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Tell your doctor where you are going, and ask if you need any shots. The shots you had when you were a child also may need to be updated. Some shots that people get before they travel are:
* Hepatitis A or B
* Influenza (”the flu”)
* Japanese encephalitis (say: en-CEF-uh-LI-tis) * Measles-mumps-rubella (or MMR, for short)
* Meningococcal meningitis (say: muh-NIN-juh-cok-ul men-un-JIE-tis)
* Pneumococcal (say: NEW-mo-cok-ul)
* Polio
* Rabies
* Tetanus and diphtheria (say: TET-nus, dip-THEE-ree-uh)
* Typhoid fever (say: TY-foid)
* Chickenpox
* Yellow fever
What should I take with me?
Carry enough of your regular medicines to last your whole trip, with some extra in case your trip home is delayed. Pack the medicines in the containers they came in, along with extra prescriptions for them. You could also take your prescription for glasses or contact lenses. Ask your doctor if you need a prescription for an antibiotic that you can take if you get traveler’s diarrhea. Wear a medical information bracelet if needed.
It can be helpful to take a first-aid kit with you (see the box on the next page).
How can I stay healthy while I am traveling?
Eat carefully if you are going to a country with a high risk of traveler’s diarrhea. Steaming hot, well-cooked food is usually safest. Do not eat foods from street vendors, dairy products that are not pasteurized, or raw or undercooked seafood.
Water also can carry germs that cause traveler’s diarrhea. Drink water from sealed bottles if possible, and do not use ice. Use bottled water when you brush your teeth. Remember that fruits and vegetables may have been washed in dirty water. Do not eat salads, and peel your fruits.
If you’re going to a country with a risk of malaria, your doctor can give you a prescription for medicine that can help you stay well. Remember to start taking your malaria medicine before you leave for your trip, and keep taking it for four weeks after you get home.
Avoid swimming and other water activities in freshwater lakes and streams. This can put you at risk for disease in some areas.
Remember that mosquitoes can carry disease. If you are going to a country with a high risk of disease carried by mosquitos, take insect repellent. Insect repellents with DEET work the best. Cover your bed with a mosquito net while you sleep.
Where can I get more information?
Your doctor
American Society of Tropical Medicine and Hygiene Web site: http://www.astmh.org
Centers for Disease Control and Prevention Web site: http://www.cdc.gov/travel
International Society of Travel Medicine Telephone: 1-770-736-7060 Web site: http://www.istm.org
World Health Organization Web site: http://www.who.int/ith
Travel First-Aid Kit
A first-aid kit to take with you could contain:
* Your prescription medicines in the containers they came in.
* Antibiotic ointment (one brand: Neosporin), adhesive bandages, and hydrocortisone cream for cuts and scrapes.
* Tools like scissors, tweezers, nail clippers, or a pocket knife. A mirror also may be helpful.
* Medicines for common problems, like diarrhea and upset stomach, coughs and colds, and allergies.
* Pain medicines like aspirin, acetaminophen (one brand: Tylenol), naproxen (one brand: Aleve), ibuprofen (one brand: Motrin) or ketoprofen (one brand: Orudis KT).
* Medicine for motion sickness, such as dimenhydrinate (one brand: Dramamine), and an antinausea drug like promethazine (brand name: Phenergan). Acetazolamide (brand name: Diamox) may help prevent altitude sickness.
COPYRIGHT 2006 American Academy of Family Physicians
COPYRIGHT 2008 Gale, Cengage Learning

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An hour ago, you gave her the first dose of promethazine through this I.V. line. The drug concentration is 25 mg/ml, so you withdrew 1 ml of promethazine into a syringe and injected it over 1 minute. At that time, you didn’t see any redness or swelling around the I.V. site; tape supporting the dressing partly blocked your view of the vein pathway. When you started to inject the drug, Ms. Thomas immediately complained of severe burning in her wrist. You stopped the injection and looked for swelling but couldn’t see any change in the area, so you gave the remaining drug and resumed the fluid infusion.
What’s your assessment?
Based on Ms. Thomas’s signs and symptoms and the fact that she’s receiving two vesicants-promethazine and potassium chloride-you suspect extravasation, the escape of a vesicant solution into subcutaneous tissue, causing tissue necrosis. Extravasation, which can lead to cosmetic disfigurement, loss of limb function, and amputation, triggers many nursing malpractice lawsuits.
What must you do immediately?
Immediately stop the infusion. If your facility protocol calls for injecting an antidote for extravasation, leave the catheter in place and inject the antidote. Remove the catheter and apply a dressing. Elevate the patient’s arm and apply cold compresses. Notify the physician.
Ms. Thomas has a strong radial pulse and 2 capillary refill in her fingers, although the edema is limiting range of motion in her left hand. Insert a 20-gauge catheter in the inner aspect of her right forearm and resume the fluid infusion at 125 ml/hour. Complete an incident report and document your interventions in the medical record.
What should be done later?
Take the following steps to prevent extravasation and to minimize the tissue damage should extravasation occur:
* Dilute drugs given by LV push to minimize the amount of drug that would contact the tissue if extravasation occurs.
* Check the LV site thoroughly. Remove tape if necessary and secure the catheter in a way that makes inspection easy. You can easily miss small amounts of swelling or slight changes in color if you can’t see the entire catheter and vein pathway.
* Check for a blood return before giving any drug via I.V. push. Catheter movement could have caused erosion through the vein wall. However, extravasation can occur even when you can obtain a good blood return.
* Stabilize the insertion site. This prevents catheter movement, which can irritate the vein and increase the potential for vein erosion and extravasation. Avoid placing I.V. lines in areas of flexion; in this case, an arm board would have supported the wrist while allowing finger movement.
* Assess for pain, tenderness, and a red streak along the vein pathway. These are signs of phlebitis. Discontinue the infusion immediately.
* Assess for blanching, swelling, and complaints of pain or burning at the insertion area. These are signs of infiltration or extravasation. Discontinue the infusion immediately.
* Don’t use pressure dressings, which will spread the extravasated drug into tissue and cause more damage.
Ms. Thomas’s swelling, pain, and discoloration lasted several weeks, but she didn’t develop tissue necrosis or arterial damage and regained complete use of her hand.
BY LYNN C. HADAWAY, RN.C, CRNI, MED Principal * Hadaway & Associates * Milner, Ga.
Copyright Springhouse Corporation Aug 2001
Provided by ProQuest Information and Learning Company. All rights Reserved

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According to estimates by the World Health Organizations smoking kills 5 million people globally each year. In 20 years, smoking will kill more than 10 million people per year. Half of the 1.3 billion smokers in the world today (650 million) will die from their habit.
“Our technology will save more lives than have been lost in all the wars in recorded history” - C. Eric Hunter, CEO and Founder of Next Safety, Inc.
“The fundamental nature of this development means that pulmonary delivery for a wide range of drug classes will be vastly improved or enabled,” said Tom Stern, MD, assistant professor of medicine in the Department of Internal Medicine at Carolinas Medical Center and member of Next Safety’s Medical Advisory Board. “To date laboratory data suggests applications such as childhood asthma or home delivery of medicines previously requiring an IV will be equally benefited. Although further testing is needed, this fundamental breakthrough may eventually be seen as important as the invention of the syringe.”
“We’ve taken a fresh approach to pulmonary drug delivery,” said Lyndell Duvall, director of technology & product development for Next Safety, Inc. “By obeying mother nature, and borrowing techniques and materials from the semiconductor industry, we are able to individually generate each droplet in an aerosol and dictate how it will behave before it is delivered to the patient.”
The company is planning clinical testing under an IRB protocol that will include antibiotics, phenergan, albuterol, tobramycin, and morphine. The tests will be conducted in coordination with Carolinas Medical Center, located in Charlotte, NC. Early results should be available July 07′.
Next Safety is located in North Carolina, an area already known for leadership in technology and medicine. The company has leveraged this expertise to develop the worlds most advanced respirator technology and to advance the field of pulmonary medicine. Next Safety’s bPure8000[TM] line of respirators provide higher protection against airborne viruses and fine particulate air pollution than any other respirator available globally. Next Safety now brings the same innovative approach to the science of pulmonary drug delivery and nicotine replacement.
For more information about Next Safety, Inc. visit www.nextsafety.com.
COPYRIGHT 2007 Business Wire
COPYRIGHT 2008 Gale, Cengage Learning

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FDA Release, 4/06
COPYRIGHT 2005 Pediatrics for Parents, Inc.
COPYRIGHT 2008 Gale, Cengage Learning

The Associated Press (AP) earlier reported that all prescription sleeping pills may sometimes cause sleep-driving. Sleep-driving became a hot headliner when Rep. Patrick Kennedy crashed his car into a security barrier outside the US Capitol. The crash happened to Kennedy after taking Ambien, an insomnia drug; and Phenergan, an anti-nausea pill that also acts as a sedative. Kennedy said he had no memory of the crash. However, he pleaded guilty to under the influence of prescription drugs. Kennedy was sentenced to court-ordered drug treatment and a year’s probation.

Ambien isn’t the only insomnia drug that can cause sleep-driving - any of the class known as “sedative-hypnotics” can, Katz stressed. Other drugs include Butisol sodium, Carbrital, Dalmane, Doral, Halcion, Lunesta, Placidyl, Prosom, Restoril, Rozerem, Seconal, and Sonata.

To lower the risk of a sleep-driving episode, Katz advised patients to never take any prescription insomnia drug along with alcohol or any other sedating drug. He added, Also, don’t take higher-than-recommended doses of the pills. We really want people to know these things can occur, and these sleep behaviors can be perhaps to a large extent mitigated by behaviors the patients can control.”

Fewer than one in 1,000 patients in studies of Ambien reported somnambulism - a scientific term that includes the sleep behaviors flagged by the FDA. This is according to Lisa Kennedy, a spokeswoman for manufacturer Sanofi-Aventis SA and she is also not related to the congressman. The side effect has remained similarly rare since widespread sales began, she added.

It is said that sleep-driving is more complicated and risky than sleepwalking. Getting up in the middle of the night and going behind the wheel to drive with no memory is not a thing to ignore. The efficiency of Hawk brakes or any car system, for that matter, could not preclude the perilous nature of sleep-driving.

Given the millions of prescriptions for insomnia drugs, Katz called the problem rare, and said he was unaware of any deaths. The FDA ordered a series of precautions last Wednesday to avoid the ill effects of insomnia drugs.

Some of the insomnia drugs may be riskier than others hence the FDA recommended that manufacturers conduct clinical trials to figure that out. Later this year, all prescription sleeping pills will start arriving with special brochures dubbed “Medication Guides.” The guide will specifically point out in an easy to follow language the risks of the pills for patients.

Promethazine is a prescription drug in the USA, but is available OTC in the United Kingdom, Switzerland, and in many other countries. For the treatment of allergy induced symptoms and itches, tablets may be taken with or without food, once every 4 to 8 hours. Though be very careful about giving it to children, especially those below 2 years of age - Promethazine can cause severe breathing problems or even death. Doctor’s instructions must be followed carefully when given to a child of any age. Always keep this medicine out of children’s reach.

As an anti-allergic medication, Promethazine can also be used to treat hay fever, or better known as allergic rhinitis. To treat allergic reactions, it can be given either alone or in combination with an oral decongestant. All patients are recommended to have their blood pressure measured frequently. Moreover, during long-term therapy, blood cell counts, liver function studies, EKG, and EEG should be undertaken. These studies and examinations are to be taken at intervals according to risk profile of the patient.

Promethazine can produce side effects that impair your thinking or reactions. It’s required that when under medication you should not be driving or do any hazardous work which takes a great deal of concentration and alertness. Also, do not take alcohol, which serves to enhance the side effects of Prometazine.

Typical side effects of Promethazine include blurred vision, confusion, fatigue, dizziness, drowsiness, and dry mouth. Serious side effects, in which the patient should contact their physician immediately include seizures, respiratory depression (most common in children under two years of age or people with compromised function of pulmonal region), and malignant neuroleptic syndrome.

Before taking Promethazine, make sure you convey to your physician if you have or have ever experienced urination problems, digestive obstruction, stomach ulcers, glaucoma, sleep apnea, bone marrow disorder, or seizure disorder. You should also notify your physician, before taking the drug, if you have any history of heart disease, high blood pressure, or liver disease.

If you have any of the above conditions, you may not be able to take Promethazine unless your doctor requires you to take adjusted dosage, or undergo special laboratory tests during treatment. In addition, this medication is harmful to an unborn baby, so if you are pregnant or plan to get pregnant, avoid this treatment, or consult further with your doctor.

Seek emergency medical attention if you think you have used too much of this medicine. Symptoms of a promethazine overdose may include severe drowsiness, dizziness, dry mouth, large pupils, flushing, nausea, vomiting, shallow breathing, and fainting.

Disclaimer: This article should not be substituted for medical advice. Please talk to a qualified professional for more information about Promethazine.

ArticleSource: ArticlesAlley.com

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Prospective data collection began in the first quarter of 2002 (January to March). A nurse in the EP lab started a data form on each of the patients surveyed. The form was completed by an RN in the unit who cared for the patient in the first 24 hours postprocedure. Results from the first quarter showed that 21% of EP patients surveyed (12 of 57) had episodes of nausea or vomiting that required nursing intervention within 24 hours after the procedure.
When the EP nurses shared this information with the physicians, the physicians agreed that nausea and vomiting was a significant problem. To improve patient safety and comfort, they agreed to order ondansetron (Zofran). Highly effective for controlling postprocedure nausea and vomiting, ondansetron is associated with fewer adverse reactions than phenothiazines and antihistamines.
Data collected in the following quarter (April to June 2002) demonstrated dramatic results: Of 46 patients surveyed, only 1 experienced nausea and vomiting requiring intervention. Data collected in the next quarter showed continued improvement in postprocedure nausea and vomiting, with just 7 of 54 patients (13%) experiencing some nausea. Some patients receiving large doses of I.V. procedural sedation or undergoing lengthy procedures also received promethazine if nausea or vomiting persisted despite ondansetron.
Nurses continue to collect data to establish the reliability of these results. Data collected on 247 patients reveal that only 22 experienced nausea; 91% of patients were nausea-free. This change in practice has improved patient safety and comfort, and decreased nursing time needed to care for patients postprocedure.
BY MARGE WARESAK, RN, BSN
Marge Waresak is a clinical nurse IV in the electrophysiology lab and the chair of the Performance Improvement Committee at Duke University Hospital, in Durham, N.C. Doing It Better is coordinated by Myra F. Ellis, RN, CCRN, CS, MSN, clinical nurse IV, cardiothoracic ICU, Duke University Hospital.
Copyright Springhouse Corporation Jun 2004
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After the medication was administered, the staff told the patient that someone must drive her home. The patient stated that her husband was waiting in the car for her. A nurse asked the patient to bring the husband into the emergency department and also offered to walk the patient to the car, but the patient refused both requests. The hospital record stated in five places that the husband was driving the patient home. In reality, the patient’s husband was not waiting in the car for her. Approximately 1 hour after receiving medication, the patient drove herself home.
The patient was involved in a one-car accident 3 miles from the hospital 1 hour and 30 minutes after discharge and sustained serious brain injuries. She died 2 years later from delayed complications.
The Plaintiff’s Case
The plaintiffs expert witness stated that the standard of care for nurses is to visually verify the presence of someone who can assume responsibility for the patient’s care and well-being following narcotic medication administration. The expert further testified that the plaintiff was mentally and physically impaired by the extreme pain and narcotics: A patient with migraine pain may experience recurring global personality changes during extremely painful episodes, which can affect information processing, perception, memory, and judgment.
Two of the hospital’s nurses testified that their practice was to visually verify a driver before discharging a patient.
The Defense
A hospital physician testified that it is reasonable for nurses to accept the patient’s word that someone will drive him or her home.
The Outcome
The jury awarded the plaintiffs estate $1,263,000; however, the hospital and the plaintiff were each found 50% negligent. Consequently, the plaintiff’s estate received $634,500.
The Lesson for NPs
Clinicians should be cautious about accepting a patient’s word in a potentially dangerous situation, particularly if the patient could be drug impaired, pain impaired, or have questionable credibility. When the standard of care requires an escort to drive the patient home, clinicians must exercise the utmost care in effectuating safety measures for the welfare of the patient and others using the roadways. The clinician should meet the patient’s driver and confirm that he or she is competent to handle the patient. Finally, discharge instructions and the clinician’s phone number should be given to the driver.
ACKNOWLEDGMENT
The author thanks James Rodriguez, Esq., of Solar and Associates, Houston, Tex., for information on this case.
Cathy . Klein, MSN, MSEd, JD
Legal File Editor
Copyright Springhouse Corporation Jul 2001
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Antinausea Drugs

Delayed gastric emptying is best diagnosed by gastric emptying scintigraphy performed for two hours after ingesting a radiolabeled meal. Longer duration testing may have a higher yield. Antroduodenal manometry measuring the coordination of gastric and duodenal motor function during fasting and postprandial periods may show decreased antral contractility and increased motor activity in the small intestine compared with the stomach in gastroparesis.
The treatment of gastroparesis includes dietary instruction and prescribing of antiemetics and prokinetic pharmacologic agents. Diet changes should include eating multiple smaller meals and replacing solids with liquids such as soup. Lowering fat and fiber intake also may be helpful. Commonly used antiemetics for the treatment of nausea and vomiting include prochlorperazine (Compazine), trimethobenzamide (Tigan), and promethazine (Phenergan). Serotonin receptor antagonists commonly used in managing chemotherapy-induced nausea and vomiting also may be useful. Prokinetic agents, including metoclopramide (Reglan) and erythromycin, can be administered orally or intravenously. Multiple treatments are available for refractory gastroparesis sufferers (see accompanying table).
The authors conclude that the current management of gastroparesis is suboptimal. Future developments may include novel prokinetic agents, fundic relaxing agents that improve accommodation and diminish early satiety, gastric slow wave antidysrhythmic medications that stabilize slow wave activity resulting in symptom improvement, and alternative and unconventional medical therapies such as ginger, hypnotherapy, biofeedback, standard acupuncture or acupressure, and electroacupuncture.
Techniques for Managing
Refractory Gastroparesis Switching prokinetic and/or antiemetic agents Combining prokinetic agents Injecting botulinum toxin into the pylorus Using gastrostomy or jejunostomy tubes Implanting a gastric electric stimulator Using surgical treatment as a last resort
RICHARD SADOVSKY, M.D.
Parkman HP, et al. American Gastroenterological Association medical position statement: diagnosis and treatment of gastroparesis. Gastroenterology November 2004;127:1589-91, and Parkman HP, et al. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology November 2004;127:1592-622.
COPYRIGHT 2005 American Academy of Family Physicians
COPYRIGHT 2008 Gale, Cengage Learning

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Manufacturers may label controlled substances with Roman or Arabic numerals, so don’t rely on symbols to identify a drug. Make sure a brandname medication has the same ingredients as a generic product before making a substitution.
Copyright Springhouse Corporation Nov 2000
Provided by ProQuest Information and Learning Company. All rights Reserved