Holy Spirit you are the only Lord of my life. Completely take over my thoughts, my words and my deeds. Because of you there is nothing that can come into my life physically, mentally and spiritually that can harm me or the lives I love and touch. My desire is to Glorify you this day. In Jesus name! Amen!

What is cholesterol?

Cholesterol is a waxy, fat-like substance that is present in every cell in your body. Some cholesterol is needed for your body to function. Your liver produces enough cholesterol for your body to function properly. Certain foods provide additional amounts of cholesterol, which may be more than your body needs.
While some cholesterol in your blood is essential to your health, too much can be harmful. If your cholesterol level is too high, it may increase your risk of heart disease. There are many reasons for a high cholesterol level, including diet, family history, obesity or some diseases such as diabetes.

Are there different kinds of cholesterol?
Yes. Different types of cholesterol and fats have different effects. The most commonly known types are:

LDL-cholesterol – Low-density lipoprotein cholesterol, is the bad cholesterol. Excess LDL builds up on your arteries and may lead to heart disease. The higher the level of LDL, the higher your risk for heart disease. Lowering high LDL-cholesterol can prevent heart attacks and save lives.
HDL-cholesterol – High-density lipoprotein, or HDL-cholesterol, is the good cholesterol because it is believed to remove cholesterol from the blood. High levels of HDL in your blood may help to reduce your risk of coronary heart disease. A low level can increase your risk of heart disease.
Triglycerides – Triglycerides are another type of fat in your bloodstream. Persons with a high blood triglyceride level may also have a high LDL. Those with a high triglyceride level in addition to an elevated LDL-cholesterol level may be at further risk of coronary heart disease.
What is high cholesterol?
High cholesterol can vary for each individual depending on other risk factors. Discuss with your healthcare professional what is considered high for you. A desirable cholesterol level consists of a total cholesterol level of less than 200 mg/dL and an LDL cholesterol level of less than 130 mg/dL.

Why is high cholesterol a health risk?
High cholesterol is a serious health risk because it can lead to coronary heart disease. More than 13 million Americans have heart disease and each year, it kills more Americans than any other cause. These individuals have already had a heart attack or experienced chest pain (angina). The American Heart Association says an elevated LDL-cholesterol level is a major risk factor for heart disease.

Risk factors for heart disease

High LDL-cholesterol
Low HDL-cholesterol level (less than 35 mg/dL)
High blood pressure
Diabetes
Increasing age
Smoking
A family history of early heart disease (a parent or sibling less than 55 years old, if male or 65 years old if female)
How does a high cholesterol level contribute to heart disease?
A healthy artery has a smooth, even surface. When too much cholesterol builds up on the walls of your arteries, however, thick deposits called plaque form. The buildup of plaque narrows the artery, so your heart must work harder to force blood through. Plaques can limit or block the blood flow in the artery. They can also rupture and form blood clots. When either happens in a major artery supplying the heart or in a major artery supplying the brain, the blood flow can be completely blocked. The result can be a heart attack or stroke.

Can lowering my elevated cholesterol level help protect against heart disease?
Yes. It has been shown that a 1% decrease in cholesterol levels leads to a 2% decrease in the risk of heart disease. Since high LDL-cholesterol is a major risk factor for heart disease, lowering it can help prevent heart attacks and save lives.

How can high cholesterol be controlled?
Sometimes changes in diet and lifestyle may be enough to lower cholesterol to a desirable level. Other times, diet and lifestyle changes must be combined with medication.

Once your cholesterol goal is reached, you must continue to maintain a healthy cholesterol level. Remember that high cholesterol cannot be cured, but it can be controlled. Your cholesterol level will likely increase again if you stop treatment. You will need to maintain a healthy lifestyle and keep your cholesterol at an acceptable level. With the help of your doctor, you can make a commitment to lower your high cholesterol forever.

How will I have to change my diet?
Limit the amount of fat, especially saturated fat, in your diet. High-fat foods include fried foods, cheese, butter, whole milk and some meats. Many animal products are generally high in fat and cholesterol. Avoid saturated fats, such as lard and hydrogenated oils. Organ meats such as kidney and liver also contain large amounts of cholesterol. Shellfish, including lobster, are high in cholesterol too, but tend to be lower in saturated fat. Egg yolk contains about 215 mg of cholesterol. A lean 4oz. piece of white-meat chicken, by comparison, has only 70 mg or so of cholesterol. High-fiber food from plants, such as green, leafy vegetables and fruits, as well as grains, do not contain any cholesterol. Choose low-fat or non-fat dairy products. Also, being overweight can increase your cholesterol level.

Polyunsaturated and monounsaturated fats are found in liquid oils from plants. Corn and soybean oils are examples of polyunsaturated fats; olive oil and canola oil have monounsaturated fats. Although fat in general should be limited, polyunsaturated or monounsaturated fat are better choices than saturated fats.

Drinking alcohol can also affect your cholesterol and triglyceride levels. Check with your healthcare professional to determine whether moderate alcohol intake is appropriate or whether alcohol should be avoided altogether.

How can exercise help improve my cholesterol levels?
Regular aerobic exercise such as swimming, vigorous walking, biking, or playing tennis increases your HDL-cholesterol level, lowers your triglyceride level, and may lower your LDL-cholesterol level. A regular exercise plan can also help to reduce body weight and fat. You should always consult your doctor before beginning any exercise program. How Often Should I Get My Cholesterol Level Checked? Experts recommend that all adults over the age of 20 have their cholesterol measured at least once every 5 years. Based on the results and your overall risk for heart disease, your cholesterol should be checked every 1 to 5 years. Your blood cholesterol level is checked by a simple blood test and measured as milligrams of cholesterol per deciliter of blood (mg/dL).

The Healing Continuum’s definition of emotional intimacy has nothing to do with sexuality but everything to do with one’s ability to know how to remain emotionally stable. It is the ability to be aware of how emotions affect thoughts, words, and actions in relationships and good mental and physical health.

MARRIAGE

Q: How do we connect as newlyweds?
A: Initially individuals come into marriages focused on getting their needs met without sacrificing much of themselves. They may be driven by individual desires in career, family, and social activities, but marriage requires self sacrifice. I refer to it in therapy as getting to the other side of the fence. It may mean disappointing your family of origin, changing your work schedule or sacrificing time with friends. In a nut shell don’t think of marriage as who is right or wrong but rather, if you can imagine a true sports enthusiast cheering on their favorite team in the last few moments of the season’s biggest game…that’s what a spouse should be. Cheer on your partner as though you really are their biggest fan… all the time.

Q: How do we keep our marriage strong after the first child is born?
A: The best way is to actually start off with a good foundation. This means taking the time to establish each other’s role in the marriage. Both partners need to assess strengths, weaknesses and communication styles. In doing so you are weaving and strengthening the basic fibers of a strong marital relationship. Being inextricably intertwined will prove beneficial when the responsibility of children and life’s other burdens start to press down on your relationship. Newborns divert attention away from the spouse and rightfully so. Remember your first commitment is to each other.

Q: How do I blend my family of origin with my spouse’s family?
A; There are two primary concerns: one is creating a healthy boundary between your old family and the new. The other is to unconditionally accept your spouse’s family. This is sometimes more of an issue with interracial marriages, but it is still a primary concern for all marriages. The goal is to allow your spouse the freedom to maintain their cultural identity as well as their family practices.
For instance it may be customary for a culture to have frequent interaction with extended family and it may also be a family practice to have all the dishes washed at night. The goal of course is to have discussions and to make known the importance of these values while not jeopardizing the strength of the nuclear family with unnecessary arguments. Marriages work best when we can accept the other unconditionally.

Stay at Home Mom

Q: How does the stay at home Mom maintain her adult identity?
A: This is a frequent problem when there are children involved. The stay at home spouse, usually the mother typically interacts only with the child. The younger the child the less intellectual dialogue occurs. Typically because they are in the home they are also expected to maintain the home. Sometimes these moms have had previous careers and identities, which they surrendered for parenthood. On top of this the other spouse has worked a full day to earn income to maintain the home and does not expect to come home to an emotionally needy partner. At times these husbands fail to understand that what the wife needs is adult attention. The primary goal is for the wife to find her own identity, she may need to enroll the child in an occasional play activity that provides both of them an opportunity for appropriate peer relationships. One possibility would be for the stay at home mom to schedule regular play dates with other stay at home moms in her community. Also, the wife needs to be proactive in scheduling quality time with her husband and not expect him to just figure it out. I recommend one evening a week when you both agree to just listen to the other person’s perspective on the marriage with out interruption. This allows you both to hone your listening and nurturing skills.

How do you get the spouse’s attention?

Arrange for a two to three hour baby sitter right before the husband comes home to reduce distraction.

• Re-invent the intimate situations that occurred prior to child birth.
• Treat him to dinner at his favorite restaurant.
• Express sincere interest in his day.
• Send him funny or romantic e-mails during the day

How do you manage the money?

This becomes a primary problem when the wife does not contribute to the home financially. At times she may even be managing the money but may be asked to control her spending. The goal is the same as though she was still working. I have discovered that marriages work best when there are “yours, mine and ours” bank accounts. Stay at home moms need to feel that they’re not a financial liability.

What is High Blood Pressure?
Since blood is carried from the heart to all of your body’s tissue and organs in vessels called arteries, blood pressure is the force of the blood pushing against the walls of those arteries. Each time the heart beats (about 60-70 times a minute at rest), it pumps out blood into the arteries. Your blood pressure is at its greatest when the heart contracts and is pumping the blood. This is called systolic pressure. When the heart is at rest, in between beats, your blood pressure falls. This is the diastolic pressure. Blood pressure is always given as these two numbers and both are important. Usually they are written one above or before the other, such as 120/80 mm Hg, with the top number the systolic, and the bottom the diastolic.

Different actions make your blood pressure go up or down. When you are physically active, your blood pressure goes up. When you are relaxed, your blood pressure goes down. These are normal changes in blood pressure.

Some people have blood pressure that stays up all or most of the time. Their blood pushes against the walls of their arteries with higher than normal force. If untreated, this can lead to serious medical problems such as:

Arteriosclerosis – High blood pressure harms the arteries by making them thick and stiff (“hardening of the arteries”). This speeds the buildup of cholesterol and fats in the blood vessels, which prevents the blood from flowing through the body, and in time can lead to a heart attack or stroke.

Heart Attack – Blood carries oxygen to the body. When the arteries that bring blood to the heart muscle become blocked, the heart cannot get enough oxygen. Reduced blood flow can cause chest pain (angina). Eventually, the flow may be stopped completely, causing a heart attack.

Stroke – High blood pressure can harm the arteries, causing them to narrow faster and less blood can get to the brain. If a blood clot blocks one of the narrowed arteries, a stroke may occur. A stroke can also occur when very high pressure causes a break in a weakened blood vessel in the brain (hemorrhagic stroke).

Enlarged heart – High blood pressure causes the heart to work harder. Over time, this causes the heart to thicken and stretch. Eventually the heart fails to function normally causing fluids to back up into the lungs.

Kidney Damage – The kidney acts as a filter to rid the body of wastes. Over many years, high blood pressure can narrow and thicken the blood vessels of the kidney. The kidney filters less fluid, and waste builds up in the blood. The kidneys may fail altogether. When this happens, medical treatment (dialysis) or a kidney transplant may be needed.

How can I control high blood pressure?
A diet low in saturated fat and rich in whole grains, fruits, and vegetables is recommended. Such suggestions are nuts, seeds, carrots, spinach, celery, mushrooms, lima beans, potatoes, avocados, broccoli, and foods that contain modest amounts of protein (preferably fish, poultry, or soy products). Loss of weight immediately reduces blood pressure and helps reduce heart size. Weight loss may allow patients with mild hypertension to safely reduce or go off medications.

Diets high in salt accelerate hypertension as we age. Salt restriction is particularly important for those who are salt-sensitive and for elderly people. Simply eliminating table and cooking salt can be beneficial.

A sufficient intake of minerals, particularly potassium, magnesium, and calcium, are beneficial for reducing blood pressure. Most people should obtain this mineral from potassium-rich foods that include potatoes, avocados, bananas, nonfat milk products, red beans, oranges, prunes, and cantaloupes.

Calcium regulates the tone of the smooth muscles lining blood vessels. Hypertension itself increases calcium loss from the body. Sufficient calcium is important for strong bones.

Vitamin C has specific benefits for hypertension by preventing dangerous effects on nitric acid, the substance that keeps arteries flexible.

Everyone should quit smoking and if you drink alcohol at all, do so in moderation. In healthy people with normal blood pressure drinking a couple of cups of coffee a day is unlikely to do any harm. People with existing hypertension should avoid caffeine altogether.

Regular exercise helps keep arteries elastic which keeps blood flowing and blood pressure low. Moderately intense exercise is recommended to lower blood pressure more effectively than high-intensity exercise. Sedentary people have a much greater risk of developing hypertension than physically active individuals do. Persons with high blood pressure should consult a physician before starting an exercise program.

Don’t let the medications you are taking have a negative effect on your health and well-being because you are not aware of how they may interact with each other.

According to the Institute of Medicine, there are more than 2 million serious adverse drug reactions and 100,000 deaths every year from negative drug interactions. Adverse drug reactions are the fourth leading cause of deaths, ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents and automobile deaths.

The well-informed person will screen every pill, liquid, needle and lozenge before they take it into their bodies. To become a well-informed person, you need to ask questions every time a physician or health-care provider prescribes a new medication for you. One of the best ways to reduce medication errors is to develop a partnership with your health-care provider. A good relationship will enable you to get the appropriate treatment and the appropriate medications.

Here are some things you can do to develop a better relationship with your health-care provider:

• Fully answer the questions asked of you
• Be open and honest and let your health-care provider know your fears and concerns
• Know your health history and the medications you are taking
• Report new symptoms or issues when they arise
• Share important events that may affect you well-being
• To develop a trusting relationship, ask questions if you do not understand
• Respect the provider’s knowledge; and when you have agreed to follow a treatment plan or take a medication, continue on that plan as prescribed.

When the health-care provider is prescribing new medications for you, be prepared to ask if you really need it, why you need it, when you need to take it and what the interactions are with the vitamins, herbs or supplements that you are taking.

If you are like most people, you see multiple physicians during the year. Often, these physicians are not communicating with each other about the medications they have prescribed for you. It is your responsibility to know the medications you are on as well as the dosages and the frequencies. Sometimes that is difficult to do. I struggle with this, and I am in the health-care field. Here are some things you can do to ensure your safety regarding medications:
- Ask your physician for a complete list of the medications he has put you on. Most offices are computerized. They should be able to print a current list for you. You can then take this list to your next doctor or specialist and they can see what medications you are taking before they prescribe a new drug. If your physician’s office is not computerized, ask them to copy the list from your chart. Before you leave the doctor’s office, review the list with your physician to ensure the list is complete, including the vitamins, herbs and supplements you are taking. Keep this list with you at all times.
- Put all of your medications in a bag and take it with you to the doctor’s office for them to review what you are taking and discuss the interactions that may occur. The key here is to just include the medications you are currently taking. Do not put into the bag all the medication bottles you can find. Clear out your medicine chest frequently. Throw away the medication bottles you are no longer taking. If your doctor is unwilling to review your medications with you, go to the least expensive, most accessible resource, your pharmacist. Well-informed people build relationships with their pharmacists. Their consultations are free and in most cases they are willing to take the time to explain the medications and answer questions you may have.
You are likely to receive your medications from a nurse. Patients should enter the hospital with an accurate list of their current medications including the dosage and the frequency that they take these medications. It is crucial for your safety and for your proper treatment to share this list with your nurse as soon as you get admitted to the hospital. Nurses and doctors in the hospital must know what medications you are on, so they can treat you appropriately and ensure there are no drug interactions.

Nurses and doctors must perform medication reconciliation when you enter the hospital, move within the hospital to a floor or unit and upon discharge from the hospital. If you have your medication sheet, present this to them in the Emergency Department. If you do not, ask a loved one to bring your medication bottles to the hospital for the nurses and doctors to review.

Also inform the nurse of any allergies you may have to medications, foods, etc. While in the hospital, you or a surrogate must take an active role in the medication process. To ensure the correct medication is being given to you, the nurse must check the armband ID that was placed on you when you were admitted to the hospital. That arm band will have your name, date of birth and your medical record number on it. The nurse must check your armband against the information on the medication order in your chart. This will help ensure you are receiving the correct medication.

If the nurse does not check your armband prior to giving the medication, you or your surrogate should stop the nurse from administering the medication and have the nurse check the medication against the armband. This small step could save your life. It is also important in your partnership with your nurse that you inform him or her of any unexpected changes in how you are feeling. If the nurse does not explain the side effects of the medications you are receiving, or does not keep you informed of changes in your medication frequency or dose, please ASK. Communicating with your health-care provider can save your life.

Deborah Cort, RN, MSN, CRRN is the Chief Nursing Officer at South Lake Hospital in Clermont, Florida

What is Edema?

Edema is a localized or general swelling caused by the buildup of fluid within body tissues. Excess fluid may be a result of poor circulation of the blood; a failure of the lymphatic system to disperse the fluid; various diseases and disorders; or a combination of factors.

Other causes of edema include fluid retention caused by disease of the heart or kidneys or a reduction in the amount of protein in the blood, which may occur as a result of cirrhosis, chronic nephritis, malnutrition, or toxemia of pregnancy. Localized edema may result from injury or infection.

At-Risk Groups

People with a history of heart disease or kidney disease can be at risk for edema. Liver disease (cirrhosis), malnutrition, and toxemia of pregnancy can cause edema. Localized edema may result from obstruction of the venous drainage, injury, or infection.

Symptoms

Symptoms of edema as it relates to chronic kidney failure can include swelling and puffiness, especially in the hands, ankles, face, and eyelids. In addition to swelling, the patient may have:

Redness
Heat
Pain

Signs and Tests

You should provide the doctor with a description of your symptoms and with your medical history. The doctor will want to check the amount of protein in your blood and urine if he or she suspects the edema was caused by kidney failure.

Treatment

Treatment will focus on correcting the underlying cause of the edema. If the underlying cause of the edema is kidney failure, treatment may include medication such as diuretics (water pills) or dialysis. Your diet may also be changed to include restrictions on salt and water intake. Excess fluid causes weight gain. Weighing yourself daily can help monitor the effectiveness of the treatment.

Diuretic drugs, which make the kidneys eliminate excess salt and water, often produce an immediate improvement. Edema caused by varicose veins or pregnancy can be prevented by wearing elastic stockings. Edema of the ankles may be eliminated by lying down with the feet raised.

Expectations

The prognosis for success with edema depends on discovering the underlying cause and treating it. Some causes are fairly simple and can be cured. Others, like chronic kidney failure, are more complex and need ongoing treatment.

Tips

Be sure your doctor has your complete medical history. Stay in contact with him or her if you have been diagnosed for a disease that causes edema.
Call your doctor if new symptoms develop or if your edema does not show signs of improvement.

What is cholesterol?

Cholesterol is a waxy, fat-like substance that is present in every cell in your body. Some cholesterol is needed for your body to function. Your liver produces enough cholesterol for your body to function properly. Certain foods provide additional amounts of cholesterol, which may be more than your body needs.
While some cholesterol in your blood is essential to your health, too much can be harmful. If your cholesterol level is too high, it may increase your risk of heart disease. There are many reasons for a high cholesterol level, including diet, family history, obesity or some diseases such as diabetes.

Are there different kinds of cholesterol?
Yes. Different types of cholesterol and fats have different effects. The most commonly known types are:

LDL-cholesterol – Low-density lipoprotein cholesterol, is the bad cholesterol. Excess LDL builds up on your arteries and may lead to heart disease. The higher the level of LDL, the higher your risk for heart disease. Lowering high LDL-cholesterol can prevent heart attacks and save lives.
HDL-cholesterol – High-density lipoprotein, or HDL-cholesterol, is the good cholesterol because it is believed to remove cholesterol from the blood. High levels of HDL in your blood may help to reduce your risk of coronary heart disease. A low level can increase your risk of heart disease.
Triglycerides – Triglycerides are another type of fat in your bloodstream. Persons with a high blood triglyceride level may also have a high LDL. Those with a high triglyceride level in addition to an elevated LDL-cholesterol level may be at further risk of coronary heart disease.
What is high cholesterol?
High cholesterol can vary for each individual depending on other risk factors. Discuss with your healthcare professional what is considered high for you. A desirable cholesterol level consists of a total cholesterol level of less than 200 mg/dL and an LDL cholesterol level of less than 130 mg/dL.

Why is high cholesterol a health risk?
High cholesterol is a serious health risk because it can lead to coronary heart disease. More than 13 million Americans have heart disease and each year, it kills more Americans than any other cause. These individuals have already had a heart attack or experienced chest pain (angina). The American Heart Association says an elevated LDL-cholesterol level is a major risk factor for heart disease.

Risk factors for heart disease

High LDL-cholesterol
Low HDL-cholesterol level (less than 35 mg/dL)
High blood pressure
Diabetes
Increasing age
Smoking
A family history of early heart disease (a parent or sibling less than 55 years old, if male or 65 years old if female)
How does a high cholesterol level contribute to heart disease?
A healthy artery has a smooth, even surface. When too much cholesterol builds up on the walls of your arteries, however, thick deposits called plaque form. The buildup of plaque narrows the artery, so your heart must work harder to force blood through. Plaques can limit or block the blood flow in the artery. They can also rupture and form blood clots. When either happens in a major artery supplying the heart or in a major artery supplying the brain, the blood flow can be completely blocked. The result can be a heart attack or stroke.

Can lowering my elevated cholesterol level help protect against heart disease?
Yes. It has been shown that a 1% decrease in cholesterol levels leads to a 2% decrease in the risk of heart disease. Since high LDL-cholesterol is a major risk factor for heart disease, lowering it can help prevent heart attacks and save lives.

How can high cholesterol be controlled?
Sometimes changes in diet and lifestyle may be enough to lower cholesterol to a desirable level. Other times, diet and lifestyle changes must be combined with medication.

Once your cholesterol goal is reached, you must continue to maintain a healthy cholesterol level. Remember that high cholesterol cannot be cured, but it can be controlled. Your cholesterol level will likely increase again if you stop treatment. You will need to maintain a healthy lifestyle and keep your cholesterol at an acceptable level. With the help of your doctor, you can make a commitment to lower your high cholesterol forever.

How will I have to change my diet?
Limit the amount of fat, especially saturated fat, in your diet. High-fat foods include fried foods, cheese, butter, whole milk and some meats. Many animal products are generally high in fat and cholesterol. Avoid saturated fats, such as lard and hydrogenated oils. Organ meats such as kidney and liver also contain large amounts of cholesterol. Shellfish, including lobster, are high in cholesterol too, but tend to be lower in saturated fat. Egg yolk contains about 215 mg of cholesterol. A lean 4oz. piece of white-meat chicken, by comparison, has only 70 mg or so of cholesterol. High-fiber food from plants, such as green, leafy vegetables and fruits, as well as grains, do not contain any cholesterol. Choose low-fat or non-fat dairy products. Also, being overweight can increase your cholesterol level.

Polyunsaturated and monounsaturated fats are found in liquid oils from plants. Corn and soybean oils are examples of polyunsaturated fats; olive oil and canola oil have monounsaturated fats. Although fat in general should be limited, polyunsaturated or monounsaturated fat are better choices than saturated fats.

Drinking alcohol can also affect your cholesterol and triglyceride levels. Check with your healthcare professional to determine whether moderate alcohol intake is appropriate or whether alcohol should be avoided altogether.

How can exercise help improve my cholesterol levels?
Regular aerobic exercise such as swimming, vigorous walking, biking, or playing tennis increases your HDL-cholesterol level, lowers your triglyceride level, and may lower your LDL-cholesterol level. A regular exercise plan can also help to reduce body weight and fat. You should always consult your doctor before beginning any exercise program. How Often Should I Get My Cholesterol Level Checked? Experts recommend that all adults over the age of 20 have their cholesterol measured at least once every 5 years. Based on the results and your overall risk for heart disease, your cholesterol should be checked every 1 to 5 years. Your blood cholesterol level is checked by a simple blood test and measured as milligrams of cholesterol per deciliter of blood (mg/dL).

According to the American Stroke Association statistics for 2007, Brain Attack is the third leading cause of death in the United States. Each year about 700,000 people experience a new or recurrent stroke. About 500,000 of these are first attacks and 200,000 are recurrent attacks. On average, every 45 seconds someone in the United States has a Brain Attack. Approximately every 3 to 4 minutes someone dies of a stroke. Each year, about 46,000 more women than men have strokes. African Americans risk of a first stroke is almost twice that of whites.Brain Attack is the leading cause of serious, long term disability and the estimated direct and indirect cost for stroke in 2007 is $62.7 billion. Of all strokes, 87% are ischemic and intracerebral and subarachnoid hemorrhage make up the other 13%. An ischemic stroke is a blockage. This type of stroke occurs when the blood vessels to the brain are blocked. Ischemic strokes are caused by fatty deposits lining the blood vessel wall within the brain. An ischemic stroke can be caused by a thrombus which is a development of a blood clot at the fatty deposits or by an embolus which is a traveling particle too large to pass through a small vessel.A hemorrhagic stroke is bleeding in the brain. This is caused by a burst or leaking blood vessels in the brain. A hemorrhagic stroke occurs when a weakened blood vessel ruptures. This could be an aneurysm, a ballooning of a weakened region of a blood vessel or an Arteriovenus Malformation (AVM), a cluster of abnormal blood vessels.

Some people are more at risk for a Brain Attack than others. According to the American Stroke Association, some risk factors cannot be treated. They are:

Age The chance of having a stroke more than doubles for each decade of life after age 55. While stroke is common among the elderly, a lot of people under 65 also have strokes.
Heredity (family history) and race Your stroke risk is greater if a parent, grandparent, sister or brother has had a stroke. African Americans have a much higher risk of death from a stroke than Caucasians do. This is partly because blacks have higher risks of high blood pressure, diabetes and obesity.
Sex (gender)Stroke is more common in men than in women. In most age groups, more men than women will have a stroke in a given year. However, more than half of total stroke deaths occur in women. At all ages, more women than men die of stroke. Use of birth control pills and pregnancy pose special stroke risks for women.
Prior stroke, TIA or heart attack The risk of stroke for someone who has already had one is many times that of a person who has not. Transient ischemic attacks (TIAs) are “warning strokes” that produce stroke-like symptoms but no lasting damage. TIAs are strong predictors of stroke. A person who’s had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn’t. Recognizing and treating TIAs can reduce your risk of a major stroke. If you’ve had a heart attack, you’re at higher risk of having a stroke, too.
Risk factors that can be treated are:

High blood pressure High blood pressure is the most important controllable risk factor for stroke. Many people believe the effective treatment of high blood pressure is a key reason for the accelerated decline in the death rates for stroke.
Cigarette smoking In recent years, studies have shown cigarette smoking to be an important risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. The use of oral contraceptives combined with cigarette smoking greatly increases stroke risk.
Diabetes mellitus Diabetes is an independent risk factor for stroke. Many people with diabetes also have high blood pressure, high blood cholesterol and are overweight. This increases their risk even more. While diabetes is treatable, the presence of the disease still increases your risk of stroke.
Carotid or other artery disease The carotid arteries in your neck supply blood to your brain. A carotid artery narrowed by fatty deposits from atherosclerosis (plaque buildups in artery walls) may become blocked by a blood clot. Carotid artery disease is also called carotid artery stenosis. Peripheral artery disease is the narrowing of blood vessels carrying blood to leg and arm muscles. It’s caused by fatty buildups of plaque in artery walls. People with peripheral artery disease have a higher risk of carotid artery disease, which raises their risk of stroke.
Atrial fibrillation This heart rhythm disorder raises the risk for stroke. The heart’s upper chambers quiver instead of beating effectively, which can let the blood pool and clot. If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results.
Other heart disease People with coronary heart disease or heart failure have a higher risk of stroke than those with hearts that work normally. Dilated cardiomyopathy (an enlarged heart), heart valve disease and some types of congenital heart defects also raise the risk of stroke.
Sickle cell disease (also called sickle cell anemia) This is a genetic disorder that mainly affects African-American and Hispanic children. “Sickled” red blood cells are less able to carry oxygen to the body’s tissues and organs. These cells also tend to stick to blood vessel walls, which can block arteries to the brain and cause a stroke.
High blood cholesterol People with high blood cholesterol have an increased risk for stroke. Also, it appears that low HDL (“good”) cholesterol is a risk factor for stroke in men, but more data are needed to verify its effect in women.
Poor diet Diets high in saturated fat, trans fat and cholesterol can raise blood cholesterol levels. Diets high in sodium (salt) can contribute to increased blood pressure. Diets with excess calories can contribute to obesity. Also, a diet containing five or more servings of fruits and vegetables per day may reduce the risk of stroke.
Physical inactivity and obesity Being inactive, obese or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. So go on a brisk walk, take the stairs, and do whatever you can to make your life more active. Try to get a total of at least 30 minutes of activity on most or all days.
Recognition of Brain Attack symptoms “FAST” and knowing the time of the symptom onset (the time when the person was last seen well or normal, not when the person was found with the stroke symptoms) are important because time saved is brain function saved. Learning the signs and symptoms of a Brain Attack can save time and precious brain function. By using the easy mnemonic device FASTto remember stroke symptoms you can help expedite medical and surgical stroke intervention. According to Dawn Kleindorfer, M.D. associate professor of neurology at the University of Cincinnati, It is so important to realize that rapid treatment can sometimes reverse stroke, break up clots and turn it all around but you have to get to the hospital right away. Only a health care professional can determine if someone is having a stroke. However, by Thinking FAST, you may be able to save someone’s life. You can Think FAST by looking for the following signs and symptoms:

F- Face (uneven smile, facial droop/numbness, visual disturbances) Have person try to smile. Does one side droop down? Is one eye more closed than the other? Do they have a difficult time seeing you?
A- Arm and Leg (weakness, numbness, difficulty walking) Have person raise both arms out in front of them. Are they able to raise both arms? Does one arm fall to their side? Can they feel you touch their arm or leg? Can they walk?
S- Speech (slurred speech, inappropriate words, can’t speak, can not follow simple commands)
T- Time Call 911 immediately if one or more of these symptoms occur. Report to EMS the time of the onset of these symptoms or if you are not aware of the time, let EMS know the last time you saw this person normal. Also report the symptoms that you observed. The information you provide can make a difference in the kind of treatment that can be safely provided.

Unfortunately, most people with stroke symptoms do not get to the hospital in time to receive the full range of possible treatments. It is crucial that you get to the hospital quickly. Do not drive yourself. Call EMS. Many people are afraid to call EMS or go to the emergency room. They think, “What if I am wrong? I don’t want to look stupid. But what if you are right? If the stroke is the result of a clot, you may receive a clot busting drug called Tissue Plasminogen Activator (t-PA). However for this drug to work, it must be given within three hours of the onset of symptoms. That is why it is so important to know the time the symptoms began. If t-PA is given with in 3 hours of the onset of stroke symptoms, t- PA has been shown to improve outcomes of all Brain Attack patients. Patients treated with t-PA are 30 -55% more likely to have minimal or no disability at 3 months after the stroke. (NINDS New England Journal of Medicine 1995, 333:1581-7). Currently < 5% of eligible patients are getting t-PA nationwide. Mostly because people do not get to the emergency room on time. Two thirds of Brain Attack patients wait 24 hours from the time of onset of their symptoms before coming in for treatment. The health care providers will need to determine the cause of the stroke before treatment is started. If the cause of the stroke is hemorrhagic, surgical intervention may be necessary.

Besides Thinking FAST and getting to the hospital quickly, it is important to know if your hospital is equipped to provide the latest treatment for stroke. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) launched a Primary Stroke Center Certification in 2003. Founded in 1951, the Joint Commission seeks to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations. The Joint Commission evaluates and accredits nearly 15,000 health care organizations and programs in the United States, including more than 8,000 hospitals and home care organizations, and more than 6,800 other health care organizations that provide long term care, assisted living, behavioral health care, laboratory and ambulatory care services. The Joint Commission also accredits health plans, integrated delivery networks, and other managed care entities. In addition, the Joint Commission provides certification of disease-specific care programs. An independent, not-for-profit organization, the Joint Commission is the nation’s oldest and largest standards-setting and accrediting body in health care. The recommendations for a primary stroke center is based on the criteria published by the Brain Attack Coalition and the American Stroke Association. To be considered for Primary Stroke Center designation, the hospital must:

Have a qualified Medical Director responsible for the stroke program
Have an effective process in place in the Emergency Department to ensure that all stroke patients receive timely care and that the number of patients eligible for and receiving TPA is maximized
Demonstrate effective multidisciplinary team effort in the treatment of stroke patients
Develop and implement a series of care protocols that follow the “Get With the Guidelines” program
Have adequate neurologists on staff to cover emergency call
Have adequate neurosurgical coverage to support emergent stroke patient surgical needs
Have 24 hour a day, 7 day a week, 365 days a year coverage in key imaging and diagnostic areas including:
CT, MRI, MRA
Cerebral Angiography
Carotid Ultrasound
Transthoracic/Transesophegeal Echocardiogram
Submit clinical data on all stroke patients to the American Stroke Association
Use an ongoing stroke team structure to evaluate stroke patient data and strive to continuously improve on compliance to stroke protocols and performance against industry recognized stroke care benchmarks
Have a structure in place to ensure that ongoing stroke education is provided for physicians, nursing and ancillary staff

The best thing for you to do if you have the risk factors for stroke is know if there is a primary stroke center in your area. You can do this several ways. You can call your local hospital and ask if they are a primary stroke center. You may need to speak to the manager for the Emergency Department or to the Chief Nursing Officer to find out this information. Another resource is contacting your local Emergency Medical System provider. They will know which hospital in the area provides this care. You can also contact the following people at the Joint Commission related to disease specific care certification:

Jean Range
Executive Director

jrange@jointcommission.org

M.J. Hampel
Associate Director

630-792-5720

mhampel@jointcommission.org

Or you can log onto the Internet Stroke Center: Stroke Center Directory at http://www.strokecenter.org/strokecenters.html. This site shows you a map of the United States. Click on your state and it will give you information on the stroke centers in your area.

Preventing a Brain Attack by knowing your risk factors and controlling the controllable is the best way to not become a statistic. Other ways to prevent yourself or your loved one from suffering permanent disability or death from a Brain Attack is being knowledgeable about the signs and symptoms of a Brain Attack, knowing that you have to Think FAST, calling 911 at the onset of stroke symptoms and knowing where in you area there is a primary stroke center.

For more information on stroke go to StrokeAssocaition.org or call 1-888-4-stroke

Deborah Cort is a registered nurse with 19 years of clinical and healthcare management. She is chief nursing officer at SouthLakeHospital in Central Florida where she directs and evaluates all aspects of patient care.

Approximately 2 million people a year get a hospital-acquired, or nosocomial, infection, and as a result of these infections, one in 20 of these people die. In a recent article in “Hospital and Health Network,” Dr. Richard Shannon, chairman of the department of medicine at Allegheny General Hospital in Pittsburgh, estimates that 90 percent of hospital-acquired infections can be prevented. This data can be quite disturbing and make you feel unsafe when entering the hospital, but there are ways to keep yourself and your loved ones protected while receiving medical care.

The most frequent hospital-acquired infections are urinary tract infections, surgical site infections and nosocomial pneumonia. Infections rates are higher among patients with increased susceptibility due to old age and other conditions such as diabetes, renal failure, leukemia, AIDS, etc. According to a World Health Organization report in 2002, urinary tract infections accounted for approximately 80 percent of all hospital-acquired infections. Urinary tract infections are associated with lower morbidity than other hospital-acquired infections, however, they can occasionally lead to death. Indwelling urinary catheters are one of the major causes of UTI. Unless it is absolutely necessary, have the catheter removed.
With the urinary catheter removed you will have to get out of bed to use the bathroom. Unfortunately, urinary catheters are left in the patient as a convenience for the nurse and not necessarily as a needed medical treatment. As stated in the article “Preventing Injury Related to Hospital Falls,” make sure you call for assistance before getting out of bed if you recently had surgery, are taking medications that make you dizzy or if you are unsteady on your feet. If your urinary catheter is a medical necessity, make sure the nursing staff cleans around the insertion site and the drainage bag remains lower than your bladder. UTIs can occur when the drainage bag is positioned too high and the urine in the bag refluxes into the tubing and back into the bladder.

Surgical-site infections can occur in up to 15 percent of all surgeries depending on the type of operation and the patient’s medical status before surgery. A surgical-site infection is evidenced by pus around the wound or the insertion site of a drain, or cellulitis (infection and inflammation of the tissues beneath the skin) spreading from the wound. There are several things you can do to decrease your risk of surgical-site infection. Before you go in for surgery, ask your surgeon about post-operative infection rates. If he or she won’t tell you or doesn’t know, consider looking for another surgeon. Surgical-site infections are often caused by poor surgical technique, the duration of the operation, your health before surgery and the operating room environment, including policies on staff entry and appropriate surgical attire, sterile equipment and preoperative preparation of the patient. Most hospitals report their surgical-site infections rates to national comparative databases. Research the hospital before you go for surgery. If the surgical-site infection rate is high at that facility, ask your surgeon if he or she will perform your operation at another hospital in your area with a lower infection rate.

According to the Centers for Disease Control, or CDC, pneumonia has accounted for approximately 15 percent of all hospital-associated infections and 27 percent and 24 percent of all infections acquired in the intensive care unit and coronary care unit, respectively. It has been the second most common hospital-associated infection after that of the urinary tract. The primary risk factor for the development of hospital-associated bacterial pneumonia is mechanical ventilation. The known risk factors for infection include the type and duration of ventilation, the quality of respiratory care, severity of the patient’s overall medical condition and whether the patient was on antibiotics. To help reduce the risk of ventilator-acquired pneumonia, ask the hospital staff about how the ventilators, tubing and other equipment used on the patient are sterilized. Make sure that when any care related to the ventilator such as suctioning is performed on the patient, sterile techniques are being used. This means that the nurse or respiratory therapist must use sterile gloves and not lay sterile tubing and suctioning equipment on nonsterile surfaces. Also ensure that the head of the bed is in an elevated position as much as possible.

The CDC reports that hospital infections cost the American public nearly $5 billion each year. The cost is the result of the additional days or weeks patients stay in the hospital to treat the new infection. Any time you are admitted to the hospital or have a surgical procedure, you are at risk for infection. You can reduce that risk by being informed and by speaking up with questions or concerns. Here are some other recommendations to reduce infections by the Committee to Reduce Infections Deaths, a nonprofit group devoted to safer hospital care.

1. Always ask hospital staff members, even doctors, to wash their hands before treating you. Most hospitals provide their staff with an alcohol-based foam that is in the hallways or in patient rooms. If the staff member’s hands are not visibly soiled with blood or other body fluids, it is acceptable for them to disinfect their hands with foam.
2. Before a stethoscope is used, ask the staff member to clean the diaphragm (the flat surface that will be touching your skin) with an alcohol pad or alcohol foam.
3. If you are having surgery, three to five days before your surgery, shower daily with 4 percent chlorhexidine soap, which is available at the drug store without a prescription.
4. Stop smoking well in advance of your surgery. Smokers are three times as likely to develop a surgical-site infection as nonsmokers and have significantly slower recoveries and longer hospital stays.
5. If you are having surgery, ask your doctor to give you an antibiotic an hour before the first incision. This will help prevent infection at the surgical site.
6. The operating room is kept very cold to prevent the spread of germs, however, ask your surgeon about keeping you warm during surgery since patients that are kept warm resist infection better.
7. Make sure you nor the staff shaves the surgical site. Razors can create nicks in the skin through which bacteria can enter. If hair must be removed, ask for clippers instead of a razor.
8. Ask that the surgeon limit the number of people in the operating room. The more people who are present, the higher the risk of infection.
9. If you are having cardiac surgery, ask your doctor to monitor your blood sugar levels during and after surgery. Research shows that if blood sugar levels are kept between 80 and 110 mg per unit, the patient resists infection better.
10. If possible, avoid having a urinary catheter inserted. If you do have one, make sure it is removed as soon as possible.
11. If you have an intravenous drip, or IV, make sure it is inserted and removed under clean conditions and that the site is changed every three or four days.

Preventing hospital-acquired infections is the hospital’s responsibility first and foremost. The policies and procedures they put in place are meant to keep you safe. However, nothing is 100 percent effective. It is important that you, as the patient, ask questions and observe the staff to ensure they keep you safe and infection free.

Deborah Cort, MSN, CRRN is the Chief Nursing Officer at South Lake Hospital in Clermont, FL.

Most of the time a hospital stay improves your health, however, sometimes a fall in the institution can cause it to deteriorate.

A patient falling is a common safety incident that occurs in the hospital. More than 200,000 falls were reported to the National Patient Safety Agency from September 2005 to August 2006. Twenty-six of those falls resulted in patients deaths; more than 530 fractured hips and another 440 patients sustained other fractures, according to the safety agency.

The human cost of falling includes distress, pain, injury, loss of confidence and loss of independence as well as impact on relatives and careers. A fall can be serious, especially if you have just had surgery or if you have an illness.

While in the hospital, it is crucial for your safety to listen to your health-care provider. They are looking out for your safety. To reduce your risk of falling, you need to call for assistance when you need to get out of bed or to go sit in a chair. Your nursing call light should be within your reach at all times. Before your nurse leaves the room, ensure you are able to contact him or her quickly if needed via the call light.

There are many environmental risk factors in your hospital room. If you have just had surgery or if you have just taken a medication, you will probably be weak, dizzy or unsteady. Attempting to get up by yourself could lead to a fall. It is often difficult to maneuver an IV pole around the room and into the bathroom by yourself. Also, be aware that the bedside table rolls and should not be used as an assistive device to get out of bed. Wearing proper footwear will also decrease your chances of falling. Make sure you have slip-resistant socks on when getting out of bed.

Most hospital falls result from poor mobility and confusion as well as from environmental hazards such as wet floors or objects left in the patient’s room, according to a 2007 National Patient Safety Agency report.

Most falls occur when patients are trying to get up to go to the bathroom. The patients who are most vulnerable to falls are those 80 years and older, however younger patients also fall, depending on their illness or injury or the medications they may have taken.

Illnesses or injuries that put patients at higher risk for falls are, stroke, arthritis, dementia, cardiac diseases, acquired brain injury, delirium, Parkinson’s disease, dehydration, disordered blood chemistry, and hypoglycemic episodes in diabetes.

Medications that put patients at a higher risk for falls are, sleeping tablets, sedatives, pain killers, medications that cause low blood pressure, alcohol and street drugs. Also, more men fall in the hospital than women and patients are more likely to fall during the weekdays around mid-morning.

Most of the patient’s falls are unwitnessed by staff because the patient has not called for assistance. To stay safe while in the hospital, call for assistance any time you need or want to get out of or back into bed.

Hospitals will often assign a fall risk number to you due to the type of illness you have, the medications you are taking or your age. Listen to the nurse and doctor when they instruct you not to get up by yourself. They are doing this to keep you safe and protect you from any injury. If you need assistance to get out of bed or a chair and you are not receiving it from the nursing staff, ask to speak to the nurse manager or director. It is important that you communicate your needs and desires to the staff and if they are not meeting your needs, let the hospital management team know. Hospitals are there to keep you safe and protected.

Deborah Cort, RN, MSN, CRRN is the Chief Nursing Officer at South Lake Hospital in Clermont, Florida