Inflammatory Bowel Disease moderated by Christa Baker, RN, BSN, FNP Student

Inflammatory Bowel Disease.

What is IBD?

Inflammatory bowel disease or IBD is a chronic inflammatory condition, which affects a person’s bowel. It is not the same as irritable bowel syndrome or IBS. IBD is made up of two diseases. These diseases cause inflammation in a person’s intestines. Inflammation means swelling and redness. These diseases are ulcerative colitis (UC) and Crohns disease (CD). Although these diseases are alike, they do have some differences. The main difference is that UC affects only the large intestine or colon, and CD can affect the whole digestive tract from the mouth to the anus. CD can occur between two patches of perfectly normal tissue. Unlike CD, UC does not skip around to different areas of the bowel; the inflammation encompasses one entire section. In UC, the whole lining of the bowel becomes reddened and inflamed. This causes sores to form. These become painful and bleed which can cause blood and mucous to appear in the stool. In CD, this inflammation goes much deeper into the bowel lining than in UC. IBD is a disease of remission and exacerbation. This means that sometimes the signs and symptoms will get better and then they will flare up again.

What causes IBD?

Nobody really knows what causes it but such things as diet, genetics and environmental factors are thought to affect the disease. Sometimes an infection in the digestive tract can trigger the disease. Smoking can also irritate IBD. The disease gets turned on but it can’t get turned off which causes the problem.

How do I know if I have IBD?

Diarrhea and stomach pain are the most common signs and symptoms. Sometimes a person can go to the bathroom 20 or more times a day. This can lead to low blood pressure, a fast heartbeat and thirstiness. Sometimes the opposite happens and a person becomes constipated. This happens when a blockage occurs in the bowel. Other signs and symptoms are tiredness, high temperature, weight loss and severe pain in the stomach. If a child has this disease, he or she may not grow properly because the body cannot absorb the proper nutrients to help them develop.

How does my health care professional find out I have IBD?

IBD is hard to diagnose because a person may not have any signs and symptoms until they get really sick. Sometimes a person can also think that he or she has something else wrong with them. A health care professional will talk to them about how they are feeling, what has been happening to them, and why they have been feeling sick. This is called taking a history. Then he or she will check their stool for blood. Sometimes a person can see blood in their stool but sometimes a special test needs to be done to find out if blood is present. Then he or she may want to look inside their intestines with a scope (camera). This is called a colonoscopy, which will show the lining of the intestines to see if it is inflamed. This does not hurt and they will be given medicine, which will cause drowsiness. A person does not usually remember this test after it is done.

How is IBD treated?

There is no actual cure for IBD, but there are ways to try to control it. A person may be given medicine, which works by slowing down the inflammation process. This is called a steroid and must be taken exactly how the health care professional tells them to take it. Antibiotics are only given to a person who has complications from IBD such as an infection around their anus from going to the bathroom too much. A person who has IBD must NEVER take antidiarrheal over the counter medicines. They MUST ALWAYS consult their primary care provider before doing this because taking them could cause a blockage in their bowel. Care should also be taken when taking such medicines as Aleve and Advil as these types of over the counter medicines can make IBD worse and can cause bleeding in the bowel. If the symptoms don’t get better then surgery may have to be performed to remove some of the affected area of the bowel. This can sometimes mean that the patient will have a bag (colostomy) on their abdomen, which collects the stool and must be emptied by the patient. Although this sounds like a bad thing, it can bring great relief to the patient because they do not have to go to the bathroom all the time, they have much less pain and can lead a normal life.

A diet, which is high in fiber, can help. Also, if a person avoids spicy and dairy foods this may also help along with eating small meals. A person who has IBD should take a vitamin supplement to help them get the proper nutrients.

There are very few resources for people who live in Northeastern Pennsylvania who have IBD. If you have questions you should ask your primary healthcare provider to help you get information. People who look after people who have IBD also need help and support because this disease is very stressful to both the patient and caregiver.

There is a lot of information available “on line” if a person has access to a computer. If they don’t have one at home then a local library should be able to help. The library is also a good source of information on support groups for people who have a wide variety of diseases.

Here are some useful places that can answer your questions.

The Crohns and Colitis Foundation of America; telephone # 1-800-932-2423. This is a number available from Monday to Friday from 9am to 5pm. This is a national organization which can answer questions about IBD and will help to find resources for people with IBD. They will send out information on these diseases to people who cannot access a computer. The web site is www.ccsa.org.

The National Foundation for Ileitis and Colitis is also a national organization which can help people find various resources who have this disease. The telephone number is 1-800-343-3637. This service is available Monday to Friday, 9am to 5pm. They will send out written information to people who ask for it. The web site is www.ccsa.org

The following web addresses have a great deal of information available on IBD.

www.nidde.nih.gov

www.ibdcrohns.com

www.about.com

www.familydoctor.org

www.niddk.nih.gov

HIV/AIDS Moderated by Dana Draina, RN, BSN; Family Nurse Practitioner Student

What Causes AIDS?

AIDS is caused by the virus HIV. This virus that will destroy the body’s technique to fight infection and certain cancers. If the virus enters your blood, you may become infected. People with HIV can have many health problems because the body’s immune system stops working. These can include severe weight loss, pneumonia, cancer, and damage to the nervous system. These illnesses could occur within a year or two or may take as long as 10 or more years to appear. The only way to tell if you have caught the virus is to get a special blood test.

How do people get HIV?

The virus is spread by three main ways:

· Having sex with a person infected with HIV

· Sharing a needle or syringe with a person infected with HIV

· Mothers infecting their babies in the womb, at birth or during breast feeding

· Years ago, people got the virus from receiving infected blood

HIV, Sex and Drugs

HIV may be in a person’s blood, semen, or vaginal fluid. It is thought that the virus can enter the blood through tiny cuts or sores in the vagina or penis. Sometimes these cuts may be so small you don’t know they are there. Many people with HIV have no symptoms. So, it is hard to know who may have the virus.

Anal sex with a person who has the virus is one of the ways it has been most often spread. Whether you are male or female, anal sex with an infected person is not advised.

HIV through oral sex may be likely. During oral sex, the person who receives semen, blood, or vaginal fluids is at a higher risk.

The more sex partners you have, the higher your chances are of catching it.

People can get HIV by sharing needles or other drug shooting supplies with someone who has HIV. Even though people stopped using dirty needles years ago, they may still be at a risk for HIV and can pass it through unprotected sex now.

How is HIV Treated?

Currently there is no way to get rid of the virus once a person is infected. But, new medicines can slow the damage that HIV causes to the immune system. Also, health care providers are getting better at treating the illnesses that are caused by HIV infection. Many people now consider the HIV infection a manageable chronic illness.

Since, HIV is a retrovirus; the drugs used to treat it are called antiretroviral medicines. The current recommended treatment for HIV is a combination of three or more medicines. This standard of medicines is called highly active antiretroviral therapy (HAART). These strong medicines control the virus and slow the rise of HIV infection. But, they do not cure it. You need to take these medicines exactly as your health care provider prescribes. How many pills you will need to take and how often you will take them depend on which medicines your doctor chooses for you. Each HAART standard is tailored to each individual patient.
Your health care provider may also prescribe other medicines for you, hinging on your CD4 cell count. Always discuss any side effects with your health care provider. Never change the way you are taking any of the medicines without first talking with your health care provider. If you don’t take your medicines the right way, they may not work as well as they should be.

Resources:

Pennsylvania Department of Health Northeast District Office

665 Carey Avenue, Suite 5

Wilkes-Barre, PA 18706-5485

HIV Prevention Nurse Consultant 570-826-2062

Provides resources, education, direction for personal, and community needs.

Centers for Disease Control and Prevention
National Center for Environmental Health

1600 Clifton Road

Atlanta, GA 30333
1-800-CDC-INFO (1-800-232-4636) or 404-639-3311
www.cdc.gov/hiv

Nationwide test site referrals, counseling, literature (upon request), clinical trials information referrals, and a wide scope of other HIV/AIDS/STD/TB-related resource information.

Wyoming Valley AIDS Council

183 Market Street, Suite 102

Kingston, PA 18704

(570)823-5808

www.XceedAmerica.org

Provides support groups for people infected or affected by HIV/AIDS.

Pennsylvania Department of Public Works

AIDS-Specific Programs Information

Case Management Unit

P.O. Box 8021

Harrisburg, PA 17105-8021

1-800-922-9384

www.dpw.state.pa.us/omap

Provides special pharmaceutical benefits program (SPBP) which pays for certain drugs for persons with HIV/AIDS with certain eligibility requirements.

U.S. National Library of Medicine

8600 Rockville Pike

Bethesda, MD 20894

http://sis/nlm.nih.gov/hiv.html/

Offering information on HIV/AIDS treatment, prevention and research.

Asthma Moderated by Mary Wilkinson, RN, BSN, Graduate Family Nurse Practitioner Student

What is asthma?

• Asthma is a chronic (long-lasting) disease that affects the lungs. Asthma causes irritation in your lung airways. Irritation can cause swelling and mucous production. The lining of the lungs is very sensitive to certain irritants or “triggers”. A “trigger” can be an allergy such as pollen, animals, mold, or house dust. A trigger can also be exercise, cold air, tobacco smoke or medications such as aspirin. When the lungs respond to a trigger, the muscles in the lung tighten (or get smaller) and the airways swell and produce thick mucous. This makes it difficult to breath. When your lung airways react to a “trigger”, this is called an asthma attack.

• An “attack” can be mild, moderate or severe. During a severe asthma attack, the airways may close so much that oxygen cannot to get to important organs in the body. This is an emergency. People can die from a severe asthma attack if it is not treated. Medication is usually needed to help breathing during an attack.

What are the symptoms?

• Coughing, especially at night or early morning, or with exercise
• Wheezing (whistling sound heard during breathing in or out)
• Feeling short of breath (unable to catch your breath)
• Chest tightness
• Faster breathing or noisy breathing

If you are having any of these symptoms, you should get in touch with your health care provider right away.

Not everyone with asthma has all of these symptoms. The symptoms are different for different people. Sometimes symptoms are only annoying and other times they are serious or even life threatening. The goal of treatment is to have few or no symptoms.

What causes asthma?

• Things in the environment can bring on your asthma attack. Some of these things include exercise, allergens (dust, molds, animals, pollen from trees or grass), and viral infections. Medications (like aspirin) can also cause an asthma attack

Who is at risk?

• Asthma is closely linked to allergies. People who have allergies may be more likely to get asthma. Most people with asthma have allergies.

• Someone with a family history of asthma (if someone in your family has asthma, you have more of a chance of getting it)
• People who where around “triggers” at a young age

How is asthma diagnosed?

• Your health care provider will ask if you have shortness of breath, chest tightness, coughing (worse at night or early morning).
• Your provider will ask if your breathing problems are worse after activity or at a certain time of the year.
• Your provider will listen to your lungs for wheezing.
• Your provider will check how well your lungs are working with a plastic tool called a “spirometer”. This test measures how much air can be blown out of your lungs after taking a deep breath. The results will be lower than normal if your airways are swollen, which may mean you have asthma.

From the results of these tests, the doctor can determine how severe your asthma is. This will tell your doctor how to treat your asthma.

What is the treatment for asthma?

There are several types of treatment for asthma. There are long-term medications and short-term medications. Most people use a both long and short-term medication to control their asthma. Some medicine can be inhaled (or breathed-in) and some can be taken as a pill.

• Short-term medicine controls the symptoms of an asthma attack. If you are using your short-term medicine more often, you should contact your health-care provider
• Long-term control medicine helps you to have fewer and less severe attacks, but don’t help you if you’re having an asthma attack. These medications are taken every day.

The important thing to remember is that you can control your asthma with your health-care provider’s help. You should make your own asthma plan so you know what to do if you have an attack. Know your plan and let your friends and family know your plan. If your symptoms become worse, contact your health-care provider.

Resources:

Centers for Disease Control and Prevention
National Center for Environmental Health
1-800-CDC-INFO (1-800-232-4636) or 404-639-3534
www.cdc.gov/nceh

American College of Allergy, Asthma & Immunology
85 West Algonquin Road, Suite 550
Arlington Heights, IL 60005
1-800-842-7777
www.acaai.org/

National Asthma Education and Prevention Program
P.O. Box 30105
Bethesda, MD 20824
301-592-8573
www.nhlbi.nih.gov/about/naepp/index.htm

American Lung Association
61 Broadway, 6th Floor
New York, NY 10006
1-800-LUNG-USA (1-800-586-4872)
www.lungusa.org

Asthma & Allergy Foundation of America
1233 20th Street, NW, Suite 402
Washington, DC 20036
1-800-7-ASTHMA (1-800-727-8462) or 202-466-7643
www.aafa.org

Allergy and Asthma Network/Mothers of Asthmatics
2751 Prosperity Avenue, Suite 150
Fairfax, VA 22031
1-800-878-4403
www.aanma.org/

How do I post questions or comments to the blog?

You can post a question or comment by clicking on the link "# of comments" in the lower right hand corner of each topic posted. Click on the "Post a comment" link appear at the left hand corner of the bottom of the topic.

Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus

Moderated by Valerie Bell, R.N., B.S.N., Family Nurse Practitioner Student

What is Type 2 Diabetes Mellitus (DM)?

Blood sugar and insulin are needed for cells to produce energy. Your body turns the food you eat into glucose (sugar). Glucose has to get into the cells so it can be used for energy. Insulin helps the blood sugar get into cells. As blood sugar rises, the pancreas (pronounced like pank-re-us) tries to make enough insulin to manage the blood sugar levels.

What causes type 2 Diabetes?

When not enough insulin is made, or body can’t use the insulin properly, to meet the blood sugar demand, the pancreas can get worn out. Body tissues do not respond to the insulin and the blood sugars continue to rise. High blood sugars can damage the nerves in the eyes, heart, kidneys, and feet.

Risk factors for diabetes:

• Being over weight
• Having high blood pressure
• Having high cholesterol
• Being inactive- not exercising
• Having someone in your family who has diabetes
• Having gestational diabetes (diabetes while pregnant)

What are the symptoms?

Being very thirsty, having an excessive hunger (a larger appetite, more then usual) and excessive urination (passing your water) more than usual can be symptoms of diabetes. Other symptoms can be feeling very tried, having numbness in the feet (the feet tingle), getting infections that keep coming back, or having blurred vision.

What if I have diabetes?

If you have symptoms, see your health care provider. Tests to see if you have diabetes may include a blood test to check your blood sugar level and a urine test. If you are told that you have type 2 diabetes, it means that your pancreas is not making enough insulin to match the blood sugar needs of your cells.

What is the treatment?

• Diet: eat right. Choose healthy foods, such as salads, fruits, and vegetables.

Eat fewer sweets. Eat smaller portions. Special lower carbohydrate diets may be ordered by your health care provider. A dietitian may help provide more information and help on healthy eating with type 2 diabetes.

• Weight control: if you are over weight, lose some extra pounds

Losing weight can lower blood sugar.

• Exercise: even 30 minutes a day 5 days a week can help you lose weight. You should check with your health care provider before starting any exercise program.

Use the stairs, walk more, park further away from where you need to go.

• No smoking!

Smoking can have a negative effect your circulation

• Your health care provider will discuss what is best with you

If healthy eating, weight loss, and exercise don’t help to control your blood sugars, you may need medication. Diabetic medicine can help to lower blood sugar or help with insulin and how it is made or used. These are usually pills that are ordered by your health care provider. You may have to check your blood sugars to see how you are doing. This is done with a blood glucose meter. Blood sugar numbers should be between 70- 110. Higher numbers mean poor control.

Are there complications?

Blood sugars that are not controlled can lead to blood sugars that are too low (hypoglycemia) or to high (hyperglycemia). If your blood sugar is lower than 70 you may feel shaky, hungry, tired, or dizzy. Did you miss a meal? Exercise too much? You will need a snack or hard candy to bring up the numbers. Orange juice or regular soda (1/2 cup or glass) will help. If your numbers are high, you might be thirsty, hungry, dizzy, and /or tired. Did you eat too much? Skip your medicine? Didn’t exercise? Drink lots of water and call your health care provider. You should call your health care provider if your numbers are too high or too low. You may need a change in your medicine.

Type 2 diabetes can have larger complications. If medicine, diet, weight control, and exercise are not helping your numbers, you may need some insulin( a medication that is injected) to help with the oral medicines.

Complications that can affect you if your blood sugars are too high and not controlled:

• Diabetes can result in blindness.
• Wear good fitting shoes. No bare feet! Sores on your feet can occur resulting in loss of a limb later on.
• Decreased sensation or burning of the feet can be caused by nerve damage.
• High blood pressure and diabetes can affect your heart and increase the risk for heart attacks
• Blood is filtered by the kidneys; they can be overworked, leak, and stop working properly.
• Gum and teeth problems can occur
• Smoking: affects your circulation… Ban the butt!

The good news is that complications can be avoided by keeping your blood sugars at safe levels and by following your health care provider's recommendations for healthy eating, exercise and medication usage. People with diabetes can sucessfully manage their disease and live heatlhier and fuller lives by taking good care of themselves.

Community Resources

• American Diabetes Association (ADA)

Toll free: 1-8099-342-2383

Web site: www.diabtes.org

Information about diabetes, exercise, recipes, diabetes prevention, and

research

• American Diabetes Association

Luzerne County Chapter

Telephone: 717-823-3355

Provides educational materials, materials about complications, support group meetings

• American Dietetic Association

Toll free: 1-800-366-1655

Web site: www.eatright.org

Food and nutritional information

• Centers for Disease Control

Toll free: 1-877-232-3422

Web site: www.cdc.gov/diabetes

Provides information about frequently asked questions, educational programs, statistics, and research

• National Institute of Diabetes & Digestive & Kidney Diseases

Toll free: 1-800-860-8747

Web site: www.niddk.nih.gov

Provides free information all reading levels and answers questions.

• Pennsylvania Department of Health Northeast District Office

Diabetes Nurse Consultant 570-826-2062

Provides resources, education, direction for personal, and community needs.

How to find credible health websites

The information superhighway has created unprecedented opportunities for people to access health information online. Unfortunately, it isn't always easy to tell which sites are reliable and credible and which are not. See the article on "How to find good health websites" by the American Association for Retired Persons (AARP) for more information on becoming a savvy health information consumer.

"How to find good health websites", AARP
http://www.aarp.org/health/Articles/a2003-03-17-wwwhealth.html

Immunization recommendations for College Students

The American Academy of Pediatrics recommends the following four vaccines for teenagers and one vaccine for college students.
Vaccines needed for teenagers
Varicella (chicken pox) vaccine
Hepatitis B vaccines
Measles-Mumps-Rubella (MMR) vaccine
Tetanus-Diphtheria vaccine
Vaccines needed for college students
Meningococcus vaccine
For more information:
Questions and answers about vaccine for teenagers and college students. (exit site)
"Meningitis on Campus: Don't Wait. Vaccinate," (.pdf) a brochure produced by the National Meningitis Association (NMA), offers college-bound students and their parents a succinct, practical introduction to meningococcal meningitis. In the space of two pages, it outlines the etiology and epidemiology of the disease and makes a strong case for vaccination. Use this link for a text-only screen-reader device version.
National Immunization Program (NIP) , CDC, 2004

Adult Immunizations

List of Vaccines for Adults
Vaccines needed by all adults
Hepatitis B vaccines (adults at risk)
Measles-Mumps-Rubella (MMR) vaccine (susceptible adults)
Tetanus-Diphtheria vaccine (all adults, every 10 years)
Vaccines for travelers
Varicella (chickenpox) vaccine (susceptible adults)
Vaccines needed for those age 50 and older
Influenza vaccine (for the flu)
Vaccines needed for those age 65 and older
Pneumococcal vaccine
Vaccines needed for all health-care workers
Influenza vaccine (for the flu)
Adult Vaccination Screening Form
It can sometimes be difficult to understand or keep track of exactly which vaccines you need. Use the following form to help you understand what vaccines might be important for you. Questions on the form help you and your doctor decide which vaccines you need and when to get them. You can print the form, fill it out, and take it with you to the office the next time you see your doctor. The clinician's version of the form can be distributed and used in clinics and healthcare professionals' offices.
Print version for general public (.pdf format, six pages)


National Immunization Program (NIP) NIP Home Contact Us Help Glossary About Accessibility
This page last modified on July 22, 2004

What is a blog?

"A blog is a web page made up of usually short, frequently updated posts that are arranged chronologically - like a what's new page or a journal. The content and purposes of blogs varies greatly... . Blogs help small groups communicate in a way that is simpler and easier to follow than email or discussion forums. A blog can help keep everyone in the loop, promote cohesiveness and group culture, and provide an informal "voice" of a project or department to outsiders" (Blogger.com).

The goals of the Health and Wellness Blog are two-fold:
1.) To provide Misericordia University graduate nursing students with an opportunity to use an on-line E-health technology.

2.) To share helpful health related information sources that can assist members of the college community to improve their level of health and wellness and their self-management of chronic conditions such as high blood pressure, high cholesterol and arthritis.

Please feel free to log on and ask questions and request information. We hope you find this resource interesting and useful.

Thank you for your support of this learning activity.

Brenda Hage, Ph.D., CRNP, APRN, B.C.
Assistant Professor, Nursing
Misericordia University
301 Lake St.,
Dallas, PA 18612
bhage@misericordia.edu

How do I post questions?

You can post a question or comment by clicking on the link "# of comments" in the lower right hand corner of each topic posted. Click on the "Post a comment" link appear at the left hand corner of the bottom of the topic.

Disclaimer

Disclaimer- Our purpose is to serve as a forum for those with health related issues or concerns. This group does not endorse any specific site or product nor do we offer medical advice. This site makes no representations and specifically disclaims all warranties, express, implied or statutory, regarding the accuracy, timeliness, completeness, merchantability or fitness for any particular purpose of any material contained in this site. Individuals should consult their primary health care provider for individualized medical advice or questions about their health condition(s).