The Heart of the Matter

Teen lives 4 months with no heart, leaves hospital

By RASHA MADKOUR, Associated Press Writer

MIAMI – D'Zhana Simmons says she felt like a "fake person" for 118 days when she had no heart beating in her chest. "But I know that I really was here," the 14-year-old said, "and I did live without a heart."

As she was being released Wednesday from a Miami hospital, the shy teen seemed in awe of what she's endured. Since July, she's had two heart transplants and survived with artificial heart pumps — but no heart — for four months between the transplants.

Last spring D'Zhana and her parents learned she had an enlarged heart that was too weak to sufficiently pump blood. They traveled from their home in Clinton, S.C. to Holtz Children's Hospital in Miami for a heart transplant.

But her new heart didn't work properly and could have ruptured so surgeons removed it two days later.

And they did something unusual, especially for a young patient: They replaced the heart with a pair of artificial pumping devices that kept blood flowing through her body until she could have a second transplant.

Dr. Peter Wearden, a cardiothoracic surgeon at Children's Hospital of Pittsburgh who works with the kind of pumps used in this case, said what the Miami medical team managed to do "is a big deal."

"For (more than) 100 days, there was no heart in this girl's body? That is pretty amazing," Wearden said.

The pumps, ventricular assist devices, are typically used with a heart still in place to help the chambers circulate blood. With D'Zhana's heart removed, doctors at Holtz Children's Hospital crafted substitute heart chambers using a fabric and connected these to the two pumps.

Although artificial hearts have been approved for adults, none has been federally approved for use in children. In general, there are fewer options for pediatric patients. That's because it's rarer for them to have these life-threatening conditions, so companies don't invest as much into technology that could help them, said Dr. Marco Ricci, director of pediatric cardiac surgery at the University of Miami.

He said this case demonstrates that doctors now have one more option.

"In the past, this situation could have been lethal," Ricci said.

And it nearly was. During the almost four months between her two transplants, D'Zhana wasn't able to breathe on her own half the time. She also had kidney and liver failure and gastrointestinal bleeding.

Taking a short stroll — when she felt up for it — required the help of four people, at least one of whom would steer the photocopier-sized machine that was the external part of the pumping devices.

When D'Zhana was stable enough for another operation, doctors did the second transplant on Oct. 29.

"I truly believe it's a miracle," said her mother, Twolla Anderson.

D'Zhana said now she's grateful for small things: She'll see her five siblings soon, and she can spend time outdoors.

"I'm glad I can walk without the machine," she said, her turquoise princess top covering most of the scars on her chest. After thanking the surgeons for helping her, D'Zhana began weeping.

Doctors say she'll be able to do most things that teens do, like attending school and going out with friends. She will be on lifelong medication to keep her body from rejecting the donated heart, and there's a 50-50 chance she'll need another transplant before she turns 30.

For now, though, D'Zhana is looking forward to celebrating another milestone. On Saturday, she turns 15 and plans to spend the day riding in a boat off Miami's coast.

Bone marrow transplant suppresses AIDS in patient

BERLIN (Reuters) - A bone marrow transplant using stem cells from a donor with natural genetic resistance to the AIDS virus has left an HIV patient free of infection for nearly two years, German researchers.

The patient, an American living in Berlin, was infected with the human immunodeficiency virus that causes AIDS and also had leukemia. The best treatment for the leukemia was a bone marrow transplant, which takes the stem cells from a healthy donor's immune system to replace the patient's cancer-ridden cells.

Dr. Gero Hutter and Thomas Schneider of the Clinic for Gastroenterology, Infections and Rheumatology of the Berlin Charite hospital said on Wednesday the team sought a bone marrow donor who had a genetic mutation known to help the body resist AIDS infection.

The mutation affects a receptor, a cellular doorway, called CCR5 that the AIDS virus uses to get into the cells it infects.

When they found a donor with the mutation, they used that bone marrow to treat the patient. Not only did the leukemia disappear, but so did the HIV.

"As of today, more than 20 months after the successful transplant, no HIV can be detected in the patient," the clinic said in a statement.

"We performed all tests, not only with blood but also with other reservoirs," Schneider told a news conference.

"But we cannot exclude the possibility that it's still there."

The researchers stressed that this would never become a standard treatment for HIV. Bone marrow stem cell transplants are rigorous and dangerous and require the patient to first have his or her own bone marrow completely destroyed.

Patients risk death from even the most minor infections because they have no immune system until the stem cells can grow and replace their own.

HIV has no cure and is always fatal. Cocktails of drugs can keep the virus suppressed, sometimes to undetectable levels. But research shows the virus never disappears -- it lurks in so-called reservoirs throughout the body.

Hutter's team said they have been unable to find any trace of the virus in their 42-year-old patient, who remains unnamed, but that does not mean it is not there.

"The virus is tricky. It can always return," Hutter said.

The CCR5 mutation is found in about 3 percent of Europeans, the researchers said. They said the study suggests that gene therapy, a highly experimental technology, might someday be used to help treat patients with HIV.

(Reporting by Oliver Denzer; Writing by Maggie Fox in Washington; Editing by Vicki Allen)

Nursing board exam ‘leakage-free’--execs

By Tetch Torres
INQUIRER.net
First Posted 14:01:00 11/11/2008

MANILA, Philippines -- The nursing board exam this November will be “leakage-free,” according to officials of the Board of Nursing, amid reports that one of the review centers have released some items in the tests scheduled for the 29th and 30th.

Carmencita Abaquin, BON chairperson, and member Marco Sto. Tomas, assured the public that they have taken the necessary steps to ensure the credibility of the forthcoming licensure exam.

They disclosed that text messages being circulated said that a review center has leaked parts of the test in Baguio, Cebu, and Surigao and that members of the Professional Regulatory Commission (PRC) -- one former, the other incumbent -- were behind this.

But Sto. Tomas said security measures have been adopted to prevent a repeat of the June 2006 scandal. These include the quarantine of the members of the PRC and BON from the time the questionnaires are “extracted, printed, and sealed.”

Sto. Tomas said 500 questions per test have been encoded into the computer. These will enter certain parameters/framework per competency (for the 5 tests) and the computer will extract these questions based on the framework by which they have been entered.

"All these are done under quarantine meaning we have no communication outside," Sto. Tomas said.

And then the questions will be extracted, printed, and sealed, he said.

Printing has been centralized unlike during the board exam controversy in 2006 when printing was done per region.

In transporting of questionnaires, there will be escorts from the Philippine National Police (PNP) and National Bureau of Investigation (NBI), Sto. Tomas said.

"These text messages from review centers are only using the leakage as a marketing ploy to entice examinees. They are capitalizing on what happened years ago and the PRC is suffering from this scheme," Abaquin said.

The BON is coordinating with the nursing schools, as well as the Commission on Higher Education (CHED), to implement strict measures to make sure that the country will have high quality nurses, Sto. Tomas said.

There are a total of 88,750 nursing graduates set to take the second licensure examination on November 29 and 30, with the figure considered to be the highest in PRC history.

The BON will go on quarantine starting November 19.

V for Venipuncture

Such a simple procedure really but the most overlooked one. Remember to always follow the Universal precaution otherwise you will be in trouble with The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). :)







video credits: PocketSnips

NCLEX Tips

NCLEX Sample Questions

1. A nurse is working in an outpatient orthopedic clinic. During the patient’s history the patient reports, “I tore 3 of my 4 Rotator cuff muscles in the past.” Which of the following muscles cannot be considered as possibly being torn?

A: Teres minor
B: Teres major
C: Supraspinatus
D: Infraspinatus


2. A nurse at outpatient clinic is returning phone calls that have been made to the clinic. Which of the following calls should have the highest priority for medical intervention?

A: A home health patient reports, “I am starting to have breakdown of my heels.”
B: A patient that received an upper extremity cast yesterday reports, “I can’t feel my fingers in my right hand today.”
C: A young female reports, ”I think I sprained my ankle about 2 weeks ago.”
D: A middle-aged patient reports, ”My knee is still hurting from the TKR.”


3. A nurse working a surgical unit, notices a patient is experiencing SOB, calf pain, and warmth over the posterior calf. All of these may indicate which of the following medical conditions?

A: Patient may have a DVT.
B: Patient may be exhibiting signs of dermatitis.
C: Patient may be in the late phases of CHF.
D: Patient may be experiencing anxiety after surgery.


4. A nurse is performing a screening on a patient that has been casted recently on the left lower extremity. Which of the following statements should the nurse be most concerned about?

A: The patient reports, “I didn’t keep my extremity elevated like the doctor asked me to.”
B: The patient reports, “I have been having pain in my left calf.”
C: The patient reports, “My left leg has really been itching.”
D: The patient reports, “The arthritis in my wrists is flaring up, when I put weight on my crutches.”


5. A 93 year-old female with a history of Alzheimer’s Disease gets admitted to an Alzheimer’s unit. The patient has exhibited signs of increased confusion and limited stability with gait. Moreover, the patient is refusing to use a w/c. Which of the following is the most appropriate course of action for the nurse?

A: Recommend the patient remain in her room at all times.
B: Recommend family members bring pictures to the patient’s room.
C: Recommend a speech therapy consult to the doctor.
D: Recommend the patient attempt to walk pushing the w/c for safety.


6. A nurse is covering a pediatric unit and is responsible for a 15 year-old male patient on the floor. The mother of the child states, “I think my son is sexually interested in girls.” The most appropriate course of action of the nurse is to respond by stating:

A: “I will talk to the doctor about it.”
B: “Has this been going on for a while?”
C: “How do you know this?”
D: “Teenagers often exhibit signs of sexual interest in females.”


7. A high school nurse observes a 14 year-old female rubbing her scalp excessively in the gym. The most appropriate course of action for the nurse to do is:

A: Request a private evaluation of the female’s scalp from her parents.
B: Contact the female’s parents about your observations.
C: Observe the hairline and scalp for possible signs of lice.
D: Contact the student’s physician.


8. A nurse is caring for a patient who has recently been diagnosed with fibromyalgia and COPD. Which of the following tasks should the nurse delegate to a nursing assistant?

A: Transferring the patient to the shower.
B: Ambulating the patient for the first time.
C: Taking the patient’s breath sounds
D: Educating the patient on monitoring fatigue


9. A nurse has been instructed to place an IV line in a patient that has active TB & HIV. The nurse should where which of the following safety equipment?

A: Sterile gloves, mask, and goggles
B: Surgical cap, gloves, mask, and proper shoewear
C: Double gloves, gown, and mask
D: Goggles, mask, gloves, and gown


10. A nurse is instructing a person who had a left CVA and right lower extremity hemiparesis to use a quad cane. Which of the following is the most appropriate gait sequence?

A: Place the cane in the patient’s left upper extremity, encourage cane, then right lower extremity, then left upper extremity gait sequence.
B: Place the cane in the patient’s left upper extremity, encourage cane, then left lower extremity, then right upper extremity gait sequence.
C: Place the cane in the patient’s right upper extremity, encourage cane, then right lower extremity, then left upper extremity gait sequence.
D: Place the cane in the patient’s right upper extremity, encourage cane, then left lower extremity, then right upper extremity gait sequence.


11. A nurse has just started on the 7PM surgical unit shift. Which of the following patients should the nurse check on first?

A: A 75 year-old female who is scheduled for an EGD in 10 hours.
B: A 34 year-old male who is complaining of low back pain following back surgery and has an onset of urinary incontinence in the last hour.
C: A 21 year-old male who had a lower extremity BKA yesterday, following a MVA and has phantom pain.
D: A 27 year-old female who has received 1.5 units of RBC’s. via transfusion the previous day.


12. A 64 year-old Alzheimer’s patient has exhibited excessive cognitive decline resulting in harmful behaviors. The physician orders restraints to be placed on the patient. Which of the following is the appropriate procedure?

A: Secure the restraints to the bed rails on all extremities.
B: Notify the physician that restraints have been placed properly.
C: Communicate with the patient and family the need for restraints.
D: Position the head of the bed at a 45 degree angle.


13. A 22 year-old patient in a mental health lock-down unit under suicide watch appears happy about being discharged. Which of the following is probably happening?

A: The patient is excited about being around family again.
B: The patient’s suicide plan has probably progressed.
C: The patient’s plans for the future have been clarified.
D: The patient’s mood is improving.


14. A patient that has delivered a 8.2 lb. baby boy 3 days ago via c-section, reports white patches on her breast that aren’t going away. Which of the following medications may be necessary?

A: Nystatin
B: Atropine
C: Amoxil
D: Loritab


15. A 13 year old girl is admitted to the ER with lower right abdominal discomfort. The admitting nursing should take which the following measures first?

A: Administer Loritab to the patient for pain relief.
B: Place the patient in right sidelying position for pressure relief.
C: Start a Central Line.
D: Provide pain reduction techniques without administering medication.


16. A 64 year-old male who has been diagnosed with COPD, and CHF exhibits an increase in total body weight of 10 lbs. over the last few days. The nurse should:

A: Contact the patient’s physician immediately.
B: Check the intake and output on the patient’s flow sheet.
C: Encourage the patient to ambulate to reduce lower extremity edema.
D: Check the patient’s vitals every 2 hours.


17. A 32 year-old male with a complaint of dizziness has an order for Morphine via IV. The nurse should do which of the following first?

A: Check the patient’s chest x-ray results.
B: Retake vitals including blood pressure.
C: Perform a neurological screen on the patient.
D: Request the physician on-call assess the patient.


18. A patient that has TB can be taken off restrictions after which of the following parameters have been met?

A: Negative culture results.
B: After 30 days of isolation.
C: Normal body temperature for 48 hours.
D: Non-productive cough for 72 hours.


19. A nurse teaching a patient with COPD pulmonary exercises should do which of the following?

A: Teach purse-lip breathing techniques.
B: Encourage repetitive heavy lifting exercises that will increase strength.
C: Limit exercises based on respiratory acidosis.
D: Take breaks every 10-20 minutes with exercises.


20. A patient asks a nurse the following question. Exposure to TB can be identified best with which of the following procedures? Which of the following tests is the most definitive of TB?

A: Chest x-ray
B: Mantoux test
C: Breath sounds examination
D: Sputum culture for gram-negative bacteria






Answer Key

1. (B) Teres Minor, Infraspinatus, Supraspinatus, and Subscapularis make up the Rotator Cuff.


2. (B) The patient experiencing neurovascular changes should have the highest priority. Pain following a TKR is normal, and breakdown over the heels is a gradual process. Moreover, a subacute ankle sprain is almost never a medical emergency.


3. (A) All of these factors indicate a DVT.


4. (B) Pain may be indicating neurovascular complication.


5. (B) Stimulation in the form of pictures may decrease signs of confusion.


6. (D) Adolescents exhibiting signs of sexual development and interest are normal.


7. (C) Observation of the student’s hair is the next step.


8. (A) Nursing assistants should be competent on all transfers.


9. (D) All protective measures must be worn, it is not required to double glove.


10. (A) The cane should be placed in the patient’s strong upper extremity, and left arm/right foot go together, for normal gait.


11. (B) The new onset of urinary incontinence may require additional medical assessment, and the physician needs to be notified.


12. (C) Both the family and the patient should have the need for restraints explained to them.


13. (B) The suicide plan may have been decided.


14. (A) Thrush may be occurring and the patient may need Nystatin.


15. (D) Do not administer pain medication or start a central line without MD orders.


16. (B) Check the intake and output prior to making any decisions about patient care.


17. (B) Dizziness can be a sign of hypotension, that may a contraindication with Morphine.

18. (A) Negative culture results would indicate absence of infection.

19. (A) Purse lip breathing will help decrease the volume of air expelled by increased bronchial airways.

20. (B) The Mantoux is the most accurate test to determine the presence of TB


Source: Test Trade