The Informed Patient

Skin
Immerse bonded areas in warm, soapy water. Peel or roll skin apart; a spatula or teaspoon handle or even a pencil will help. Remove cured adhesive with warm, soapy water (may take several applications). Fingernail polish remover with an acetone base has also been successful for removal of cured adhesive from skin.
Lips
If lips are accidentally stuck together, apply a generous amount of warm water and encourage maximum wetting and pressure from saliva from inside the mouth. Peel or roll (do not pull) lips apart. It is almost impossible to swallow the adhesive as a liquid. The adhesive solidifies upon contact with saliva (moisture) and could adhere to the inside of the mouth. Saliva will lift the adhesive in 1-2 days, avoid swallowing the adhesive after detachment.
Eyelid, Vagina, Scrotum to legs
In the event that eyelids are stuck together or bonded to the eyeball, wash thoroughly with warm water and apply a gauze patch. The eye will open without further action within 1-4 days. There has never been a documented case of adhesive in the eye causing permanent damage. Do not try to force eyes or vagina open or attempt to force the scrotum off whatever part it is stuck to.
Eyeball
The adhesive will attach itself to the eye protein and will disassociate from it over time, usually within several hours. Periods of weeping and double vision may be experienced until clearance is achieved. Use of a warmed 3% sodium bicarbonate (put 1 teaspoon in 8oz of water) solution to wash eyes repeatedly may assist in aiding more rapid removal of the adhesive.

The basic message is given enough time the glue will wear off the body.

Raymond Zakhari, NP

MetroMedicalDirect.com

Medical House Calls in New York City.

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Starting a Concierge Medicine Practice Medical Blog: The Patient’s Doctor: Concierge Medicine For the Masses

October 20, 2009 · Leave a Comment

Starting a Concierge Medicine Practice Medical Blog: The Patient’s Doctor: Concierge Medicine For the Masses

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Recovering in the Hospital After surgery: 10 things to be aware of

October 20, 2009 · Leave a Comment

Yes a lot of wrong things can happen in the hospital, but a lot more right things happen there as well. In fact more things go right than wrong. Here is a list of things to do if you are going to be in the hospital overnight after surgery.

1) Keep the leg squeezing boots on during the night. Even if they disturb your sleep try to ignore them. You can get use to them they are there for a really good reason. They are to prevent you from getting blood clots (which can kill you and are common after surgery). This non-invasive inconviencence should be tolerated.

2) Use your call light and ask for help especially if you are getting out of bed for the first or second time. Also, make your request specific (help going to the bathroom, pain medicine, drink, etc.). Do not just ask for the nurse for every request. Most hospitals have nurses aides to help with simple tasks. The RN is caring for several other patients. The aide can fill the water pitcher, boost you up in bed, help you to the bathroom, get you another blanket etc.

3) Request pain medication and take the whole dose. One Percocet after surgery is not going to be sufficient to control your pain. Take the 2 pills in the first 24 hours. Once you go home you can reduce as you see fit. In the hospital there is not much to do but lay around and think about how bad something hurts.

4) Don’t repeatedly ask if you can eat after or before surgery. The answer is NO for a reason. Before surgery it is because your stomach needs to be empty so that you don’t vomit during the anesthesia induction which could easily be missed. If you do vomit you could breath it into your lungs and really have complications. After surgery you still cannot eat until you pass gas. If you eat too soon you can have major complications that may require you to go back to surgery. The answer is not NO just to be mean, but for a legitimate reason. The hospital staff and your doctor do have vested interest in you getting well.

5) Bring your essential medications with you to the hospital in the clearly labeled bottle. Hospitals have formularies. Your particular medication may not be on it. Your doctor is probably not aware of what exactly is on the formulary. Medical people do not think of drugs in the same way you do. They think in terms of drug classes not brand names. Also, all the supplements that you take (vitamins, herbs, aroma therapy, etc.) leave them all at home. They are considered non essential in the immediate post-operative phase (24-72 hours). Also keep in mind the more pills you are giving the more chance for errors.

6) Do Not refuse vital signs. I know you want to sleep, but the whole reason you are in the hospital is to be monitored overnight. That means vital signs every four hours at least, and your drains emptied and measured. You should also know that if your records vital signs are not updated in a timely manner your insurance company may deny payment because the hospital cannot charge for care that was not rendered. Many claims have been denied for insufficient charting and data that is consistent with the unit you are staying on.

7) Yes you do need to get out of bed when they tell you. It will help you heal faster, and it may even help relieve your pain, and it will prevent other complications. It would be much easier for the staff to leave you in bed, but because they care and have your health promotion in mind–take the pain medication and walk.

Do Not ask what is going on with the patient in the next bed, next room etc. Also, do not ask if their is a certain celebrity on the floor. All of this is confidential. None of this is any of your business. You put the staff in an awkward situation. They are going to say they can’t tell you and you are going to pout.

9) Do I have to have the IV? Probably Yes, otherwise they would not have ordered it. Do I have to have my blood drawn? Again, Yes. That is how they can tell what is going on inside you without cutting you open. Do I have to have this tube in me? Yes, it’s there to help measure, track, drain.

10) The middle of the night is not the time to bring up routine concerns. Overnight you are being monitored by a covering person. That means the person really doesn’t know you or the specific things that you and your doctor discussed. This covering person knows just enough about your type of case and general recovery and emergency protocols to get you through the night. Any specific questions about your care that are not emergent should be saved for the primary doctor.

Observing these suggestions will make for a more pleasant hospital stay, and get you out as quickly as possible. This is written with an intended humorous tone. It is based on the requests and behaviors that I have observed in many patients over the years.

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Tagged: doctor, elective surgery, hospital, insurance payment, post-op, recovery, surgery

PROSTATE HEALTH

October 8, 2009 · Leave a Comment

PROSTATE HEALTH

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Registered Nurses: Tell me more

October 8, 2009 · Leave a Comment

Nursing is the most diverse of all health care professions and they practice in a wide range of settings, but generally nursing responsibilities are divided depending on the needs of the person being nursed. The major divisions involve the nursing of patients with mental health problems, nursing of children (pediatric nursing), nursing of older adults (geriatric nursing), and the nursing of people in their own homes (home health nursing). There are also specialist areas such as cardiac nursing, orthopedic nursing and oncology nursing.

Nursing focuses on assisting in attaining, maintaining, and recovering optimal health and functioning. Modern definitions of nursing define it as a science and an art that focuses on promoting quality of life as defined by persons and families, throughout their life experiences from birth to care at the end of life.

RNs can specialize in one or more patient care specialties. The most common specialties can be divided into roughly four categories—by work setting or type of treatment; disease, ailment, or condition; organ or body system type; or population. RNs may combine specialties from more than one area—for example, pediatric oncology or cardiac emergency—depending on personal interest and employer needs. RNs, regardless of specialty or work setting, perform basic duties that include treating patients, educating patients and the public about various medical conditions, and providing advice and emotional support to patients’ family members. RNs record patients’ medical histories and symptoms, help to perform diagnostic tests and analyze results, operate medical machinery, administer treatment and medications, and help with patient follow-up and rehabilitation.

RNs teach patients and their families how to manage their illness or injury, including post-treatment home care needs, diet and exercise programs, and self-administration of medication and physical therapy. Some RNs also are trained to provide grief counseling to family members of critically ill patients. RNs work to promote general health by educating the public on various warning signs and symptoms of disease and where to go for help. RNs also might run general health screening or immunization clinics, blood drives, and public seminars on various conditions.

RNs may specialize by work setting or by type of care provided. For example, Ambulatory Care Nurses treat patients with a variety of illnesses and injuries on an outpatient basis, either in physicians’ offices or in clinics. Some ambulatory care nurses are involved in telehealth, providing care and advice through electronic communications media such as videoconferencing or the Internet. Critical Care nurses work in critical or intensive care hospital units and provide care to patients with cardiovascular, respiratory, or pulmonary failure. Emergency or Trauma work in hospital emergency departments and treat patients with life-threatening conditions caused by accidents, heart attacks, and strokes. Some emergency nurses are flight nurses, who provide medical care to patients who must be flown by helicopter to the nearest medical facility. Holistic nurses provide care such as acupuncture, massage and aroma therapy, and biofeedback, which are meant to treat patients’ mental and spiritual health in addition to their physical health. Home Health Care nurses provide at-home care for patients who are recovering from surgery, accidents, and childbirth. Hospice and Palliative Care nurses provide care for, and help ease the pain of, terminally ill patients outside of hospitals. Infusion nurses administer medications, fluids, and blood to patients through injections into patients’ veins. Long-term Care nurses provide medical services on a recurring basis to patients with chronic physical or mental disorders. Medical-Surgical nurses provide basic medical care to a variety of patients in all health settings. Perianesthesia nurses provide preoperative and postoperative care to patients undergoing anesthesia during surgery. Perioperative nurses assist surgeons by selecting and handling instruments, controlling bleeding, and suturing incisions. Some of these nurses also can specialize in plastic and reconstructive surgery. Psychiatric nurses treat patients with personality and mood disorders.

Nurse Practitioners are experienced RNs with a Master’s Degree in a sub specialty as listed above. NPs can do all of the same things a primary care physician can do within a scope of practice.

Metro Medical Direct is a Nurse Practitioner owned Private Practice in New York City. Providing the first web-based primary care medical house calls practice that takes the hassles out of going to the doctor.

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