Archive for the ‘Uncategorized’ Category

Water Heater Maintenance Tips

August 16, 2013

Paying more than you have to for hot water is the same as pouring energy dollars down the sink. In this article, you’ll find hands-on advice about how to maintain your water heater for no cost, meaning a more economical and ecological way of heating water. Over time, you can expect your energy savings will more than repay your initial labor investment.

Water Heater Maintenance

Keeping your water heater free of buildup and sediment will make it work more efficiently, and this is especially important if you live in an area with hard water. Because hard water is laden with minerals, these can build up in your heater and reduce its efficiency. Houston emergency plumber

Keeping your water temperature below 120 degrees will slow sediment accumulation, and the water will be typically hot enough for most household purposes (unless you love a scalding shower). Dishwashers often require hotter water, but most contemporary dishwashers come with their own internal heaters that can raise the temperature of the water to the 140 degrees they need.

Eliminating Sediment

To drain sediment out of your water heater, start by turning off the water supply to the heater at the cold water intake or at your home’s main shut-off valve. If you have a gas-fired heater, turn the temperature knob all the way to OFF and then close the gas supply valve to the gas line. If you have an electric water heater, simply turn off the electricity at the main service panel.

Next, attach a length of garden hose to the heater’s drain valve and run it to a floor drain in your basement or outside (but below the level of the heater). If you don’t have a long enough hose, place a bucket or tub under the drain, but be prepared to stop and go as you empty the buckets. Plumber in Missouri City

Open the heater’s drain and a close faucet for hot water to let air into your water system. The water will begin coming out of the valve. Once the water starts running clear, you can close the valve. If the water still runs cloudy for an extended period of time, turn on the supply valve for the cold water to flush out any remaining sediment.

When you’re done, close the drain valve and shut off the nearby hot water faucet. If you haven’t done so already, reopen the cold water supply valve to refill the tank. Once the tank is full and you can no longer hear water running into it, turn on the power by either restoring electric power or opening the gas line and reigniting the pilot light. To keep sediment at bay, set your thermostat to below 120 degrees.

Living Forensics

July 28, 2009

Living Forensic is a part of forensic science that focus on living victims of abuse or trauma. Nurses in general are often exposed to the aftermath of many of these forensic matters. Unfortunately a lot of these cases do go unnoticed due to lack of training in the field of forensic. For this reason alone, I think that all nurses should undergo some form of forensic training. Having knowledge of the forensic principles and guidelines will assist nurses in upholding the rights of the patient by being able to recognize and protect evidence that can be used in determining verdict or cause.

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Suicide Risk Assessment in Nursing Practice, comment

July 14, 2009

I recently was invited to help create a suicide risk screening form for our busy ER. With the help of our Psyche Nurse Clinician and Nurse Manager, we came up with a form that consists of several "observations" as well as questions to ask the patient. Their responses dictate a score and the score dictates the severity. Since the creation of the form, nurses are having difficulty assessing for this risk because they are uncomfortable and feel the questions are intrusive. A good interviewer will find a way to incorporate the questions into the interview. We have counseled several nurses regarding the interview process, having to work closely with them to find that level of comfort and professionalism that "allows" other nurses to comfortably ask questions. Some other barriers are nurses perceptions to mental illness. Some nurse believe that ALL psyche patients will lie or try to cover the truth, when in fact if you treat the psyche patient like they have an acute illness or a chronic illness, they are more likely to open up. Nurses should not be afraid to ask about diagnoses or medications. I have actually had one patient respond to this question: "Sir, what do you take this medicine for?" His response: "I take it so I don’t do what the voices tell me to do." Of course I was taken aback at first, but allowed my professionalism to rise up and move right on to the next question in my interview. He was very matter-of-fact about his mental illness and actually seemed at ease in speaking with someone without feeling judged. Embracing mental illness like heart disease and lung disease will only help the nurse in the care of this patient population.

Original Post:
July 13, 2009
Suicide Risk Assessment in Nursing Practice, comment
Nurses should not find themselves in uncomfortable positions when they reach the psychiatric section of an intake assessment. We must remember that medicine is holistic. The mental health of our patients is just as important as their physical health. If the patient is on psychiatric medications, we need to know that. We must know what the medications are, their doses, and their actions. If a person states that they have “chronic back pain”, this should not be any worse for an RN to hear than “I am chronically depressed”. Since depression can lead to suicidal thoughts, it should only be natural that the RN asks the patient if they have ever thought about suicide. It is of utmost importance to treat the entire person.

Original Post:
May 26, 2009
Title: Suicide Risk Assessment in Nursing Practice
I wanted to briefly address the need to emphasize suicide risk assessment in the acute care setting. I see in this inpatient setting a hesitancy by many nurses to assess patients for suicide risk. As acute care nurses, we often overlook the psychiatric components to our patients health and as a result, do not give the care often needed by our patient population. As psychiatric illness can play the role of contributing factor in some physical illness, I do see it as necessary to not forget this aspect of our nursing assessment, especially on patient admission. We are often afraid of offending or creating an awkward introduction to our patient/ nurse relationship, however I do see this as an obstacle that we, as nurses need to overcome to provide adequate care to our patients. The more open we are in addressing psychiatric needs, such as suicide risk or other chronic psych illnesses, the better trust we will build with our patients.

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March 1, 2009

This is a test.


February 18, 2009


Informed consent, comment

February 18, 2009
I read in the blog some discussion of informed consent. As a consumer
of medical services I rarely get much out of the informed consent
documents, and will admit that I rarely read them in much detail.
Granted, if we were talking about more than just a general doctor’s
visit I would take a little more notice.
I have also participated on several research studies and have written a
number of IRB applications, including drafts of the informed consent
documents that are given to participants. While I have tried to make
these the most accessible to the participant as I can, the university I
worked for required certain headings and certain, stock legal language.
The purpose of the documents from the IRB’s side didn’t seem to be
“make the participant aware” and the purpose from the principal
investigator’s perspective was “get it through IRB” (and typically
after the research activity had already begun).
I won’t even go into the issues around working with a non-English
speaking population, where while translation is required actually
putting time and resources into achieving a translation that actually
communicates meaning is definitely not the priority. Rather, the
priority is having a document where the written word is in the language
desired regardless of the meaning communicated.
As a massage therapist, I am working directly with clients to provide a
service. There are legal concerns to be addressed, definitely, with the
informed consent. There are also scope of practice issues to be
clarified. Finally, and most interesting to me, are the issues around
getting the client to understand what the purpose of the service is and
how s/he may contribute. I found the one poster’s comments about a
“teach-back” approach intriguing, and will look more into this. While
not brain surgery, a client has the right to understand what they are
about to participate in and having them tell me “in their own words”
what it is–the legal issues, the scope of practice issues, and their
contributions to the outcome–sounds like a great strategy.

Original Post:
February 6, 2009
Informed Consent: Is it really understood?
I find the articles regarding informed consent exceedingly interesting.
It was a subject that was recently brought to my attention regarding
Radiography Techs and consent for IV contrast. For years, RT’s were
able to witness consent, then all of a sudden they could not. Being the
only RN in a busy Imaging Department, this became a huge burden. I did
some research recently and found articles from ARRT that describes the
RT Scope of Practice. Their scope of practice specifically states that
they are to “verify” that consent was obtained. Now comes another
wrench. There is no definition of “verify” and in our department, it
had become a bone of contention among the Radiologists that the
ordering provider was responsible for “Informed Consent”, to include
risks, benefits, options, etc. Now comes the fun part: Some
practitioners don’t even order the proper tests. Try convincing a
steadfast NP that by ordering a CT Thorax WITH CONTRAST, they were
actually prescribing the contrast. She did not appear to get what I was
trying to explain to her. (She must have finally, because she began to
order tests without contrast, which is a questionable practice because
it may not always be the best exam for a patient and they have a delay
in care or another CT with contrast) I even went so far as to go to the
ANA website and download the RN Scope of Practice, which explains
consent is again “verified”, not witnessed like we do. Both the NYS DOH
and DOE do not specifically state whether an RN or an RT respectively
can or cannot witness consent forms. It has come down to many crucial
conversations between patient and staff and the knowledge of the
patient regarding testing. If this wasn’t my job, I would find it
rather humorous and ironic, all these issues that arise that are truly
not addressed in the RT or RN Scope of Practice.

Original Post:
February 2, 2009
Informed Consent: Is It Really Understood?, comment
work in a Liver Failure Clinic and have end stage liver failure
patients. I perform paracentesis procedures to remove fluid from some
of these patients peritoneum. The patients are in pain need fluid taken
of their peritoneum NOW so they can breathe.
The patient has to be able to make decisions to sign the consent.
We inform the patient they may need blood if a vessel was punctured. We tell them they may get an infection and even die.
We have the patient sign on a pad that transmits the signature to a computer. A witness and I sign it also.
 All of this is before the procedure is done.
has a patient not wanted the procedure even when death, bleeding, pain
and infection were mentioned in the informed consent.

I agree
that it is important to have an informed consent. It takes time and
sometimes the patient’s signature is almost unrecognizable.
There is
pressure on the patient and staff to get this signature. I agree that
sometimes the patient does not really know what is going to happen
because they are in need of the procedure now. We explain the entire
procedure to them before the procedure but just how much is really
understood is questionable.

Original Post:
July 10, 2008
Informed Consent: Is It Really Understood?
is good to see the topic of informed consent included in the text book
Health Promotion Throughout the Lifespan. As a nurse, who practiced for
twenty plus years in the acute care field, this topic is of vital
interest to me. It was not often enough that I felt patients fully
understood what they were agreeing to. Now, with mounting concerns
about patient safety and lawsuits arising out of botched
communications, the area of informed consent is drawing national
attention. Informed consent is one aspect of patient autonomy. Informed
consent occurs when with “substantial understanding” and without
substantial control by others an individual authorizes a professional
to do something. As a witness to the typical “informed consent”
process, in the acute care setting, it is no wonder that breeches in
patient autonomy are realized and being awarded financial remuneration
following legal action. In my opinion, critical flaws in the current
system include; the patient condition at the time information is being
provided, lack of complete information including treatment
alternatives, lack of patient education prior to procedures including
the recovery phase, lack of time to process information, cumbersome
written consent documents, language and other communication barriers.
The Centers for Medicare and Medicaid Services have now called upon
hospitals to design patient-friendly informed-consent processes. Theses
processes are now required to include treatment alternatives and the
consequences of declining recommended therapies. The Joint Commission,
which accredits hospitals, is advocating the use of easy-to-read forms
and the use of “teach-back” methods, which involve asking patients to
repeat back what they have been told about the proposed treatment,
risks and benefits. The Department of Veterans Affairs (VA) hospital
system is conducting several new studies in the area of informed
consent utilizing the “teach-back” method to determine patient
understanding. It is the beginning of what I believe to be a long
overdue focus in healthcare delivery. Hopefully, the inf
ormation gained
will be utilized in a standardized approach to increase patients
understanding of proposed treatments with the outcome of preserving
patient autonomy.

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Benadryl, comment

February 12, 2009
Benadryl is a medication that most people
would consider safe because it’s given over the counter on a regular
basis. All the comments made about this medication and the tragic
occurrences resulting from overdose is a very serious issue that needs
to be looked at. This is the first i’ve heard of adolescents smoking
benedryl to get high, because it is a cheap and easily accessible drug.
It becomes very scary when you hear of these things happening on a
regular basis. But really what is the answer? Parents need to be
educated, as well as elementary and highschool students about the
possible effects of experimenting with even over the counter
medication. I think more time needs to be spent with elementary and
highschool students, so that they are well aware of the possible
outcomes of consuming foreign substances, as well as ones they are
familiar with.

Original Post:
February 9, 2009
Benadryl, comment
Reading articles like the Benadryl article
scare me. Society appears to be very flippant about the use of
medications for other that what they are intended. Articles abound from
ISMP. One that comes to mind recently had to do with a Fentanyl patch.
The grandmother was watching a young girl who was complaining of pain.
Grandma had some “leftover” Fentanyl patches and placed one on the
granddaughter, subsequently leading to respiratory arrest and death.
Now I see commercials by lawyers, soliciting through the TV for people
who have had problems with Fentanyl patches and the potential for
overdose. Education about the proper use of and misuse of all drugs
should be paramount. If medication errors are one of the leading causes
of death IN the hospital, what are the numbers that are associated with
death OUT of the hospital. Action needs to be taken, not in the form of
litigation, but through vigorous education, with understanding by the
learner, so that these horrible incidents can be prevented.

Original Post:
December 29, 2008
Benadryl, comment

It is a tragedy when a child is injured or killed secondary to a
pharmaceutical drug. Children are given prescription and OTC
medications too often. There are many herbal and homeopathic remedies
available to treat everyday complaints. This tragedy not only impacted
the mother of the child, but the siblings as well. In the instance
presented here, perhaps the natural herb valerian would have been a
safer choice over benadryl.

Original Post:
December 1, 2008
Benadryl, comment
agree that Benadryl, an antihistamine often used for its sedation
effect in adults, can cause paradoxical central nervous stimulation in
children with effects ranging from excitation to seizures and death.
Many young parents have used Benadryl to give their children to calm
them down when they travel. I was working the emergency room one night
when a mother with 3 small children came running into the emergency
room with her youngest who was 12 months old. She said they were
traveling to Iowa and she stopped at a road side park to change the
baby’s diaper. She started screaming her baby was cold and not
breathing. She tried to do CPR and drive at the same time. She did not
have a cell phone and no other cars were at the park. We assessed the
baby and did a tox screen which also showed nothing. I asked the mother
if she ever gave her kids any over the counter medicine for colds or
coughs. She said sometimes. The 6 year old sister said, “mommy gave us
some pink medicine”. The mother then told us she gave them Benadryl
liquid. We tried to revive the baby, but after 45 minutes of CPR she
died. The death was ruled accidental and no charges were made. But I am
sure the mother was emotionally blaming herself for what she did and
will have to live with that the rest of her life. I think there needs
to be an education program for parents that over-the-counter
medications can be lethal at any age.

Original Post:
November 21, 2008
Benadryl, comment
do we combat the abuse of drugs that are unable to be detected through
any toxicology tests? The fact remains that people, especially young
teenagers, will try almost anything to attempt to get high. It becomes
almost impossible for law enforcement to prevent such actions and
therefore lies solely on the parents. It is definitely time to be
involved in the lives of your kids and know what they are doing.

Post: November 12, 2008 Benadryl, comment I have a response for the
blog entry from November 10, 2008 entitled Benadryl. In the emergency
department I work in we had an adolescent arrive in a psychotic state.
He was hallucinating, was manic, combative and then would calm down and
become very docile. He was slightly tachycardic and at times tachapneic
and his blood pressure wavered between normo to slightly hypertensive.
He didn’t have a diagnosed mental disorder. Our toxicology screens all
came back negative and so we were getting ready to transfer him to an
inpatient mental hospital when one of his relatives came in with
Benadryl wrappers and opened capsules of Benadryl found in his waste
basket in his room (they think he may have smoked it on a cigarette or
joint). The kid overdosed on Benadryl. Not because he wanted to die,
because he wanted to get high. Benadryl doesn’t show up in a tox screen
and all his other labs were pretty normal. He ended up going to our ICU
for a day and was discharged.

Original Post November 10, 2008
Benadryl, an antihistamine often used for its sedation effect in
adults, can cause paradoxical central nervous stimulation in children
with effects ranging from excitation to seizures and death. Teenagers
have discovered Benadryl, an over-the-counter medication, which is
easily obtainable and affordable. The effects of Benadryl produce a
“High.” Benadryl in this population is also taken with alcohol and high
energy drinks. Parents also give their infants Benadryl to produce
sleep and the outcome has been fatal intoxication. I have been made
aware of Benadryl and its deadly side effects when a 10-year-old child
was told by his mom to take a Benadryl tablet for his allergies. The
child unfortunately took an overdose and was placed in the hospital for
2 days to withdraw from medication.

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Narcotic Abuse

February 11, 2009
At this time I own/operate a drug testing business and we currently have a program through the court system to prevent juveniles from serving “adult” sentences if there are drugs involved. I live in eastern KY and I’m sure if you watch the news you have seen we are the RX drug capital of the US. Anyway, these kids are stealing their parents narcotics and snorting them or selling them. The parents are doctor hopping and have not 2-3 bottles but 40-50 bottles of different narcotics. It sickens me to think about the life these kids are getting into. Sometimes I wonder if it wouldn’t just be better to let them serve some “real” time and see what “innocent” snorting will get you. As a nurse, this is a rampant problem even among professionals. I am shocked at the number of nurses, doctors and nursing students that we have positive drug tests on that are taking large volumes of narcotics with legal RX while treating patients. It makes me want to drug test all physicians or nurses before they touch me!!

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Deep Vein Thrombosis

February 11, 2009
In regards to forensic science, a DVT can have an affect on the cause of death. If a thrombi is not discovered and treated in time it will continue to flow through the artery and finally make its way to the heart which may results in a possible death. If a coroner is trying to decide the cause of death, if they come across the thrombi, they will most likely have found the cause of death for the individual.

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Chronic Inflammation

February 11, 2009
In terms of forensic pathology, keeping on eye on chronic inflammation can help during an autopsy that is done on a deceased person. If cause of death is to be determined it could possible be traced back to a chronic inflammation due to prolonged exposure to potentially toxic agents. An example of this would be exposure to silica which when inhaled can result in inflammatory lung disease called silicosis. This information would be very important for a coroner to know because it would be able to find the cause of death due to prolonged exposure to such toxins. If people were exposed to these toxins in factories, workshops, etc… then a cause of death would be able to be established and the family would be able to fight back due to the long exposure to this chemical if need be. I would have never thought that prolonged exposure to certain chemicals could produce a chronic inflammation and this is very important information for me to know because I am going to work in the medical field and this is something that can be useful in a history of a patient if there is some kind of infection going on.

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