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Use of Psychotropic Drugs in Juvenile

Behavior Modification.

By: Dr. Betrand N. Okwesili, M.B.B.Ch; RNS; CM/DN

Psychotropic substances are chemicals that affect the function, behavior, or experience of the mind. Although their exact mechanism of action is still subject to controversy, they are thought to act upon the biochemistry of the brain through the various neurotransmitters of the brain and hence, affect thinking mechanisms, emotional control, and other behavioral processes. These chemical substances include; Neuroleptics such as Haldol, Anti-psychotics such as Zyprexa, antidepressants such as Prozac, stimulants such as Ritalin, anti-anxiety such as Buspar, and so forth.

Emotional and Behavioral Problems among Children

  • Attention Deficit Hyperactivity Disorder (ADHD) and Learning Disability (LD) – ADHD refers to the developmentally inappropriate degree of inattention, impulsiveness, and hyperactivity. While an LD refers to the heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, mathematical abilities, or social skills. ADHD and LD conditions affect every aspect of a child’s life but are most obvious in the classroom. Early identification of affected children is very important since the characteristics of the disorder significantly interfere with the normal course of emotional and psychological development. Many children develop maladaptive behavior patterns that impede psycho-social adjustments while they try to cope with cognitive dysfunction. 1Their behavior evokes negative responses from others, and repeated exposure to negative feedback adversely affects their self-perception, scholastic competence, social acceptance, and behavioral conduct in children with ADHD.
  • Conduct Disorder or Oppositional Defiant Disorder – This affects 1-4% of 9-17 year-olds. Children with a conduct disorder act out their feelings or impulses in destructive ways, including aggression, lying, theft, setting fires, and vandalism; the degree of offense growing more serious over time.
  • Post-Traumatic Stress Disorder (PTSD) – this refers to the development of characteristic symptoms following exposure to an extremely traumatic experience or catastrophic event. An accident, assault, natural disaster, sexual abuse, or witnessing violence can lead to PTSD. Children with PTSD tend to relive or visualize traumatic experiences for years and retain some fear specific to the event.
  • Depression – before puberty, boys and girls are at equal risk for depression; after puberty onset, the rate of depression is twice as high for girls. Childhood depression is often difficult to detect. Children may be unable to express their feeling and tend to act out their problems and concerns.
  • Substance Abuse – Drug abuse is the regular use of drugs other than the accepted medical purposes and to the extent that it results in physical or psychological harm to the user and/ or is detrimental to society. Drug abuse, misuse, and addiction are culturally defined and are voluntary behaviors. Drug tolerance and physical dependence are involuntary physiological responses to the pharmacologic characteristics of drugs. Most drugs that young people use induces changes in perception, feelings of well-being, a sense of closeness, and a feeling of happiness. In the majority of cases, drug use among children begins with experimentation. The individual may try a drug only once, may use it occasionally or may make it an integral part of a drug centered lifestyle. For many young people, drugs produce a dreamy state of altered consciousness or a feeling of power, excitement, heightened acuity, or confidence. Others seek visual hallucinatory experiences and sexual sensation. Many youngsters use drugs not only for perceptual and sensory experiences but also for social aspects. They use drugs because their peers use them and because they want to “belong”. Any drug can be abused and the chemically active substances most frequently abused are caffeine and theobromines contained in chocolate, tea, coffee, and colas. Ethyl alcohol and nicotine are other substances that although recognized as drugs, are sanctioned by society. These drugs can produce mild to moderate euphoric and/ or stimulant effects and can lead to physical and psychic dependence. Alcohol, a socially accepted depressant, is responsible for the acts of violence, suicide, accidental injury, and death among youngsters. The most remarkable effects of alcohol are on the central nervous system, evidence by lack of coordination, marked mood changes, impaired judgment, impaired memory, and impaired perception. Youngsters often rely on alcohol as a defense against depression, anxiety, fear, or anger. Not all of these signs may be present, but if some are evident, the youngster should be considered at risk and detoxification therapy initiated to ensure safe and complete withdrawal from the drug. Other drugs abused by children include Cocaine (Crack), although pharmacologically not a narcotic but legally categorized as one. Cocaine induces a sense of euphoria and/ or indefinable high. Withdrawal symptoms from cocaine are as dramatic as observed in withdrawal from other substances. Effects include depression, lack of energy and motivation, irritability, appetite changes, psychomotor retardation, and irregular sleep patterns. Other serious symptoms include cardiovascular manifestations and seizures. Narcotics include opiates such as heroin, morphine, meperidine hydrochloride (Demerol), Fentanyl, Hydromorphone (Dilaudid) and codeine. They produce euphoria by removing painful feelings and creating a pleasurable experience, and a sense of success accompanied by clouding of consciousness and a dreamlike state. Signs of narcotic abuse include constricted pupils, respiratory depression, and often cyanosis. Withdrawal from opiates is extremely unpleasant unless controlled with supervised substitutions of Methadone. The use of narcotics has brought many youngsters brouhaha with the legal system. Health problems resulting from self-neglect of physical needs (nutrition, cleanliness and dental care) overdose, contamination, and infection, including HIV infection and Hepatitis B can not be overemphasized. Marijuana – this is a green, brown, or gray mixture of dried, shredded leaves, stems, seeds, and flowers of the hemp plant. Marijuana has many street names including pot, herb, weed, grass, boom, gangster, Mary Jane, or chronic. Other marijuana street names include; sinsemilla, hashish, Indian-hemp, smoke, catch a fire, stone, Igbo, ganja, g-force and so forth. All forms of marijuana are mind-altering. They change how the brain works. They all contain δ-9-THC (Delta-9-Tetrahydrocannabinol), the main active ingredient in marijuana. They also contain more than four hundred other chemicals. Marijuana’s effects on the user depend on its strength or potency, which is directly related to the amount of δ-9-THC it contains. The short term effects of marijuana include; problems with memory and learning, distorted perception (sight, sound, time, touch); trouble with thinking and problem-solving, loss of motor coordination, and increases in heart rate. These effects are even greater when other drugs are mixed with Marijuana. Marijuana can mess up a youngsters schooling, sports activities or clubs, or with the youngster’s friendships with others. If one is high on Marijuana, one is more likely to make mistakes that could embarrass or hurt the individual or others. Individuals who use Marijuana may lose interest in how they look and how they are getting along at work or school and may lead to risky sexual behavior, resulting in possible exposure to sexually transmitted diseases like Human Immunodeficiency Virus (HIV), the virus that causes AIDS.
  • Suicide – this is the act of intentionally killing one’s self. Suicide is the third leading cause of death during the teenage years, surpassed only by death from injury or homicide. Suicide ideation involves a preoccupation with thoughts of committing suicide and maybe a precursor to suicide. Suicide attempt (parasuicide) is intended to cause injury or death. The term parasuicide is used to refer to all behaviors ranging from gestures to serious attempts to kill one’s self. The term does not include intent or motivation. For many adolescents, the motivation for a suicidal gesture or attempt may be obscure, complex, and difficult to articulate. However, all suicidal activity should be taken seriously and should not be taken lying low.
  • Eating disorders _ 2Obesity is defined as an increase in body weight, resulting from an excessive accumulation of body fat relative to lean body mass. Children are considered obese when their weight exceeds the 95th percentile for their age, gender, and height, on the NCHS growth charts. Anorexia Nervosa (AN) is an eating disorder characterized by a refusal to maintain minimally normal body weight and by severe weight loss in the absence of obvious physical causes. It occurs predominantly in adolescent or young adult females, and the incidence is increasing. Bulimia – This is an eating disorder characterized by binge eating. This consists of secretive, frenzied consumption of a large number of high caloric foods during a brief period. The disorder is observed more frequently in older adolescent girls and young women.

Psychotropic drugs that may be encountered in juvenile behavior modification

Medication – Ritalin, Concerta

Indications/ Symptoms – ADHD, LD, Inattention, Distractability, agitation, behavior problems.

What nurse should watch out for – Nervousness, insomnia, decreased appetite, weight loss, headaches, skin rash, jitteriness, and social withdrawal.

Medication – Prozac

Indications/ Symptoms – Depression, obsessive disorder, panic disorder, bulimia nervosa, anorexia nervosa.

What nurse should watch out for – Anxiety, nervousness, insomnia, mania, agitation, decreased appetite, rash or hives, thoughts of suicide, attempted suicide, or actual suicide in rare cases, seizure.

 

Medication – Depakote, Lithium CO3

Indications/ Symptoms – Severe change in mood, hypersexuality, overly inflated self-esteem, increased energy.

What nurse should watch out for – Nausea, drowsiness, dizziness, vomiting, abdominal pain, headache, tremor, severe pancreatitis, and liver disease.

Medication – Risperdal, clozaril, zyprexa, seroquel.

Indications/ Symptoms – Schizophrenia, Bi-polar disorder, mania.

What nurse should watch out for – Hyperglycemia, diabetes mellitus, hypertension, cognitive or motor impairments. Rare: serious cardiac and neuromuscular effects.

Medication – Wellbutrin, Buproprion, Propranolol, buspirone.

Indications/ Symptoms – Anxiety, shakiness, jumpiness, trembling, tension, muscle aches, fatigability, inability to relax, twitching, depression, panic attacks, aggressive behavior.

What nurse should watch out – Dizziness, nausea, headache, nervousness, light handedness, excitement, slowness, or sedative effects. Agitation. anxiety, insomnia, hypertension, possible hallucinations, or delusions, weight loss, dose-related risk of seizure, excessive tiredness, upset stomach, vomiting, rash, diarrhea, difficulty breathing, sore throat, unusual bleeding, swelling of feet or hands, low heartbeat, chest pain fever, and depression.

Medication – Paxil, Zoloft, Celexa, Anafranil.

Indications/ Symptoms – Depression, obsessive-compulsive disorder, panic disorder.

What nurse should watch out for – Anxiety, nervousness, insomnia, mania, agitation, decreased appetite, rash or hives, thoughts of suicide, attempted, or actual suicide.

Medication – Remeron

Indications/ Symptoms – Depression.

What nurse should watch out for – Drowsiness, weakness, dizziness, dry mouth, increased appetite, weight gain, constipation.

Medication – Trazodone

Indications/ symptoms – Depression, anxiety disorder, sleeplessness.

What nurse should watch out for – Drowsiness, weakness, dizziness, dry mouth, increased appetite, weight gain, constipation.

Medication – Trileptal

Indications / symptoms – Convulsion, seizure

What nurse should watch out for – Drowsiness, dizziness, dry mouth, constipation, nausea, vomiting, headache, rash, and fatigue.

Medication – Lexapro

Indications/ Symptoms – Depression, generalized anxiety disorders

What nurse should watch out for – Nausea, vomiting, diarrhea, constipation, upset stomach, loss of appetite, drowsiness, dizziness, dry mouth, trouble sleeping, back pain.

Due to the controversy surrounding the use of psychotropic drugs in children, it is the responsibility of the nurse to monitor, document, and report to the appropriate prescribing individual the presence of any side effects of these medications on the child involved. In many institutions, the trough level of these medications is obtained from time to time to monitor the toxicity level of the medication.


1 Dumas and Pelletier, 1999

2 Keller & Stevens, 1996

REFERENCES

1. The center for health and health care in schools. The School of Public Health & Health Services, the George Washington University: Psychotropic Drugs and Children. Reversed in 2004. Accessed at www.healthinschools.org.

2. Wong, D. L; et al; Wongs Essentials of Pediatric Nursing, 6th Ed. MI; Mosby, Inc; 2001

3. National Institute on Drug Abuse. Marijuana: Facts for Teens. Reversed in 2005. Accessed at http://www.nida.nih.gov/marjbroch/teenpg7-8.html.

4. The Columbia Encyclopedia, 6th Ed. 2006. Columbia University Press. Accessed at http://yahooligans.yahoo.com/reference/encyclopedia/entry/depressa.


Respiratory Syncytial Virus (RSV), Nursing Intervention and Prevention.

By: Dr. Betrand N. Okwesili, RNS; M.B.B.Ch; CM/DN

Respiratory Syncytial Virus (RSV) is the leading cause of lower respiratory tract infections in infants and young children. RSV is implicated in Bronchiolitis, which is an acute viral infection with maximum effect at the bronchiolar level. The infection occurs primarily during the winter and spring of the year and is rare in children over two years of age. Adeno viruses and parainfluenza viruses may also cause acute bronchiolitis. Infection begins in the fall, reached a peak during the winter, and decreases in Spring. It is easily spread from hand to eye, nose, or other mucous membranes. It is a suspected cause of fatal respiratory diseases in infants and can cause serious illness in immuno-compromised adults, institutionalized elderly persons, and patients with underlying cardiopulmonary disease.

PATHOPHYSIOLOGY

In RSV infection, the virus attaches to cells, eventually resulting in necrosis of the bronchiolar epithelium. The mucosa of the Bronchiole is swollen, resulting in the lumina filled with mucus and exudate, these attract inflammatory cells resulting in peribronchiolar interstitial pneumonitis. The variable degrees of obstruction produced in small air passages by these changes lead to hyperinflation, obstructive emphysema resulting from partial obstruction, and patchy areas of atelectasis. Dilation of bronchial passage on inspiration allows sufficient space for the intake of air, but a narrowing of the passages on expiration prevents air from leaving the lungs. This air is trapped distal to the obstruction and causes progressive overinflation with the result being emphysema.

SIGNS AND SYMPTOMS OF RSV

Initial

  • Rhinorrhea (running or watery nose)
  • Pharyngitis
  • Coughing/sneezing
  • Wheezing
  • Possible ear or eye drainage
  • Fever

With the progression of an illness

  • Increased coughing and wheezing
  • Air hunger
  • Tachypnea and retractions of intercostal cartilages
  • Cyanosis

Severe illness

  • Tachypnea, >70 breath per minute
  • Listlessness
  • Apneic spells
  • Poor air exchange, poor breath sounds

COMPLICATIONS OF RSV

  • Pneumonia and progressive pneumonia
  • Bronchiolitis
  • Croup
  • Otitis media
  • Respiratory failure
  • Sudden Infant Death Syndrome (SIDS)
  • Residual lung damage

NURSING ASSESSMENT

History

  • Nasal congestion
  • Coughing
  • Wheezing
  • Malaise
  • Sore throat
  • Earache
  • Dyspnea
  • Fever

Physical findings

  • Nasal and pharyngeal inflammation
  • Otitis media
  • Severe respiratory distress marked by nasal flaring, retraction of intercoastal cartilages, cyanosis, and tachypnea
  • Wheezes, rhonchi, and crackles
  • Apnea may be the first recognized indicator of RSV infection in very young infants

LABORATORY EVALUATION

  • Syncytial virus
  • Elevated serum respiratory syncytial virus antibodies titers
  • Arterial blood gas values showing hyponatremia
  • Elevated blood urea nitrogen in dehydration

TREATMENT

  • Respiratory support is very important
  • The importance of adequate nutrition in RSV infection can not be overemphasized.
  • Overhydration of an RSV individual should be avoided.
  • Rest is very important when fatigued during the period of infection.
  • Medication includes the use of Ribavirin.
  • Tracheostomy is a possible surgical intervention.

NURSING DIAGNOSIS

  • Activity intolerance, impaired gas exchange related to bronchiolar edema and increased mucus production.
  • The risk for fluid volume deficit related to increased water loss through inhalation and decreased fluid intake.
  • Hyperthermia related to infection.
  • Social isolation related to isolation precautions.
  • Fatigued related to respiratory distress.
  • Altered nutrition, less than body requirements related to lack of knowledge about the child’s condition.
  • Knowledge deficit related to home care.

EXPECTED OUTCOME

  • The child will have improved gas exchange as evidenced by ease of respiration and pinkish skin.
  • The child will maintain fluid balance as evidenced by urine output of 1 to 2ml/kg/hr and good skin turgor.
  • The child will maintain a body temperature of less than 1000F ((38.70C).
  • The child will demonstrate effective social interactions in both one-on-one and group settings.
  • The child will rest at least one hour in the morning and afternoon.
  • The child has improved nutritional intake as evidenced by consuming at least 80% of each meal.
  • The child and parents will be less anxious as evidenced by expressing an understanding of home care instructions.

NURSING INTERVENTIONS AND RATIONALE

  • Provide a high-humidity environment by placing the child in a mist tent or cool humidification device; the cool mist from a mist tent helps liquefy secretions and decreases bronchial edema.
  • Administer oxygen by face mask, nasal cannula, or oxygen tent, as ordered, because oxygen helps relieve the restlessness associated with respiratory distress and hypoxia.
  • Position the child with his / her head and chest elevated and neck slightly extended, because this position maintains an open airway and eases respiration by decreasing pressure on the diaphragm.
  • Administer bronchodilator as ordered.
  • Suction the child as ordered to remove secretions.
  • Administer antiviral agents as ordered.
  • Promote adequate rest by decreasing noise and lights, and providing warmth and comfort.
  • Assess the child’s respiratory rate and rhythm hourly.
  • Teach the parent(s) and child (if appropriate) how and when to administer medication, including dosage details and adverse reactions.
  • Explain the signs and symptoms of respiratory distress and infection, including fever, dyspnea, a change in sputum color and wheezing.
  • Explain the importance of adequate rest for the child to the parent(s), and to the child (if appropriate).

PREVENTION OF RSV

There are two drugs used for the prevention of RSV infections is recommended and approved by the American Academy of Pediatrics (AAP) and the Federal Drug Administration (FDA). These drugs include; RSV immune globulin (RSV-IGIV or Respigam) and Monoclonal antibody, palivizumab (Synagis.) By the year 2000, the AAP had set up specific standards for who should receive the drugs and specified instruction for their use. Most patients receive the shot throughout the RSV season.

Presently, Global Medical and Health Services, LLC (GMHS, LLC) is undergoing seasonal RSV prevention by prophylactically using the Synagis every month for our high-risk clients. This is on-going and will continue throughout the RSV season. Each year, 125,000 infants in the United State are hospitalized with severe RSV infections, the leading cause of infant hospitalization, and severe RSV infections cause up to 500 deaths annually (MedImmune, 2005).

WAYS TO HELP PREVENT THE SPREAD OF RSV

RSV is easily spread by physical contact. Touching, kissing, and shaking hands with an infected person can spread RSV. It is also spread by coughing or sneezing and can live up to six hours on countertops and for several hours on used tissue. RSV usually spreads very quickly. Nearly all babies get RSV by the age of two. Here are some ways you can help prevent the spread of RSV:

  • Wash your hands before touching a baby and ask others to do the same.
  • Keep babies away from crowds, especially other young children during the period of the RSV infection outbreak (winter periods).
  • Keep people with colds away from infants in your care
  • Wash the baby’s toys and bedding (share this information with the primary caregiver)
  • Do not smoke near your client and do not let others smoke near your client. Exposure to tobacco smoke increases the risk of RSV.

PROTECT OUR PEDIATRIC CLIENTS TO BE HEALTHY TODAY, FOR A HEALTHIER TOMORROW!!!!

REFERENCES:

  • Kathleen, MS. Pediatric Care Planning, 3rd ed. Pennsylvania; Springhouse Corp. 1999.
  • Lippincott Williams & Wilkins. Nurse’s three-minute clinical reference, ed. PA., 2003
  • Wong, D.L., et., Wong’s Essentials of Pediatric Nursing, 6th ed. MI; Mosby, Inc., 2001
  • MedImmune 2005. Avoiding the spread of RSV-RSV protection.

SEASONAL ALLERGY, PREVENTION, AND NURSING CONSIDERATIONS

By: Dr. Betrand N. Okwesili, RNS; M.B.B.Ch; CM/DN

An allergy is an abnormal or pathological reaction to environmental substances such as pollen, food, dust, or microorganisms, while allergic reactions or hypersensitivity reactions are the inappropriate immune responses to a normally harmless substance. Two out of every ten (10) people suffer from some form of allergy arising from a hyperactive immune system (Hypersensitivity). People who are not hypersensitive can breathe, taste, and touch things that are a normal part of the environment without suffering. The unlucky few percentages of hypersensitive people have immune systems that overreact to one or more things. Their immune systems are too vigorous in defending the body against certain foreign invaders. The normal immune system includes antibodies, white blood cells, mast cells, complement proteins and other substances (called antigens). In susceptible people, the immune system can overreact to certain antigens (called allergens) which are harmless in most people. the result is an allergic reaction. Some people are allergic to one substance, others are allergic to many. A seasonal allergy is a result of the exposure to airborne substances (such as pollens) that appear only during certain times of the year. A seasonal allergy (commonly called “hay fever”), occurs only during certain times of the year particularly the Spring, Summer, or Fall, depending on what the person is allergic to. The term “hey fever” commonly associated with the seasonal allergy is a misnomer because any fever associated with a seasonal allergy should not be taken with a pinch of salt. A seasonal allergy or “hay fever” is usually a reaction to pollens and grasses. Different parts of the globe have very different seasons and so also different parts of the United States have very different pollen seasons. People may react to one or more pollens, so a person’s pollen allergy season may be from early Spring to late Fall. Seasonal allergies are also caused by mold spores, which can be airborne for long periods during the Spring, Summer, and Fall. Other causes include animal dander, house dust, and dust mites. Primarily the part of the body affected by the pollen, which comes in contact with them in allergic reactions includes; nurse and the doctorsthe membrane lining of the nose, causing allergic rhinitis or the membrane lining of the eyelids and covering the whites of the eyes (conjunctiva) causing allergic conjunctivitis. Rhinitis and conjunctivitis may be caused by other disorders. A seasonal allergy may trigger off an asthmatic attack in an asthmatic individual, causing bronchial constriction with resultant dyspnoea and wheezing respiratory sounds.

Pathophysiology

Allergen may cause an allergic reaction when they land on skin or in the eye, are inhaled, are eaten, or are injected. An allergic reaction can occur as part of a seasonal allergy (such as hey fever) caused by exposure to such substances as grass or pollen, breathing in dust, or animal dander. When exposed to an allergen, the immune system produces a type of antibody called immunoglobulin E (IgE). This binds to the white blood cell basophil in the bloodstream and the mast cells in the tissues. The individual becomes sensitized on first exposure, the cells that have IgE on their surface releases substances such as histamine, prostaglandin, and leukotrienes. These substances cause inflammation in the surrounding tissues resulting in swelling. These substances begin a cascade of reactions that continue to irritate and harm tissues; these may range from mild to severe reactions.

Signs and Symptoms

  • Itching – Seasonal allergy can cause itching of the nose, the roof of the mouth, back of the throat and eyes. Itching may start gradually or abruptly. The itching is sometimes severe that individual causes breakage of the membrane during vigorous itching, which results in infection. Itching, skin rashes, including hives, are also common.
  • Rhinorrhea – Due to the inflamed nasal mucosa (rhinitis) the nose runs, producing a clear, watery discharge and may become stuffy. Clear watery discharge from the nose and itching are pathognomonic of seasonal allergy in the absence of other upper respiratory tract infections.
  • Sneezing – This is very common in seasonal allergy due to the continual irritation of the cilia mucosal lining of the nose and upper respiratory tracts.
  • Conjunctivitis – Allergic conjunctivitis may result when airborne substances, such as pollens, contact the eyes directly causing profuse itching, tearing, and the whites of the eyes and the eyelids may become red and swollen. Wearing contact lenses can irritate the eyes further.
  • Anosmia – Loss of smell may result in the inflammation of the olfactory bulb in the nasal mucosa.
  • Other symptoms include headache, coughing, wheezing, and irritability.
  • More rarely, depression, loss of appetite, and insomnia may develop.

Treatment

Antihistamines – They competitively block the effects of histamine at peripheral H1 receptor sites. They also have anticholinergic (atropine-like) and antipruritic effects. These include;

  • Diphenhydramine
  • Brompheniramine maleate
  • Chlorpheniramine maleate,

as ordered by the physician.

Nasal Decongestant – Such as pseudoephedrine to help relieve a stuffy nose. Antihistamine and nasal decongestants may come in combination as a single tablet. Also, non-prescription nasal decongestant sprays are available; but these sprays should not be used more than a few days at a time, as prolonged use may worsen or prolong nasal congestion. cromolyn, which is available as a non-prescription nasal spray may be useful. Corticosteroid nasal spray may be prescribed by the physician if the above non-prescription medications are not effective.

Artificial tears – Can be used to wash the eye in allergic conjunctivitis to help reduce irritation. Other eye drops are also available depending on the physician’s discretion. Prolong use of eye drops containing vasoconstrictors to relieve the redness of the eyes can worsen conjunctivitis. Corticosteroid use for a long period may predispose the individual to glaucoma, hence regular check of intra-ocular pressure is recommended.

Prevention and Nursing Considerations

Avoiding an allergen if possible is the best approach. The way to protect one from an allergic reaction is to know what one is allergic to and to avoid the allergen whenever possible. At present, various tests are available that detects the specific pollen origin that causes individuals allergic reaction. Your physician will assist you to determine which test is appropriate and how to go about it. If your allergy is to certain grasses or trees; pay attention to the cycle of pollination where you live. Staying in an air-conditioned building will help. Be sure that air filters are kept clean. An electronic filter incorporated in a central heating and air-conditioning system will help. If mold or fungi are implicated in allergy, they can be especially heavy around grains, trees, and other plants. Cottages that have been closed for Winter can be full of mold. When in contact with such areas, a protective mask may be of help. All individuals on corticosteroid therapy must be observed for infections as corticosteroid suppresses immunity and may make the individual susceptible to opportunistic infections. When an infection is suspected, this should be reported appropriately to the physician’s concern. Check for a rise in ocular pressure regularly for individuals on prolonged use of corticosteroid eye drop preparations. If no particular pollen grain is known as the cause of the seasonal allergy, it might be suggested that individuals should wear a protective breathing mask when outside during periods of pollination cycle to avoid inhalation of pollen grains, abundant in the air at that particular period.

References

  • Friedlander, Mark P., Et al. The Immune System, Your Body’s Disease Fighting Army, Lerner Publication Company, Minneapolis.
  • Mark H. Beers Et Al. The Merck Manual of Medical Information. 2nd Home Edition; Merck Research Laboratories; White House Station, NJ 2003
  • Lawrence M. Tierney, Jr. Et. Al. 2005 Lange Current Medical Diagnosis & Treatment, 44th Edition. McGraw-Hill Companies, Inc; NY
  • Amy M. Karch; Lippincott’s Nursing drug guide 2005; Lippincott Williams & Wilkins, Philadelphia.

 

Coronavirus Disease (COVID-19) Outbreak, Spread, and Prevention Based on CDC and WHO Perspectives.

Dr. Betrand N. Okwesili, NP; MSc; M.B.B.Ch; BSc; CM/DN
President/ CEO
GMHS, LLC & GMHSB, Inc
Asst. Professor of Human Anatomy & Physiology
Adjunct Faculty
BCCC.

Coronavirus occurs as a big family of Viruses that produce ailment varying from the common cold to farther critical illnesses such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Coronaviruses are zoonotic, indicating that they are transmitted between animals and people. The novel coronavirus (nCoV) is a new strain that has not been previously identified in humans (World Health Organization [WHO], 2020).
The outbreak of respiratory disease caused by the novel (new) coronavirus that was first detected in Wuhan City, Hubei Province, China has now been detected in 37 locations internationally, including the United States. The virus which has been named “SARS-CoV-2” is responsible for causing the coronavirus disease 2019 (COVID-19). The International Health Regulations Emergency Committee of the WHO declared the outbreak a “public health emergency of international concern” (PHEIC). The Secretary of the US Health and Human Services declared a public health emergency (PHE) for the United States to aid the nation’s healthcare community in responding to COVID-19 (Centers for Disease Control and Prevention [CDC], 2020).
According to the CDC, 2020 the source and spread of the viruses common in many different species of animals include bats, cattle, cats, and camels. According to CDC, 2020; although rarely, animal coronaviruses can infect people and then spread between people such as with MERS-CoV, SARS-CoV, and now with this new virus (named SARS-CoV-2). The SARS-CoV-2 virus is a betacoronavirus, in the same way as MERS-CoV and SARS-CoV. All these viruses, according to CDC, 2020 have their pedigrees in bats. The progressions from U.S. patients are like the ones that China primarily displayed, indicating a possible single, recent development of this virus from an animal pool (CDC, 2020). In the beginning, several of the patients in the COVID-19 eruption in Wuhan, China had a certain relation to significant seafood and live animal arcade, insinuating animal-to-person spread. Soon, a rising figure of patients who did not have contact with animal arcades, signifying person-to-person disseminate. Person-to-person spread has been reported outside China, including in the United States and other locations (CDC, 2020).
Current understanding about how the virus COVID-19 spreads is largely based on what is known about similar coronaviruses. As indicated by the CDC, 2020, the virus is thought to spread mainly from:
 Person-to-person: Between people who are in close contact with one another (within about 6 feet). Via respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.
 Spread from contact with infected surfaces or objects: It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.
For substantiated COVID-19 cases, as noted by CDC, 2020; reported infections have varied from mild symptoms to severe illness and even death. Symptoms can include:
 Fever
 Cough
 Shortness of breath
CDC believes at this time that symptoms of COVID-19 may appear in as few as 2 days or up to 14 days after exposure. This is based on what has been seen previously as the incubation period of MERS-CoV viruses (CDC, 2020).
There is currently no vaccine to prevent COVID-19. The best way, as has always been to prevent illness is to avoid being exposed to this virus. CDC as usual, recommends everyday preventive actions to help prevent the spread of respiratory diseases. Management of Global Medical & Health Services, LLC always implores its healthcare personnel to be proactive in not only preventing infection and spread of diseases but to also educate our numerous patients and families on how to do the same to stay healthy. GMHS, LLC follows the CDC recommendations in preventing infection and spread of disease by adhering to the following:
 It’s currently flu and respiratory disease season and CDC recommends getting a flu vaccine, taking everyday preventive actions to help stop the spread of germs, and taking flu antivirals if prescribed. GMHS, LLC health care providers must ensure that their flu shots records are up to date.
 Avoid close contact with people who are sick.
 Avoid touching your eyes, nose, and mouth.
 Stay home when you are sick.
 Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
 Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
 Follow CDC’s recommendations for using a facemask.
 CDC does not recommend that people who are well wearing a facemask to protect themselves from respiratory diseases, including COVID-19.
 Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others. The use of facemasks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a health care facility).
 Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
 If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.
 For information about handwashing, see GMHS, LLC’s Handwashing policy and procedure manual, and GMHS, LLC Handwashing Technique.
For information specific to healthcare, see CDC’s Hand Hygiene in Healthcare Settings, and the GMHS, LLC Handwashing Technique.
These are everyday habits that can help prevent the spread of several viruses. CDC does have specific guidance for travelers, endeavor to consult their website for such information as pertains to traveling. The above are informational and are based strictly on CDC recommendations and suggestions. The outbreak of COVID-19 in the USA is seriously being anticipated with great anxiety. “It is not so much a question of if this will happen anymore, but more really a question of when it will happen – and how many people in this country (USA) will have a severe illness.” – Dr. Nancy Messonnier – CDC. (Stein & Wamsley, 2020). The management of GMHS, LLC advises all its numerous health care providers, patients, and families to be very alert for further information and instructions as may be released by the CDC, as we embrace the anticipated scourge.

 

References
Centers for Disease Control and Prevention [CDC] (2020). How COVID-19 Spreads. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html
Centers for Disease Control and Prevention [CDC] (2020). Coronavirus Disease 2019 (COVID-19) Situation Summary. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/summary.html
CDC (2020). Symptoms of coronavirus. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html
Stein, R., & Wamsley, L. (2020). Health officials warn Americans to plan for the spread of coronavirus in U.S. Health news from NPR. Retrieved from: https://www.npr.org/sections/health-shots/2020/02/25/809318447/health-officials-warn-americans-to-start-planning-for-spread-of-coronavirus-in-u
World Health Organization [WHO] (2020). Current novel coronavirus (COVID-19) outbreak. Retrieved from: https://www.who.int/health-topics/coronavirus