Maggie Aime
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An outbreak of monkeypox has recently been confirmed in several countries in Europe, in Canada, and in the United States; these are countries where the disease does not naturally occur and is not typically reported. It's not known how the infected individuals contracted the disease as they did not report recent travel to Central or West Africa where monkeypox is prevalent. Monkeypox is not a new virus and it has been studied over several decades; however, the current outbreak is very concerning to public health officials as the disease has never been found simultaneously in different countries/continents where it is not endemic. What is Monkeypox? Monkeypox is a disease caused by the monkeypox virus which is a zoonotic virus (a virus that is transmitted to humans through close contact with infected animals). This virus was discovered in 1958 with the first human case diagnosed in 1970. It is endemic to Central and West Africa where it is found primarily in non-human primates and rodents. Two different strains of monkeypox have been studied: The one from West Africa is less severe with a fatality ratio of 1% and is usually self-limiting. The other strain, from Central Africa, causes more severe illness with a fatality ratio of up to 11%. According to the World Health Organization (WHO), between May 13, 2022 and June 2, 2022, a total of 780 confirmed cases of monkeypox have been reported in non-endemic countries. As of June 6, 2022, there are 31 confirmed monkeypox cases in the United States (CDC). Modes of Transmission Human-to-human transmission of monkeypox occurs primarily through: Close and prolonged contact with the respiratory secretions of an infected person. Skin-to-skin contact with the mucous membranes, skin lesions, or bodily fluids of an infected person. Contact with contaminated objects belonging to an infected person. The Centers for Disease Control and Prevention (CDC) reports individuals at a higher risk of being infected with monkeypox include anyone who: Had close physical contact, kissing, hugging an infected person or someone who has symptoms. Had contact with objects (including clothing, linen, etc.) or other personal items belonging to someone who is infected or has symptoms. Traveled abroad to a country where monkeypox has been reported or where monkeypox is prevalent. Had contact with wild or exotic animals (dead or alive), this includes contact with their meat or byproducts. Ate raw or inadequately cooked meat of infected animals. While monkeypox is not known to be a sexually transmitted infection, the CDC says that, with the current outbreak, many of the reported cases involve individuals who had sex with an infected person and men who had sex with men. It is known, though, that contact with monkeypox skin lesions during sexual relations can cause an infection. An individual is considered infectious from the onset of symptoms until the scabs have crusted over and fallen off. Signs and Symptoms According to the CDC, monkeypox infection follows a clinical course like that of smallpox. Once infected, there is an incubation period of approximately 5 to 21 days, after which the initial symptoms of fever, headache, muscle aches, sore throat, cough, weakness develop. In addition, people infected by monkeypox will also develop lymphadenopathy (swelling of the lymph nodes) in the neck, axilla, and/or groin which is a symptom that is not typical of smallpox. About 1 to 3 days after the initial symptoms, a rash will develop with lesions that first look like macules. These macules will then progress to become papules, then vesicles, then pustules, and eventually scabs that will fall off, after which the person is no longer considered contagious. At-a-glance: Stages of Monkeypox Lesions (CDC) Type of lesion Last about... Macules (flat lesions usually on the face, arms, legs, hands, feet including palms and soles, look like chickenpox but larger) 1 to 2 days Papules (raised lesions) 1 to 2 days Vesicles (sacs filled with clear or yellow fluid) 1 to 2 days Pustules (filled with an opaque fluid resembling pus) 5 to 7 days Scabs 7 to 14 days The CDC reports that, with this current outbreak, they have noted common initial symptoms of genital rash or rash around the orifice. In some cases, patients developed pustules before developing constitutional symptoms. These are different from the typical presentation of monkeypox. Diagnosis Monkeypox is best diagnosed by polymerase chain reaction (PCR) testing with samples taken from the roof or fluid from skin lesions. A biopsy may also be performed. The WHO reports that PCR blood tests are typically inconclusive and should not be routinely performed. Treatment Currently, there is no targeted treatment for monkeypox. Antivirals that are used to treat smallpox can be used for monkeypox. Individuals who have been exposed are asked to monitor themselves for the development of symptoms for 21 days after their last exposure. Post-exposure prophylaxis (PEP) with smallpox vaccine has been shown to offer protection against monkeypox. Most cases of monkeypox resolve on their own; however, medical complications from monkeypox infection have been reported especially in the young and in people who are immunosuppressed. Patient Care and Precautions Patients with monkeypox and those suspected to have the virus should be isolated in a private room with the door closed. Currently, the CDC does not recommend a negative air pressure room for patient placement; however, procedures like intubation, extubation, and those that can spread respiratory secretions must be done in an airborne isolation room. Transport and movement of infected patients should be kept to a minimum and, if necessary, patients should wear a surgical mask that fits well over their nose and mouth, and all skin lesions should be covered with a sheet to prevent aerosolization or contact with the lesion. Healthcare providers are instructed to consult their state health department immediately for any suspected case of monkeypox. Precautions for Healthcare Personnel When caring for an infected or potentially infected patient, healthcare personnel must follow standard, contact, and droplet precautions: Wear personal protective equipment (PPE) to include a gown and gloves. Make sure eyes, nose, and mouth are fully covered with a face shield. Wear a fit-tested NIOSH-approved N95 mask or higher-level respiratory protection. Use dedicated or disposable equipment. Practice good hand hygiene. Pre-exposure prophylaxis (PrEP) with smallpox vaccine is available to protect certain designated healthcare employees. Education for the Public As nurses and healthcare providers, we have a duty to educate the public about prevention measures and what to do if exposed to monkeypox or if symptoms develop: Avoid contact with people who have symptoms or are confirmed to have monkeypox. Avoid contact with wild or exotic animals (dead or alive). Do not eat raw or inadequately cooked meat of exotic animals. Monitor for symptoms if recent travel to an area where monkeypox has been reported. Contact a healthcare provider immediately if suspected infection or if symptoms develop. Stay in a room separated from others if suspected infection or if symptoms develop. If infected, wear a mask and keep lesions covered with long sleeves and pants to avoid contaminating others. If infected, avoid contact with pets as they are susceptible. Keep any infected person in the household in a separate room with the door closed. Wash hands frequently. Wear a medical mask and use gloves when caring for an infected person at home. Avoid contact with the skin lesions of infected individuals. References: Clinical Recognition | Monkeypox | Poxvirus | CDC Monkeypox - StatPearls - NCBI Bookshelf (nih.gov) Monkeypox Q&A - PAHO/WHO | Pan American Health Organization Multi-country monkeypox outbreak: situation update (who.int) U.S. Monkeypox 2022: Situation Summary | Monkeypox | Poxvirus | CDC
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Every 40 seconds, a person has a stroke in the United States; and every 3 to 4 minutes, a person dies of a stroke. This translates to about 795,000 people having a stroke every year in the United States and 137,000 deaths from stroke. Today, over 4 million people are living with some type of deficit or lasting damage from a stroke, making stroke a leading cause of significant long-term disability nationwide. Early recognition of the signs and symptoms of stroke and the prompt initiation of treatment increase the chances of survival exponentially while decreasing permanent brain damage and reducing deficits. In the acute care setting, nurses play a pivotal role in every aspect of stroke patients' care throughout their inpatient stay. About stroke Just like every organ in the body, the brain needs blood to function properly. A stroke occurs when blood flow to the brain is blocked because of either a ruptured blood vessel or a clot. This lack of blood flow causes brain cells to start dying very quickly. A stroke is also known as a "cerebrovascular accident (CVA)” or a "brain attack". 3 Common Types of Stroke Hemorrhagic Stroke When a blood vessel ruptures causing an interruption of blood supply to the brain and pressure on brain cells. Uncontrolled blood pressure and aneurysms are the leading causes of hemorrhagic strokes. Ischemic Stroke Occurs when there is disruption of blood flow to the brain due to blockage of a blood vessel by either plaque or a clot. It is the most common type of stroke. An ischemic stroke can also turn into a hemorrhagic stroke. Transient ischemic Attack (TIA) Known as a mini-stroke, is a temporary blockage of blood flow to the brain that resolves on its own before there is any permanent damage to the brain. TIAs tend to be of short duration, lasting a few minutes to one hour, but they are an important warning sign of a possible future and more serious stroke; and it is crucial to seek medical care immediately. Is it a Stroke? BE-FAST The American Stroke Association (ASA) reports that for every minute that stroke treatment is delayed, 1.9 million brain cells die. Use the acronym BE-FAST to recall the warning signs of a stroke: B – Balance Is there sudden unsteady gait, lack of balance, or dizziness? E – Eyes Are there sudden visual disturbances, loss of or blurred vision, either in one or both eyes? F – Face Is there sudden numbness, or weakness of the face? Is the face drooping on one side or is uneven when the person smiles? A – Arms Is there sudden numbness, weakness, and/or drifting of one arm when the person holds his or her arms outstretched with palms up and eyes closed (the pronator drift test)? S - Speech Is there sudden confusion, difficulty speaking, slurred speech, or trouble understanding speech? T - Time If any of the above signs are present, it's time! Call 9-1-1 immediately. Another warning sign of stroke is a sudden onset of intense headache that comes out of nowhere. Who's at risk of a stroke? According to Mayo Clinic, any of the following modifiable risk factors (factors that can be changed or treated) increase a person's risk of having a stroke: Having high blood pressure. Being overweight or obese. Leading a sedentary lifestyle. Using birth control pills or hormone replacement therapy. Having diabetes. Having heart disease, especially those that can form blood clots like atrial fibrillation. Having an elevated low-density lipoproteins (LDL) cholesterol, known as the bad cholesterol. Being under high levels of stress or anxiety. Having obstructive sleep apnea. Being a smoker or having exposure to second-hand smoking. Having a brain aneurysm or arteriovenous malformations (AVMs). Having a viral infection, like COVID-19, or an illness that causes inflammation. Using illicit drugs such as cocaine. Drinking alcohol excessively. Having a suboptimal diet. The following risk factors for stroke are non-modifiable risk factors (factors that can't be changed): Being age 55 or older (the risk of stroke increases with age). Being of African American, Hispanic, or American Indian descent. Being a male (men are more likely to have a stroke than women). Having sickle cell disease. Having a family history of stroke, TIA, and/or heart disease. Having had a previous stroke or TIA. The ASA reports that 80% of strokes are preventable. The modifiable risk factors listed above can be managed and treated through lifestyle changes, medical treatments, stroke risk screenings, and education. Stroke care begins with prevention! The Nurse's Role in Stroke Care: A Brief Overview Stroke is an emergency and stroke care is complex. Nurses and healthcare providers have a key responsibility to improve outcomes and decrease disability and mortality in stroke patients by timely recognition of the signs and symptoms of stroke and early intervention. In the acute care setting, competent nursing management in all phases of care, from arrival to the emergency room through discharge, is vital; and nurses must have a full understanding of their role: Please note that the succession of events, steps, and responsibilities listed below are not all-inclusive and will vary based on the facility. It is strongly recommended that institutional policies and protocols are reviewed and adhered to. In the Emergency Room When a stroke is suspected at presentation to the emergency room, remember the principle "Time is Brain". The triage nurse's role is to promptly screen the patient using an institution-designated stroke screening tool. The National Institutes of Health Stroke Scale (NIHSS) is a commonly used tool that uses a scoring system to determine the severity of strokes. Many institutions have established a Stroke Alert process – which mimics the concept of a Code Blue – that is used to notify a pre-designated team of providers of an acute stroke and to quickly activate the stroke response system. Usually, the triage/emergency room nurse will activate the Stroke Alert. A 60-minute or less protocol, developed by the ASA, lists specific medical interventions that must be performed at set intervals within the first 60 minutes of the patient's arrival in the emergency room to optimize outcomes. In most facilities, the emergency room nurse is responsible to document the arrival time of a stroke patient and, if possible, document the patient's last known normal (LKN). This is used to mark the start of the 60-minute timer for tracking of time-sensitive interventions. A non-contrast CT scan of the head must be performed within 25 minutes of the patient's arrival. In most facilities, the emergency room nurse accompanies the patient to the CT scan department and ensures patient safety. Based on the CT scan results – and if an ischemic stroke – treatment with tissue plasminogen activator (tPA), also known as alteplase or Activase, is initiated. This intravenous medication is usually given within 3 hours of the onset of symptoms and can be given up to 4.5 hours in certain cases. This is done to dissolve the clot and restore blood supply to the brain. Among other duties, the nurse administers the treatment and closely monitors the patient for complications. In the case of a hemorrhagic stroke, the primary focus of care is to control the bleeding and blood pressure, as needed, using medication. Surgery to repair the ruptured blood vessel may be indicated. The nurse closely monitors the patient for any concerns or changes in status. In the ICU At this point, the patient may be transferred to the intensive care unit (ICU), and the emergency department nurse accompanies the patient to the ICU and ensures a safe transition of care. For eligible patients with an ischemic stroke, a mechanical thrombectomy may be indicated. This surgical procedure is done to remove the clot via catheterization and is typically performed within 6 hours of the onset of stroke symptoms and can be done up to 24 hours from onset. Among many other responsibilities, the ICU nurse's role is to monitor for postoperative complications, condition deterioration, perform neurologic assessments, titration of medications, and other system monitoring per practice guidelines and institution protocol. In some severe stroke cases, the patient may need to be intubated. The ICU nurse is responsible to monitor for airway patency per hospital guidelines. On the Floor When the patient is stable and ready for transfer, the floor nurse's responsibilities include, among countless others: Continuing to closely monitor for and prevent complications, including the possibility of a second stroke. Helping with improvement of patient's mobility. Assisting the patient with managing and coping with disability such as sensory and/or communication deficits. Collaborating with the multidisciplinary team to include Physical Therapy, Speech Therapy, Occupational Therapy. Assessing the patient for depression, as needed, and addressing accordingly. Preparing the patient for discharge whether to home or to a rehabilitation facility. Providing education on the risk of recurrent strokes and prevention methods. A stroke is a life-threatening and life-changing event. Early action is vital during stroke care. The nurse's role, as the patient transitions across care environments, is very diverse and complex and includes effectively meeting the patient's various care needs, collaborating, providing education and support, promoting recovery, contributing to positive patient and family outcomes, and more. It is of utmost importance for nurses to stay abreast of proper stroke care and advancements in treatment modalities, become familiar with their facilities' stroke protocols, and take an active role in advocating for and educating the public about stroke signs and symptoms, prevention methods and the management of risk factors. References About Stroke | American Stroke Association Characteristics of the stroke alert process in a general Hospital - PMC (nih.gov) Prevention | American Stroke Association Role of the nurse in acute stroke care - PubMed (nih.gov) Stroke - Symptoms and causes - Mayo Clinic Stroke Facts | CDC.gov Update: Stroke guidelines: Nursing Management (lww.com) Updated guidance confirms crucial role of nurses for patients with acute ischemic stroke | American Heart Association
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Melanoma is the leading cause of skin-cancer-related deaths. The American Cancer Society expects about 99,780 new melanoma cases and approximately 7,650 deaths from melanoma in 2022 alone. Early detection and prevention are the best means to improve prognosis, increase survival, and limit further incidences of melanoma. What is Melanoma? Melanoma develops when the pigment-producing cells on the skin, also known as melanocytes, degenerate and grow uncontrollably. This growth is usually triggered by unprotected exposure and burning from ultraviolet (UV) radiation coming from the sun and is also found in tanning beds. Other names for melanoma are "malignant melanoma" or "cutaneous (related to the skin) melanoma". However, melanoma is not only found on the skin; it can develop in extracutaneous (outside the skin) sites such as the eyes, nails, mouth, genitals, or elsewhere inside the body, although those are rare. How Prevalent is Melanoma? While melanoma is more likely to develop in men than women, the rates of melanoma in people under age 50 tend to be higher in women. According to the American Cancer Society, melanoma is 20 times more common in those with fair skin than those with a darker complexion, and the risk of developing melanoma increases with age. In the United States, the incidences of melanoma have increased significantly over the past decades, reported at a six-fold rise over the past 40 years! These numbers illustrate that melanoma is a rising cancer threat, and awareness and educating the public are of utmost importance. What are the Risk Factors for Melanoma? According to Mayo Clinic, the following factors increase one's risk of developing melanoma: Exposure to UV light/History of sunburn. Excessive and unprotected exposure to the sun with severe sunburn as well as exposure to UV light from tanning beds is a major risk for melanoma. Fair skin. People with a light skin complexion – have less pigment to protect against UV rays – as well as people with blue or green eyes, light or red hair, those with freckles and tend to burn easily when in the sun, are predisposed to developing melanoma. Moles. People with many moles as well as those with large moles are at increased risk for melanoma. Genes. Those with a family history of melanoma have been found to be at increased risk of developing melanoma. Immunosuppression. People who have a weakened immune system, such as those undergoing treatment for cancer or for autoimmune disease, those with human immunodeficiency virus (HIV), and those who have undergone organ transplant, are more likely to develop melanoma. What to Look for? Easy as ABCDE Early detection of melanoma is key to increase the chances of survival. The American Academy of Dermatology Association says that checking a mole for melanoma is as easy as knowing your ABCDE: A – Asymmetry (if you visually split the mole in half, do the two halves match?) B – Border (are the borders of the mole uneven, irregular, ragged?) C – Color (are there varying colors or different shades within the mole?) D – Diameter (is the mole greater than the size of a pencil eraser, about 6 millimeters or 1/4 inch?) E – Evolution (does the mole look different than other moles on the body or than it did before?) It is, however, always recommended to see a healthcare provider if unsure as some melanoma may not have all the ABCDE characteristics. The rule of thumb is to seek medical care if any new or unusual skin changes are seen. Another way to check for melanoma is called the Ugly Duckling method which means comparing moles on the body to see if any one of them stands out like an "ugly duckling". Is it bigger, darker, smaller, raised, lighter than the other moles? Can Melanoma be Prevented? While melanoma, or any cancer, is not 100% preventable, certain steps can be taken to reduce the risk of developing melanoma: Stay in the shade. Avoid the sun during peak times, usually between 10 a.m. and 4 p.m. when the sun's rays are more powerful. Cover up. Protect skin with clothing, and wear a wide-brimmed hat and sunglasses that block UVA and UVB rays. Lather up (with sunscreen that is!). Two tablespoons of sunscreen with an SPF of at least 30, generously applied to the entire body 15 minutes before going outside, is recommended for extended outdoor activities. Remember to reapply every two hours or more often after being in the water or sweating. Say "No" to tanning beds. They emit UV rays which increase the risk of skin cancer. Do skin checks. Every month, perform a skin self-exam, from head to toe, to check for new or changing moles. If in doubt, get it checked out! Myths and Facts About Melanoma Myth: People with dark complexion don't get melanoma. Fact: Although more prevalent in those with fair skin, anyone is at risk of developing melanoma. There is no discrimination by race, gender, or age when it comes to melanoma. Myth: If the mole does not have all the ABCD characteristics, then it's not melanoma. Fact: Just like with almost everything, there are exceptions. Not all melanocytic moles or lesions will have all the ABCD characteristics. If unsure, get examined by a healthcare professional. Myth: Melanoma only affects middle-aged and older people. Fact: The American Cancer Society reports that melanoma is one of the most common cancers in young adults (ages 20 to 39), and even more so in younger women. Myth: Sunscreen and other sun protection are not needed on cloudy days. Fact: UV rays can still affect the skin even on cloudy days. Sun protection before going outdoors is essential! Myth: Melanoma is not a big deal! It's only skin cancer. Fact: Melanoma is a very serious type of skin cancer that can metastasize (spread to other organs) rapidly; but if caught early, it can be easily treated with a good prognosis. What Can We Do? Educate! Educate! Early diagnosis of melanoma can save lives. As nurses and healthcare providers, we have a duty to become familiar with the signs and risk factors of melanoma and share that knowledge with the public. Teach about the importance of monthly skin self-exam and the avoidance of unprotected sun exposure and tanning beds. Encourage the appropriate use of skin protection and sunscreen. It's never too early or too late to start early detection and prevent melanoma! Resources Melanoma - Symptoms and causes - Mayo Clinic Melanoma Warning Signs and Images - The Skin Cancer Foundation Early detection of cutaneous melanoma improves prognosis Can Melanoma Be Prevented? What Is Melanoma Skin Cancer? What to Look for: ABCDEs of Melanoma How to Do a Skin Self-Exam
