequal pupils
· Severe Nausea/Vomiting
· Confusion/Perseverating that does not go right away/Restlessness/Agitation
· Extreme drowsiness, weakness or inability to walk
· Severe headache/Slurred speech

A child with a grade III concussion will need to be evaluated by a physician in an emergency setting. A full neurologic exam will be performed to check reflexes, vision, hearing, pupil response, balance, memory, concentration, and coordination. A brain CT scan will be performed to check for any bleeding or bruising in the brain tissue. Admission to the hospital for neurologic observation may also be necessary.

Returning a child to sports after a concussion should be a well defined 4 step process:

1. This should be a gradual process and should be done under the supervision of qualified people. When the player does not have any symptoms, they may be able to do light exercise, stationary cycling or walking.
2. The next step is to do sports specific activity without contact for example running. If there are any symptoms returning then take a step back.
3. Next step is on field practice without contact. Again, any symptoms indicate a return to the previous stage.
4. When a medical doctor has given the go ahead on field practice with contact can begin. The time taken to get to this stage will depend on the severity of the concussion.
Long term consequences of repeated concussions are functional changes that affect thinking, language, emotions, behavior, and sensations. There may be an increased risk of seizure disorders, Alzheimer’s and Parkinson’s disease. Premature return to play can cause permanent neurologic disability from cumulative trauma, death from secondary impact and post concussion syndrome.

Some ways to prevent concussions and their severity are to, wear appropriate headgear at ALL times. Learn proper techniques for tackling opposing players and heading a soccer ball. Understand and recognize the symptoms of a concussion. Never allow an athlete to play if you suspect a concussion. The effects both short and long term are simply not worth it.

Tuesday, July 15, 2008

The 5 Rights of Dispensing Medication

By Laura Dillon
Service Coordinator
Saint Francis Home
Care Services, Inc.

Caregivers assume many responsibilities in order to keep their loved ones safe at home. And if you are a caregiver for a loved one at home, chances are that at some time you have had to tackle the task of dealing with your loved one’s medications. This includes calling a prescription into the pharmacy, picking up medications, dispensing medications or helping organize and fill your loved one’s pill box.
If your loved one takes multiple medications, you know that filling a pill box can take extreme concentration and organization. And although it is often a daunting task as several bottles of medication lie before you week after week, let’s remember that medication compliance is extremely important for your loved one’s health and well being.
With that in mind, before giving a loved one any medication, remember to read each medication label to check for the “5 Rights” - Right Person, Right Medication, Right Dose, Right Time, and Right Route. Here is why checking the labels can be so important:

1. Right Person: Make sure that the name on the bottle matches who will be receiving the medication. This step seems self-explanatory and obvious however, if more than one person living in the home takes medications it is easy to mix them up. Often people have a tendency to store all medication in the kitchen as a visual reminder to take the medication either at a meal time or with food. Instead, each resident of the home should have a separate place to store their medications. If pill boxes are used, make sure to clearly label each box with the proper patient name. Do not trust that you will remember a color-coded system.

2. Right Medication: If you are a caregiver to someone who takes more than two medications you know how confusing labels can be. A patient may be taking one medication and suddenly their physician switches them to the generic version. Make sure to ask the physician if you are unsure what the medication is for or if a generic medication was prescribed as a “substitute.” (Hint: To make life easier for yourself as well as medical professionals in case of an emergency, keep an updated list of medications handy and make sure to update it after each doctor’s appointment.) If the physician no longer prescribes a medication to your loved one, discard the old medication and bottle immediately. If it is not discarded, it may accidentally find its way back into your box of medications. Also, do not reuse old, expired medication bottles to store new medication. A healthcare professional would not be able to administer these medications and it may also confuse the patient and caregivers. Additionally, remember that the manufacturers of the medications may change without notice, thus changing its size, shape and/or color. Do not assume what the medication is just by the way it looks! To be safe, keep all medications in their respective bottles unless putting it directly from the bottle into a pill box.

3. Right Dose: Know the correct dose of each medication. A physician may change the dosages of medication at any time, especially medication that has been prescribed for only a short time period or one whose dose depends on how a patient is reacting to it. Stay current on the dosages so as to not over or under medicate your loved one. Do not adjust dose amount without consulting your physician! Although medications can often be costly, “cutting back” on how many pills you take in order to save money can be very dangerous.

4.Right Time: Be sure to know when your loved one should take their medication. Many times there is a reason the medication should be taken at the time specified. The medication may not interact well with food or may cause drowsiness or alertness. If you have concerns about how a medication is affecting your loved one, consult your physician. Do not change medication times prior to a physician consultation.

5. Right Route: Always know how the medication should be taken (orally, inject able, etc.) and follow the instructions properly.
Hopefully the “5 Rights” will help caregivers remember the importance of carefully and correctly reading their loved one’s medication labels. Next time we’ll take a look at alternatives available through Saint Francis Home Care Services, Inc. if a caregiver is no longer able to assist with their loved one’s medications.

Tuesday, July 1, 2008

Caring for Wounds, Big and Small

By Frances T. Traver
Clinical Manager

Most of us have cared for some type of wound. You cut your finger, wash it out and put on a Band Aid. However, when you’ve been hospitalized or injured the wounds may be much more complicated and frightening. Despite the size or type of wound, the principles to healing wounds are the same.
There are many different types of wounds. You may have had surgery and need to care for the incision. You may have been bedridden for awhile and had a sore as a result of pressure. You may have burned your hand. All these wounds need some type of care to heal. Whatever the care, the wound needs to be protected from trauma or infection. Your doctor and/or nurse will direct you as to which treatment is best for your wound.
There is a saying that a wound is not a hole in the patient but rather the whole of the patient makes the wound. Your overall condition plays a big role in the healing of any wound. If you have chronic disease, such as diabetes, it will take longer for your wound to heal. A proper diet is important in healing a wound. Certain medications may also slow the healing process of a wound. Your nurse can help you understand your individual condition and discuss how it may be affecting your wound healing.
Here at Saint Francis Hospital, Home Care Services (Certified), Inc. we are blessed to have Helen Bunyi, RN, one of the best wound care nurses working with us. She has recently been recognized as the New York State Nursing Association’s District 19 Clinician of the Year and was honored for nursing excellence by our hospital. But more importantly, our patient’s are always grateful to her. She always seems to know how to heal that wound which just won’t heal.
So don’t be afraid of your wound, there are people to help. You doctor will give you the treatment to best help heal your wound. You need to help heal your wound with good nutrition and chronic disease management.