7 Spanish Healthcare Phrases You NEED to Know

Did you know that the United States is now the world’s second largest Spanish-speaking country after Mexico, and the US Census Office estimates that the US will have 138 million Spanish speakers by 2050? Learn these 7 must-know phrases for healthcare providers…

Did you know that the United States is now the world’s second largest Spanish-speaking country after Mexico, and the US Census Office estimates that the US will have 138 million Spanish speakers by 2050?

Don’t let a language barrier impact your quality of care! Learn these 7 must-know phrases for healthcare providers from presenter Tracey Long, RN, PhD, MS, CDE, CNE, CHUC, COI, CCRN.


Tracey Long, RN, PhD, MS, CDE, CNE, CHUC, COI, CCRN, has been an RN and Nurse Educator for 28 years, teaching courses in Medical Spanish, Diabetes Education, Cultural Competence, Critical Care, and Global Nursing. She has lived in Spain and served as a health welfare missionary in Colombia, South America for 18 months. She serves as faculty for International Service Learning with nursing students in Belize, Peru, Colombia and Costa Rica providing free medical clinics in underserved areas. With a passion for active learning, and as an international speaker and award winning educator, Tracey helps students not just memorize, but truly learn the content material needed to successfully master skills and learning.


Spanish for Healthcare Providers: A self-paced
online course

Are you ready to learn Spanish in an effective, non-threatening language learning experience, with “real-life” instruction geared for today’s busy professional? Sign up now to get instant access to the Spanish vocabulary medical personnel need to know.

Spanish

Wound Care Challenges: Physical Therapy Strategies to Support Healing

Four questions may guide you in assigning etiology of areas of the trunk where moisture may be a contributing factor. Do you know what they are?

Physical therapy modalities of ultrasound, E-stim, and sharp debridement allow for aggressive treatment of wounds. Some deficits may occur in etiology treatment of skin issues traditionally not managed by therapists, such as moisture-associated skin dermatitis.

Four questions may guide you in assigning etiology of areas of the trunk where moisture may be a contributing factor:

  1. Where is the wound located on the body?
  2. What is the appearance of skin/wound?
  3. What is the clinical history?
  4. What are the best treatment options?

Below are examples of the answers to these questions as well as treatment options per four etiologies of the trunk.

Incontinence-Associated Dermatitis

  1. Location
    • Perineal, buttocks, thighs
  2. Appearance
    • Superficial
    • With or without fungal component
  3. History
    • Persistent or recurrent incontinence
    • Fecal and/or urinary
  4. Treatment Options
    • Resolve incontinence when possible through toileting, thickening stool, eliminating aggravating factors
    • Contain incontinence through super absorbent polymer (SAP) briefs/pads
    • Protect/treat skin through emollients (lanolin, mineral oil, petroleum types) or crusting applications (copolymer powders & skin barrier wipes/sprays)

Intertriginous Dermatitis

  1. Location
    • Base of body fold
    • Opposing surfaces of body fold
  2. Appearance
    • Linear opening/break in the skin
    • Shallow kissing lesions
    • No ischemia
  3. History
    • Diaphoresis
    • Trapped moisture
  4. Treatment Options
    • Separate wet skin folds
    • Use wicking products for weeping skin folds
    • Drying powders or skin barrier wipes

Friction

  1. Location
    • Fleshy skin areas in contact with linens, bed, or chair
    • Heel or area that rubs against linen, etc.
  2. Appearance
    • Skin moist or fragile
    • Serous blister over heel
    • No ischemia
  3. History
    • Patient restless
    • Fragile skin
    • Frequent perineal cleansing
  4. Treatment Options
    • Manage moisture
    • Protect skin in agitated patients
    • Emollients or skin protectants for prevention/treatment
    • Early recognition

Pressure Ulcer

  1. Location
    • Over bony prominence
    • Under medical device
  2. Appearance
    • Defined edges
    • Tissue ischemia
  3. History
    • Periods of immobility
    • Compression by device
  4. Treatment Options
    • Redistribute pressure and envelopment within a surface
    • Moisture management via surface & wicking products
    • Debridement
    • Infection prevention/treatment
    • Nutrition

This blog was brought to life by PESI speaker and author Kim Saunders, MSN/ED, RN, CWON®, CFN. Kim Saunders has 18 years as a wound, ostomy, and continence expert in home health, acute care, hospice, and outpatient settings. Kim consults for patients related to wounds, ostomy, and incontinence-associated dermatitis. Her experience includes healthcare system-projects related to bed, stretcher, and wheelchair surfaces as well as system processes for skin and wound issues. She also is a co-owner of WOC Consulting, LLC.


Our new Intensive Skin and Wound Care Course will have you feeling confident treating patients regardless of where you’re practicing right now or where you might be practicing in the future.

LEARN MORE

WoundCourse

More Than Just Memory Loss: Not all dementia is created equal

By 2050 51% of adults aged 65 or older in the United States will have Alzheimer’s disease if we don’t find a cure. As a healthcare provider, this means that you will continue to see an increase in dementia cases in your practice. These patients are challenging and each case requires care tailored to your patients unique needs. Are you prepared to help them?

Dementia is not a specific disease. Instead, it’s a general term that describes a wide range of symptoms that affect the ABC’s of life: Activities of Daily Living (ADL’s), Behavior and Cognition. With the decline in memory, so too is there a decline in ADL’s. Behaviors are an unfortunate symptom that commonly accompanies the disease, but not all dementias are created equal. Knowing the type of dementia a patient has, can help in tailoring how the disease is treated. It also helps in understanding what types of functional or behavioral symptoms a patient may be expected to have.

Are you up-to-date with the most current dementia types? Are you familiar with what treatments may be the most effective for them? Do you know what medications are FDA approved for Alzheimer’s dementia? Answer the questions below to test your knowledge base.

1. What are the medications that are FDA approved for Alzheimer’s dementia?

There are four different medications prescribed for Alzheimer’s dementia. They include:

  • Donepezil (Aricept)
  • Rivastigmine (Exelon)
  • Galantamine (Razadyne)
  • Memantine (Namenda)

2. Which dementia type is the most common: Alzheimer’s, Parkinson’s Disease Dementia, or Dementia with Lewy Bodies? 

Alzheimer’s dementia is the most common dementia affecting about 5.3 million Americans. Age is the most common risk factor to developing this disease. Alzheimer’s currently affects approximately 1 in 9 adults aged 65 and greater, but it affects 1 in 3 adults age 85 or older. Given older adults are the fastest growing population in the country, if a cure for Alzheimer’s is not found by 2050, 51% of adults aged 65 or older in the United States will have Alzheimer’s disease.

3. Do people with Parkinson’s Disease get dementia?

Approximately 20% of people with Parkinson’s Disease get dementia. It is rare for a Parkinson’s patient to get dementia. This disease is characterized by more of a movement disorder causing bradykinesia (slowness of movement), tremor, hypophonia (a weak and sometimes soft voice), a stooped posture and a mask-like face. Memory stays intact for a very long time though. Of all the dementia types, Parkinson’s Disease Dementia only accounts for approximately 5% of those with dementia.

4. Can you diagnose dementia with a memory screen? 

There is no single test that is routinely done to diagnose dementia. In fact, brain biopsy is still considered the gold standard for diagnosis of Alzheimer’s Disease. However, given the likelihood of complications by such an invasive procedure, most doctors will rely on a careful medical history, a through physical exam, lab tests, possibly request imaging studies, and discuss characteristic changes in thinking as well as day-to-day functional changes that may be occurring. A cognitive screen is just one of many tests that should be done in order to rule in dementia but as a screening tool alone, a “memory test” is a poor individual tool.

5. Do patients with Dementia with Lewy Bodies oftentimes hallucinate?

Patients suspected of having Dementia with Lewy Bodies nearly always hallucinate. Those hallucinations are oftentimes vivid and real enough that even practitioners can be fooled by how true they seem. And although other dementia types can cause hallucinations too, it is one of the most distinguishing features of this disease.

6. What risk factors increase your risk of getting Alzheimer’s Dementia?

Age is the biggest risk factor for developing Alzheimer’s Dementia and although genes do play a role in this disease, it is less significant than what a lot of people realize. Research has shown us that risk factors such as: controlling hypertension and cholesterol; cardiovascular factors; exercising and not smoking; physical factors; managing cholesterol and blood sugar; and maintaining a healthy diet have been shown to be powerfully influential for PREVENTING this disease.


This blog was brought to life by PESI speaker Steven Atkinson, PA-C,  MS.

Steven Atkinson is a Board Certified Physician Assistant specializing in geriatric internal medicine. In his work with older adults, he is directly involved with the unique pharmacological challenges faced by the geriatric population on a daily basis. In addition to patient care, Steven has been an educator at the University of Utah since 1994.His published works include the book, “Geriatric Pharmacology: The Principals of Practice & Clinical Recommendations” as well as materials in several regional publications promoting mental and physical health.


If older adults are routinely under your care, minimize your risk of escalating the problems associated with troublesome, often irrational behavior by viewing Challenging Geriatric Behaviors: A comprehensive and dignified approach to care.

$199.99 now $99 when you use promo code DEMENTIA0416 at checkout.

LEARN MORE

Geriatric_Banner

*Offer valid through Saturday, April 30, 2016 at 11:59 pm (CST). Not valid on previous purchases or combined with other offers. Select product only. 

The 3 Most Important Questions When Treating a Wound

Assessing a wound is never just about the ‘Polaroid’ picture. The skin being the largest organ, doesn’t fail on its own. It is affected by other factors. Thus, when treating a wound, start with 3 important questions…

Assessing a wound is never just about the ‘Polaroid’ picture. The skin being the largest organ, doesn’t fail on its own. It is affected by other factors. Thus, when treating a wound, you need to start with 3 important questions:

1. What is the wound etiology? Four examples can occur on the perineal/sacral/trunk area of the body and can be confused when assigning etiology.

  • Pressure ulcers present as well-defined edges caused by an ischemic injury to the tissue over the bone or under a medical device. They are bottom up tissue injuries that usually take longer to heal than superficial top-down injuries.
  • Moisture-associated skin damage occurs peri-stomal, peri-wound, incontinence-associated, or intertriginous dermatitis (skin folds). This top-down, irregular-edge skin damage occurs from hyper-hydrated skin. Primary goals including moisture containment and prevention/treatment of skin.
  • Friction is top-down superficial skin damage caused by the skin rubbing against something else. It can present like a blister from a shoe, or it can present initially like a patchy, irregular-edge appearance on the fleshy part of the buttocks as they rub on the bed-sheet.
  • Shearing is bottom-up damage caused by blood vessel distortion. It presents with irregular edges, often linear in the direction of the damage, and is the culprit of undermining in pressure ulcers.

2. The next question should focus on the patient as a person: What are the ‘life goals’?

  • Is the patient palliative care or hospice? If so, your goals should focus on quality of life: minimize trauma, control odor, manage excess exudate, prevent deterioration & infection, and optimize pain management.
  • There are many topical wound products that can assist in this management to support any systemic medication needed.

3. Thirdly, what are the wound healing goals (comfort, maintenance, healing)?

  • Comfort is the usual goal at end of life. Focus on goals for palliative care, and keep wound care simple.
  • Maintenance is the goal when healing is unlikely because we are unable to correct the etiology. Focus on preventing infection and monitor wound presentation. Manage wound exudate. Use passive dressings such as alginates, foams, gels, etc.
  • Healing is the usual goal with a comprehensive approach of etiology, systemic support, and topical therapy per wound presentation. Measure weekly and consider active therapies that change the tissue, add a matrix, or promote angiogenesis if wound size doesn’t progress by 30-40% in 3-4 weeks.

Of course there are more questions in the assessment of a wound and the etiology work-up. However, these three questions are foundational in the next steps of diagnostics, topical and/or systemic treatment, and possible referrals.


CASE EXAMPLE:  A 76 year-old man with a sacral stage IV pressure ulcer is a full code. Diagnostics reveal he has sacral osteomyelitis. The patient does not desire surgery or antibiotics intravenously. He is not palliative care. His wound goals are maintenance because wound healing is unlikely due to the inability to correct/treat the osteomyelitis. Thus, our goals are to prevent symptomatic infection (pain, induration, fluctuance, odor) through passive dressings that manage drainage and address local bacterial count as needed (methylene blue/gentian violet dressings, silvers, manuka honey). Contraindicated active/adjunct therapies include negative pressure wound therapy (angiogenesis), bioengineered skin grafts, or collagen products (matrix and tissue changes). Monitor wound presentation and alter topical wound dressing as needed.


Always remember…

Skin and wound assessment can be challenging and rewarding at the same time. The wound bed and skin presentation will give you hints as to its needs; You just have to be able to interpret the presentation and know the products that will help you achieve wound bed homeostasis.


This blog was brought to life by PESI speaker and author Kim Saunders, MSN/ED, RN, CWON®, CFN. Kim Saunders has 18 years as a wound, ostomy, and continence expert in home health, acute care, hospice, and outpatient settings. Kim consults for patients related to wounds, ostomy, and incontinence-associated dermatitis. Her experience includes healthcare system-projects related to bed, stretcher, and wheelchair surfaces as well as system processes for skin and wound issues. She also is a co-owner of WOC Consulting, LLC.


Our new Intensive Skin and Wound Care Course will have you feeling confident treating patients regardless of where you’re practicing right now or where you might be practicing in the future.

LEARN MORE

WoundCourse

Q and A: Venous ulcers with concurrent lymphedema

Have you ever treated that wound that you just can’t get to heal even with proper assessment and treatment? There are always those few wounds that challenge our skills, and without a solid understanding of the complexities of mixed etiology, we may actually cause harm. Here are the three most commonly asked wound care questions by clinicians…

Venous ulcers account for 70-90 percent of all lower extremity ulcers in the United States. In addition, upwards of one million of these venous patients have concurrent lymphedema. In spite of this staggering statistic, most will heal well with proper assessment and treatment.

There are, however, those few wounds that challenge our skills, and without a solid understanding of the complexities of mixed etiology, we may actually cause harm. Here are the three most commonly asked wound care questions by clinicians…

Q. I routinely use compression on my venous ulcer patients with good success. This week, however, when I removed a four layer compression wrap, my patient had blistered in multiple places. What could have caused this?

Barring any sensitivity to the cast padding layer, the most common reason for blistering under compression is an underlying diagnosis of lymphedema. While venous wounds respond exceptionally well to this type of compression (known as long stretch wraps), lymphedema will worsen.

Long stretch means the wrap is giving constant and continual compression. Fragile lymphedema channels will be cut off from normal flow causing a backup of lymph leading to blisters. Patients with lymphedema should only use short stretch wraps which give compression only when the patient is walking; at rest there is no compression allowing for proper lymphatic drainage.

Q. How can I tell if my patient has lymphedema?

A simple test called the Stemmer Sign is a quick assessment tool. An inability to pinch a fold of skin at the base of the second toe is indicative of lymphedema.

Q. I have tried multiple topical antimicrobials, even those able to kill MRSA and VRE, and still my patient’s wound looks dull with no bright, beefy granulation. It has a thin vail of yellow slough throughout the bed. My patient has had this wound for over 10 years. She has good arterial flow, yet compression for over 4 weeks has yielded no result. What could be wrong?

Chronic wounds often develop a biofilm. Biofilms are bacteria and fungi encapsulated in a thick, sticky barrier made of polysaccharides and proteins. These protect the bacteria from external threats and attach it to the wound surface rendering antimicrobials and wound cleansing ineffective. The only way to eliminate them is with low frequency ultrasound treatment or surgical debridement.


Have more questions about venous disease and lymphedema? Get the answers in this FREE 2 hour CE Seminar: Venous Disease & Lymphedema Assessment and Treatment Strategies. BONUS: Get up to 1.8 free CE Hours for watching.

VenousDiseaseFreeCE


This blog was brought to life by PESI speaker Cheryl Aaron, PT, DPT, CWS. Cheryl has over 36 years of hands-on experience in physical therapy and wound care. Her clinical practice, specializing in all aspects of wound care, has encompassed a variety of settings, including: acute care, subacute, long-term care, and private practice. In her current role, she is responsible for the educational and consultation needs for multidisciplinary professionals. She established an advanced wound management program and is responsible for clinical competency within the wound care team for nursing and physical therapy staff.

3 Common Cardiac Assessment Questions

Although each area of physical assessment has its own art and mystery, many report struggling the most with cardiac assessment. Here are three common questions about cardiac assessment and their answers.

A thorough assessment of your patient is like an adventure in hunting, and it enables you to make sense of the clues to your patient’s current health status. But in order to find and understand those clues, one must have a strong foundation in their assessment skills. Although each area of assessment has its own art and mystery, many report struggling the most with cardiac assessment. When teaching assessment programs, I repeatedly hear some common questions. Here are three of those questions and their answers.

Q. What does it mean when I hear an S3 heart sound, and where can it be heard the clearest?

An S3 is the most commonly heard extra heart sound in adults and is heard with fluid volume overload, such as that related to heart failure. Left-sided heart failure is heard best at the mitral valve location. Remember, S3 heart sounds are soft and subtle, so a quiet environment is necessary when listening for one. Frequently, S3 sounds are heard best in the left lying position, shifting the heart towards that part of the chest wall. This extra heart sound is heard right after lub (S1) and dub (S2), leading to pneumonic Kentucky—a short extra sound tagged on to the end of S1 and S2. One last reminder – after the fluid volume overload is resolved, an S3 heart sound will no longer be heard, and we go back to just hearing S1 and S2.

Q. Are there clues on auscultation to whether a heart murmur is systolic or diastolic?

In reality, the distinction between systolic and diastolic is not hard to tell. First, identify the swooshing sound of a murmur being present. Then listen again to identify where in the cycle you hear it. Is it between S1 and S2? If so, that is a systolic murmur. If you hear it between S2 and S1, then that is a diastolic murmur. Ironically, even though systolic murmurs are often benign or functional (medically managed unless severely symptomatic), they are often the louder of the two.

Q. How do I tell the difference in my cardiac assessment findings between  right- or left-sided failure?

Visualizing blood’s journey through the body may help us see clues to right- or left-sided failure. Before the blood hits the right side of the heart, it comes from the body. Blood makes its journey to the tissues dropping off oxygen and picking up carbon dioxide (CO2), and then journeys up the superior vena cava to the right side of the pump. If the patient is having right-sided heart dysfunction, blood backs up to the body causing systemic symptoms, such as lower extremity edema, jugular vein distention, and engorgement of the liver. If the liver engorges enough, the patient may start to develop ascites.

From the right side, blood goes to the lungs and then to the left side of the pump. If a patient is having left-sided pump dysfunction, blood backs up the lungs and the patient experiences pulmonary symptoms. These may include dyspnea, hypoxia, the development of rales (crackles in the bases), and orthopnea (when patient lies flat, they feel they can’t breathe).

Now that being said, I need to remind you: The most common cause of right-sided failure is severe left-sided failure, where blood finally backs up to the right side of the heart. Those patients have both pulmonary and systemic symptoms. Many of the patients you work with may have this mixed failure.

Were you able to answer these questions? Has it lead you to pondering more cardiac questions? Or perhaps you have questions about other aspects of the physical assessment. To give the best care to our patients we need to understand how to find the clues and decipher what they are telling us.


Are you hungry to learn more about physical assessments? Get a free hour of CE when you watch Mastering the Neurological Assessment with Cyndi Zarbano.

FreeCE_Zarbano


PUB074500
Get quick access to essential reference information. This full color pocket guide is filled with descriptive images for effective physical assessments. Available now!

This post was brought to life by PESI speaker Cyndi Zarbano, MSN, BSN, CCRN, CMSRN, CLNC, NLCP. Cyndi is an intensive care nurse with over 20 years of nursing experience who is currently practicing in the Twin Cities area of Minnesota. She is a nationally-recognized seminar speaker who has opened multiple national symposiums and speaks on several topics for PESI, as well as a variety of other companies in the US and Canada. Her national acclaim is well deserved for her ability to make knowledge practical, as well as encouraging knowledge retention by her frequent use of stories, humor and case studies.

 

6 Questions to Test Your Diabetes IQ

Every patient you see is unique, and so is their diabetes treatment plan. Diabetes care is constantly evolving as we continue to learn more about the disease and the way it affects the body. Are you up to date with the most current diabetes knowledge? See if you can answer the 6 questions listed here.

Every patient you see is unique, and so is their diabetes treatment plan. Diabetes care is constantly evolving as we continue to learn more about the disease and the way it affects the body. Are you up to date with the most current diabetes knowledge? See if you can answer the 6 questions below.

Q: What new medications are available for Diabetes Mellitus?

There are now 8 classes of medications available to treat Type 1 diabetes (T1DM) and Type 2 diabetes (T2DM) respectively. They include:

  • Sulfonylureas
  • Biguanides
  • Meglitinides
  • Thiazolidinediones
  • DPP-4 inhibitors
  • SGLT2 Inhibitors
  • Alpha-glucosidase inhibitors
  • Bile Acid Sequestrants

Q: What are the differences between T1DM and T2DM?

T1DM is absolute insulin deficiency caused by an autoimmune response, which attacks the beta cells of the pancreas and represents less than 10% of all cases of diabetes. It generally occurs in children and in the past was called Juvenile diabetes.

T2DM is a relative insulin deficiency and insulin resistance and represents 90% of all people with diabetes. Often 75% of those are overweight or obese, thus the name “diabesity” has been coined representing the obesity and diabetes epidemic in the United States.

Q: Have you wondered what LADA and MODY mean?

LADA stands for Latent Autoimmune Diabetes of the Adult and has been termed “Diabetes 1.5” as it manifests clinically as T1DM but occurs in an adult who requires insulin management.

MODY stands for Mature Onset Diabetes of the Young and manifests clinically as T2DM with overweight or obesity but in children.

Q: Do you know what MDI and CGM are?

MDI is an acronym for Multiple Daily Injections and means a person is receiving several injections of insulin each day. CGM stands for Continuous Glucose Monitoring and is a monitor applied below the skin for generally 7 days to read changing blood glucose levels throughout the day minute by minute instead of just one data point after a finger stick sugar reading.

Q: Did you know that inhaled insulin is now available again?

Afrezza by Sanofi is inhaled fast acting insulin and given generally before meals to help with post prandial (after meal) high blood sugar levels. After nasal insulin was recalled by the FDA for too many respiratory complications several years ago, the new Afrezza offers insulin without injection and hope for many people with diabetes.

Q: Are you aware of current research on the artificial pancreas technology?

The artificial pancreas is the use of technology that combines the continuous subcutaneous insulin infusion (CSII) “insulin pump” and continuous glucose monitor (CGM). They work together to measure blood glucose levels in real time and automatically deliver the required insulin. Several companies are racing to provide the method to truly respond how the natural pancreas works within us and will revolutionize the management of diabetes mellitus.


If diabetes mellitus isn’t a “sweet topic” to you because you’re not up to date, then fear no more! Taking an online course where you learn at your own pace can provide you with a strong foundation for understanding the basics and beyond about diabetes mellitus. Learn more about the new diabetes online course on sale from $220 to $174.99


This blog was brought to life by PESI speaker Tracey Long, PHD (C), RN, BSN, MS, MSN, CDE, CNE, CHUC, CCRN. Long has over 28 years of nursing experience working in critical care & cardiology. She developed Spanish programs in health education and diabetes for local hospitals in Las Vegas, and currently, she is faculty of nursing at the College of Southern Nevada. With a passion for active learning, and as an international speaker and award winning educator, Tracey helps students not just memorize, but truly learn the content material needed to successfully master skills and learning.