US State Boards of Nursing

US State Boards of Nursing

Boards of Nursing

Boards of Nursing are state governmental agencies that are responsible for the regulation of nursing practice. More than 100 years ago, state governments established boards of nursing to protect the public's health and welfare by overseeing and ensuring the safe practice of nursing. Boards of nursing achieve this mission by outlining the standards for safe nursing care and issuing licenses to practice nursing. Once a license is issued, the board's job continues by monitoring licensees' compliance to state laws and taking action against the licenses of those nurses who have exhibited unsafe nursing practice.

NCSBN has 60 Member Boards. NCSBN Member Boards are comprised of the boards of nursing in:

·         Fifty U.S. states

·         District of Columbia

·         Four U.S. territories-American Samoa, Guam, Northern Mariana Islands, and the Virgin Islands

·         Four states have two boards of nursing, one for registered nurses (RNs) and one for licensed practical/vocational nurses (LPN/VNs): California, Georgia, Louisiana and West Virginia

·         One state, Nebraska, has both the board of nursing and the board for advanced practice nurses (APRNs) represented

NCSBN has seven Associate Members:

·         Bermuda Nursing Council

·         College of Licensed Practical Nurses of Alberta

·         College of Registered Nurses of Alberta

·         College of Licensed Practical Nurses of British Columbia

·         College of Registered Nurses of British Columbia

·         College of Registered Nurses of Manitoba

·         College of Nurses of Ontario

The most current list of State Board of Nursing Web Sites can be found at The National Council of State Boards of Nursing

NCSBN Member Boards of Nursing

Alabama Board of Nursing

770 Washington Avenue
RSA Plaza, Ste 250
Montgomery, AL 36104

Phone: 334.242.4060
Fax: 334.242.4360
Website: www.abn.alabama.gov 
Contact Person: N. Genell Lee, MSN, JD, RN, Executive Officer

Alaska Board of Nursing

550 West Seventh Avenue Suite 1500
Anchorage, Alaska 99501-3567

Phone: 907.269.8161
Fax: 907.269.8196
Website: www.dced.state.ak.us/occ/pnur.htm
Contact Person: Nancy Sanders, PhD, RN, Executive Administrator

American Samoa Health Services

Regulatory Board
LBJ Tropical Medical Center 
Pago Pago, AS 96799

Phone: 684.633.1222
Fax: 684.633.1869
Contact Person: Toaga Atuatasi Seumalo, MS, RN, Executive Secretary

Arizona State Board of Nursing

4747 North 7th Street, Suite 200
Phoenix, AZ 85014-3655

Phone: 602.771.7800
Fax: 602.771.7888
Website: www.azbn.gov
Contact Person: Joey Ridenour, MN, RN, FAAN, Executive Director

Arkansas State Board of Nursing

University Tower Building
1123 S. University, Suite 800
Little Rock, AR 72204-1619

Phone: 501.686.2700
Fax: 501.686.2714
Website: www.arsbn.org
Contact Person: Sue Tedford, MNSc, RN, Executive Director

California Board of Registered Nursing

1625 North Market Boulevard, Suite N-217
Sacramento, CA 95834-1924

Phone: 916.322.3350
Fax: 916.574.8637
Website: www.rn.ca.gov
Contact Person: Louise Bailey, MEd, RN, Executive Officer

California Board of Vocational Nursing and Psychiatric Technicians

2535 Capitol Oaks Drive, Suite 205
Sacramento, CA 95833

Phone: 916.263.7800
Fax: 916.263.7859
Website: www.bvnpt.ca.gov
Contact Person: Teresa Bello-Jones, JD, MSN, RN, Executive Officer

Colorado Board of Nursing

1560 Broadway, Suite 1370
Denver, CO 80202

Phone: 303.894.2430
Fax: 303.894.2430
Website: www.dora.state.co.us/nursing
Contact Person: Kennetha Julien, JD, Program Director

Connecticut Board of Examiners for Nursing

Dept. of Public Health
410 Capitol Avenue, MS# 13PHO
P.O. Box 340308
Hartford, CT 06134-0328

Phone: 860.509.7624 (860.509.7603 - for testing candidates only)
Fax: 860.509.7553
Website: www.state.ct.us/dph
Contact Person: Jennifer L. Filippone, Chief, Practitioner Licensing and Investigations Section

Delaware Board of Nursing

861 Silver Lake Blvd.
Cannon Building, Suite 203
Dover, DE 19904

Phone: 302.744.4500
Fax: 302.739.2711
Website: http://dpr.delaware.gov/boards/nursing
Contact Person: David Mangler, MS, RN, Executive Director

District of Columbia Board of Nursing

Department of Health
Health Professional Licensing Administration
District of Columbia Board of Nursing
717 14th Street, NW
Suite 600
Washington, DC 20005

Phone: 877.672.2174
Fax: 202.727.8471
Website: http://hpla.doh.dc.gov/hpla/cwp/view,A,1195,Q,488526,hplaNav,|30661|,.asp
Contact Person: Karen Scipio-Skinner MSN, RN, Executive Director

Florida Board of Nursing

Mailing Address:
4052 Bald Cypress Way, BIN C02
Tallahassee, FL 32399-3252

Physical Address:
4042 Bald Cypress Way
Room 120
Tallahassee, FL 32399

Phone: 850.245.4125
Fax: 850.245.4172
Website: www.doh.state.fl.us/mqa
Contact Person: Joe Baker, Jr. Executive Director

Georgia Board of Nursing

237 Coliseum Drive
Macon, GA 31217-3858

Phone: 478.207.2440
Fax: 478.207.1354
Website: www.sos.state.ga.us/plb/rn
Contact Person: Jim Cleghorn, Executive Director

Georgia State Board of Licensed Practical Nurses

237 Coliseum Drive
Macon, GA 31217-3858

Phone: 478.207.2440
Fax: 478.207.1354
Website: www.sos.state.ga.us/plb/lpn
Contact Person: Jim Cleghorn, Executive Director

Guam Board of Nurse Examiners

#123 Chalan Kareta 
Mangilao, Guam 96913-6304

Phone: 671.735.7407
Fax: 671.735.7413
Website: www.dphss.guam.gov
Contact Person: Margarita Bautista-Gay, RN, BSN, MN, Interim Executive Director

Hawaii Board of Nursing

Mailing Address:
PVLD/DCCA
Attn: Board of Nursing
P.O. Box 3469
Honolulu, HI  96801

Physical Address:
King Kalakaua Building
335 Merchant Street, 3rd Floor
Honolulu, HI 96813

Phone: 808.586.3000
Fax: 808.586.2689
Website: www.hawaii.gov/dcca/areas/pvl/boards/nursing
Contact Person: Lee Ann Teshima, Executive Officer

Idaho Board of Nursing

280 N. 8th Street, Suite 210
P.O. Box 83720
Boise, ID 83720

Phone: 208.334.3110
Fax: 208.334.3262
Website: www2.state.id.us/ibn
Contact Person: Sandra Evans, MAEd, RN, Executive Director

Illinois Board of Nursing

James R. Thompson Center
100 West Randolph Street
Suite 9-300
Chicago, IL 60601 

Phone: 312.814.2715
Fax: 312.814.3145
Website: www.idfpr.com/dpr/WHO/nurs.asp
Contact Person: Michele Bromberg, MSN, APN, BC, Nursing Act Coordinator

Indiana State Board of Nursing Professional Licensing Agency

402 W. Washington Street, Room W072
Indianapolis, IN 46204  

Phone: 317.234.2043
Fax: 317.233.4236
Website: www.in.gov/pla
Contact Person: Sean Gorman, Board Director

Iowa Board of Nursing

RiverPoint Business Park
400 S.W. 8th Street
Suite B
Des Moines, IA 50309-4685  

Phone: 515.281.3255
Fax: 515.281.4825
Website: http://nursing.iowa.gov
Contact Person: Lorinda Inman, MSN, RN, Executive Director

Kansas State Board of Nursing

Landon State Office Building
900 S.W. Jackson, Suite 1051
Topeka, KS 66612 

Phone: 785.296.4929
Fax: 785.296.3929
Website: www.ksbn.org
Contact Person: Mary Blubaugh, MSN, RN, Executive Administrator

Kentucky Board of Nursing

312 Whittington Parkway, Suite 300
Louisville, KY 40222

Phone: 502.429.3300
Fax: 502.429.3311
Website: www.kbn.ky.gov
Contact Person: Charlotte F. Beason, Ed.D, RN, NEA, Executive Director

Louisiana State Board of Nursing

17373 Perkins Road
Baton Rouge, Louisiana 70810

Phone: 225.755.7500
Fax: 225.755.7585
Website: www.lsbn.state.la.us
Contact Person: Barbara Morvant, MN, RN, Executive Director

Louisiana State Board of Practical Nurse Examiners

3421 N. Causeway Boulevard, Suite 505
Metairie, LA 70002

Phone: 504.838.5791
Fax: 504.838.5279
Website: www.lsbpne.com/
Contact Person: Claire Doody Glaviano, BSN, MN, RN, Executive Director

Maine State Board of Nursing

Regular mailing address:
158 State House Station
Augusta, ME 04333

Street address (for FedEx & UPS):
161 Capitol Street
Augusta, ME 04333

Phone: 207.287.1133
Fax: 207.287.1149
Website: www.maine.gov/boardofnursing
Contact Person: Myra Broadway, JD, MS, RN, Executive Director

Maryland Board of Nursing

4140 Patterson Avenue
Baltimore, MD 21215  

Phone: 410.585.1900
Fax: 410.358.3530
Website: www.mbon.org
Contact Person: Patricia Ann Noble, MSN, RN Executive Director

Massachusetts Board of Registration in Nursing

Commonwealth of Massachusetts
239 Causeway Street, Second Floor
Boston, MA 02114  

Phone: 617.973.0900 / 800.414.0168
Fax: 617.973.0984
Website: www.mass.gov/dpl/boards/rn
Contact Person: Rula Faris Harb, MS, RN, Executive Director

Michigan/DCH/Bureau of Health Professions

Ottawa Towers North
611 W. Ottawa, 1st Floor
Lansing, MI 48933

Phone: 517.335.0918
Fax: 517.373.2179
Website: www.michigan.gov/healthlicense
Contact Person: Amy L. Allen, MPA, Policy Manager

Minnesota Board of Nursing

2829 University Avenue SE
Suite 200
Minneapolis, MN 55414

Phone: 612.617.2270
Fax: 612.617.2190
Website: www.nursingboard.state.mn.us
Contact Person: Shirley Brekken, MS, RN, Executive Director

Mississippi Board of Nursing

1080 River Oaks Drive
Flowood, MS 39232

Phone: 601.664.9303
Fax: 601.664.9304
Website: http://www.msbn.state.ms.us/
Contact Person: Melinda E. Rush, DSN, FNP, Executive Director

Missouri State Board of Nursing

3605 Missouri Blvd.
P.O. Box 656
Jefferson City, MO 65102-0656  

Phone: 573.751.0681
Fax: 573.751.0075
Website: http://www.pr.mo.gov/nursing.asp
Contact Person: Lori Scheidt, BS, Executive Director

Montana State Board of Nursing

301 South Park
Suite 401
P.O. Box 200513
Helena, MT 59620-0513  

Phone: 406.841.2345
Fax: 406.841.2305
Website: www.nurse.mt.gov
Contact Person: Cynthia Gustafson, PhD, RN, Executive Director

Nebraska Advanced Practice Registered Nurse Board

301 Centennial Mall South P.O. BOX 94986
Lincoln, NE 68509-4986

Phone: 402.471.6443
Fax: 402.471.1066
Website: www.hhs.state.ne.us/crl/nursing/nursingindex.htm
Contact Person: Karen Bowen, MS, RN, Nursing Practice Consultant

Nebraska Board of Nursing

301 Centennial Mall South
Lincoln, NE 68509-4986

Phone: 402.471.4376
Fax: 402.471.1066
Website: www.hhs.state.ne.us/crl/nursing/nursingindex.htm
Contact Person: Diana Baker, MSN, RN, Executive Director

Nevada State Board of Nursing

5011 Meadowood Mall Way, Suite 300
Reno, NV 89502

Phone: 775.687.7700
Fax: 775.687.7707
Website: www.nursingboard.state.nv.us
Contact Person: Debra Scott, MSN, RN, FRE, Executive Director

New Hampshire Board of Nursing

21 South Fruit Street
Suite 16
Concord, NH 03301-2341

Phone: 603.271.2323
Fax: 603.271.6605
Website: www.state.nh.us/nursing
Contact Person: Margaret Walker, Ed.D, MBA, RN, Executive Director

New Jersey Board of Nursing

P.O. Box 45010
124 Halsey Street, 6th Floor
Newark, NJ 07101  

Phone: 973.504.6430
Fax: 973.648.3481
Website: www.state.nj.us/lps/ca/medical/nursing.htm
Contact Person: George Hebert, MA, RN, Executive Director

New Mexico Board of Nursing

6301 Indian School Road, NE
Suite 710
Albuquerque, NM 87110  

Phone: 505.841.8340
Fax: 505.841.8347
Website: www.bon.state.nm.us
Contact Person: Deborah Walker, MSN, RN, Executive Director

New York State Board of Nursing

Education Bldg.
89 Washington Avenue
2nd Floor West Wing
Albany, NY 12234 

Phone: 518.474.3817, Ext. 120
Fax: 518.474.3706
Website: www.op.nysed.gov/prof/nurse
Contact Person: Barbara Zittel, PhD, RN, Executive Secretary

North Carolina Board of Nursing

4516 Lake Boone Trail 
Raleigh, NC 27607 

Phone: 919.782.3211
Fax: 919.781.9461
Website: www.ncbon.com
Contact Person: Julia L. George, RN, MSN, FRE, Executive Director

North Dakota Board of Nursing

919 South 7th Street, Suite 504
Bismarck, ND 58504

Phone: 701.328.9777
Fax: 701.328.9785
Website: www.ndbon.org
Contact Person: Constance Kalanek, PhD, RN, Executive Director

Northern Mariana Islands Commonwealth Board of Nurse Examiners

Regular Mailing Address
P.O. Box 501458
Saipan, MP 96950  

Street Address (for FedEx and UPS)
Commonwealth Health Center, 
New Administration Bldg.
Navy Hill
Saipan, MP 96950

Phone: (670) 234-8950, ext. 3587
Fax: 670.664.4813
Contact Person: Aurelia G. Long, RNC, FNP, Board Chairperson

Ohio Board of Nursing

17 South High Street, Suite 400
Columbus, OH 43215-3413

Phone: 614.466.3947
Fax: 614.466.0388
Website: www.nursing.ohio.gov
Contact Person: Betsy J. Houchen, RN, MS, JD, Executive Director

Oklahoma Board of Nursing

2915 N. Classen Boulevard, Suite 524
Oklahoma City, OK 73106  

Phone: 405.962.1800
Fax: 405.962.1821
Website: www.ok.gov/nursing/
Contact Person: Kimberly Glazier, M.Ed., RN, Executive Director

Oregon State Board of Nursing

17938 SW Upper Boones Ferry Rd
Portland, OR 97224

Phone: 971.673.0685
Fax: 971.673.0684
Website: www.osbn.state.or.us
Contact Person: Holly Mercer, JD, RN, Executive Director

Pennsylvania State Board of Nursing

P.O. Box 2649
Harrisburg, PA 17105-2649  

Phone: 717.783.7142
Fax: 717.783.0822
Website: www.dos.state.pa.us/bpoa/cwp/view.asp?a=1104&q=432869
Contact Person: Laurette D. Keiser, RN, MSN, Executive Secretary/Section Chief

Rhode Island Board of Nurse Registration and Nursing Education

105 Cannon Building
Three Capitol Hill
Providence, RI 02908  

Phone: 401.222.5700
Fax: 401.222.3352
Website: www.health.ri.gov
Contact Person: Pamela McCue, MS, RN, Executive Officer

South Carolina State Board of Nursing

Mailing Address:
P.O. Box 12367
Columbia, SC 29211

Physical Address:
Synergy Business Park, Kingstree Building
110 Centerview Drive, Suite 202
Columbia, SC 29210

Phone: 803.896.4550
Fax: 803.896.4525
Website: www.llr.state.sc.us/pol/nursing
Contact Person: Joan K. Bainer, MN, RN, NE, BC, Administrator

South Dakota Board of Nursing

4305 South Louise Ave., Suite 201
Sioux Falls, SD 57106-3115  

Phone: 605.362.2760
Fax: 605.362.2768
Website: www.state.sd.us/doh/nursing
Contact Person: Gloria Damgaard, RN, MS, Executive Secretary

Tennessee State Board of Nursing

227 French Landing, Suite 300
Heritage Place MetroCenter
Nashville, TN 37243

Phone: 615.532.5166
Fax: 615.741.7899
Website: http://health.state.tn.us/Boards/Nursing/index.htm
Contact Person: Elizabeth Lund, MSN, RN, Executive Director

Texas Board of Nursing

333 Guadalupe, Suite 3-460
Austin, TX 78701  

Phone: 512.305.7400
Fax: 512.305.7401
Website: www.bon.state.tx.us
Contact Person: Katherine Thomas, MN, RN, Executive Director

Utah State Board of Nursing

Heber M. Wells Bldg., 4th Floor
160 East 300 South
Salt Lake City, UT 84111 

Phone: 801.530.6628
Fax: 801.530.6511
Website: www.dopl.utah.gov/licensing/nursing.html
Contact Person: Laura Poe, MS, RN, Executive Administrator

Vermont State Board of Nursing

Office of Professional Regulation
National Life Building  North F1.2
Montpelier, Vermont 05620-3402

Phone: 802.828.2396
Fax: 802.828.2484
Website: www.vtprofessionals.org/opr1/nurses
Contact Person: Linda Davidson, APRN, Executive Director

Virgin Islands Board of Nurse Licensure

Mailing Address
P.O. Box 304247, Veterans Drive Station
St. Thomas, Virgin Islands 00803  

Physical Address (For FedEx and UPS)
Virgin Island Board of Nurse Licensure
#3 Kongens Gade  (Government Hill)
St. Thomas, Virgin Islands 00802

Phone: 340.776.7131
Fax: 340.777.4003
Website: www.vibnl.org
Contact Person: Diane Ruan-Viville, MA, BSN, RN, Executive Director

Virginia Board of Nursing

Department of Health Professions
Perimeter Center
9960 Mayland Drive, Suite 300 
Henrico, Virginia 23233

Phone: (804) 367-4515
Fax: (804) 527-4455
Website: www.dhp.virginia.gov/nursing
Contact Person: Jay Douglas, RN, MSM, CSAC, Executive Director

Washington State Nursing Care Quality Assurance Commission

Department of Health
HPQA #6
310 Israel Rd. SE
Tumwater, WA 98501-7864  

Phone: 360.236.4700
Fax: 360.236.4738
Website: www.doh.wa.gov/hsqa/professions/nursing/default.htm
Contact Person: Paula Meyer, MSN, RN, Executive Director

West Virginia Board of Examiners for Registered Professional Nurses

101 Dee Drive
Charleston, WV 25311  

Phone: 304.558.3596
Fax: 304.558.3666
Website: www.wvrnboard.com
Contact Person: Laura Rhodes, MSN, RN, Executive Director

West Virginia State Board of Examiners for Licensed Practical Nurses

101 Dee Drive
Charleston, WV 25311 

Phone: 304.558.3572
Fax: 304.558.4367
Website: www.lpnboard.state.wv.us
Contact Person: Lanette Anderson, RN, MSN, JD, Executive Director

Wisconsin Department of Regulation and Licensing

Physical Address:
1400 E. Washington Avenue
Madison, WI 53703  

Mailing Address:
P.O. Box 8935
Madison, WI 53708-8935

Phone: 608.266.2112
Fax: 608.261.7083
Website: http://drl.wi.gov
Contact Person: Jeff Scanlan, Bureau Director, Health Services Boards

Wyoming State Board of Nursing

1810 Pioneer Avenue 
Cheyenne, WY 82001

Phone: 307.777.7601
Fax: 307.777.3519
Website: http://nursing.state.wy.us
Contact Person: Mary Kay Goetter, Executive Officer

NCSBN Associate Member Boards of Nursing

Bermuda Nursing Council

Mailing Address
P.O. Box 1195
Hamilton
Paget, Bermuda, HMBX

Physical Address
#7 Point Finger Road
Paget, Bermuda

Phone: 441.278.4987
Fax: 441.292.7627
Contact Person: Gaylia Landry, Chief Nursing Officer, Ministry of Health.

College of Licensed Practical Nurses of Alberta

St. Albert Trail Place, 13163 - 146 Street
Edmonton, AB T5L 4S8

Phone: 780.484.8886 
Fax: 780.484.9069
Website: www.clpna.com
Contact Person: Linda Stanger, Executive Director/Registrar

College of Licensed Practical Nurses of British Columbia

260-3480 Gilmore way,
Burnaby BC V5G 4Y1 Canada 

Phone: 778-373-3100 
Fax: 778-373-3102
Website: www.clpnbc.org
Contact Person: Pat McDonald, Interim Executive Director

College of Nurses of Ontario

101 Davenport Road
Toronto, Ontario
M5R 3P1 Canada

Phone: 416.963.7525
Fax: 416.928.5916
Website: www.cno.org
Contact Person: Anne Coghlan, RN, MScN, Executive Director

College of Registered Nurses of Alberta

11620-168 Street
Edmonton, Alberta
T5M 4A6 Canada

Phone: 800.252.9392
Fax: 780.452.3276
Website: www.nurses.ab.ca
Contact Person: Mary-Anne Robinson, Executive Director

College of Registered Nurses of British Columbia

2855 Arbutus Street
Vancouver, British Columbia
V6J 3Y8 Canada

Phone: 800.565.6505 / 604.736.7331
Fax: 604.738.2272
Website: www.crnbc.ca
Contact Person: Laurel Brunke, Registrar/CEO

College of Registered Nurses of Manitoba

890 Pembina Highway
Winnipeg, Manitoba
R3M 2M8 Canada

Phone: 204.774.3477
Fax: 204.775.6052
Website: www.crnm.mb.ca
Contact Person: Diane Wilson Maté, Acting Executive Director

Read More

Head To Toe Nursing Assessment

Nursing Assessment, Assessment is the process of collecting, validating, and clustering data. It is the first and most important step in the nursing process. The assessment phase sets the tone for the rest of the process, and the rest of the process flows from it. If your assessment is off the mark, then the rest of the process will be too. Assessment identifies your patient’s strengths and limitations and is performed not just once, but continuously throughout the nursing process. After performing your initial assessment, you establish your baseline, identify nursing diagnoses, and develop a plan. Then, as you implement your plan, you also assess your patient’s response. Finally, you assess the effectiveness of your plan of care for your patient

Data can be classified as subjective and objective. Subjective data are covert and not measurable. They reflect what the patient is experiencing and include thoughts, beliefs, feelings, sensations, and perceptions. Subjective findings are referred to as symptoms. The health history is an example of subjective data. Objective data are overt and measurable. Objective data are referred to as signs. The physical examination and diagnostic studies are examples of objective data. Data sources are either primary or secondary. The patient is a primary data source. Secondary data sources are anyone or anything aside from the patient, including family members, friends, other healthcare providers, and old medical records. Both primary and secondary data can also be subjective or objective.

Read More

Nursing diagnosis ineffective breathingpattern

Nursing diagnosis: ineffective breathing pattern
Related to:
Decreased lung expansion due to air or fluid accumulation; musculoskeletal impairment; pain and anxiety; inflammatory process

Possibly evidenced by:

• Dyspnea, tachypnea
• Changes in depth or equality of respirations; altered chest excursion
• Use of accessory muscles, nasal flaring
• Cyanosis, abnormal ABGs

Desired Outcomes/Evaluation Criteria Client Will

• Respiratory Status: Ventilation
• Establish a normal and effective respiratory pattern with ABGs within client’s normal range.
• Be free of cyanosis and other signs or symptoms of hypoxia.

Nursing intervention with rationale:

• Identify etiology or precipitating factors, such as spontaneous collapse, trauma, malignancy, infection, and complication of mechanical ventilation. Rationale: Understanding the cause of lung collapse is necessary for proper chest tube placement and choice of other therapeutic measures.
• Evaluate respiratory function, noting rapid or shallow respirations, dyspnea, reports of “air hunger,” development of cyanosis, and changes in vital signs. Rationale: Respiratory distress and changes in vital signs occur because of physiological stress and pain or may indicate development of shock due to hypoxia or hemorrhage.
• Monitor for synchronous respiratory pattern when using mechanical ventilator. Note changes in airway pressures. Rationale: Difficulty breathing with ventilator or increasing airway pressures suggests worsening of condition and development of complications, such as spontaneous rupture of a bleb creating a new pneumothorax.
• Auscultate breath sounds. Rationale: Breath sounds may be diminished or absent in a lobe, lung segment, or entire lung field (unilateral). Atelectatic area will have no breath sounds, and partially collapsed areas have decreased sounds. Regularly scheduled evaluation also helps determine areas of good air exchange and provides a baseline to evaluate resolution of pneumothorax.
• Note chest excursion and position of trachea. Rationale: Chest excursion is unequal until lung reexpands. Trachea deviates from affected side with tension pneumothorax.
• Assess fremitus. Rationale: Voice and tactile fremitus (vibration) is reduced in fluid-filled or consolidated tissue.
• Assist client with splinting painful area when coughing, or during deep breathing. Rationale: Supporting chest and abdominal muscles makes coughing more effective and less traumatic.
• Maintain position of comfort, usually with head of bed elevated. Turn to affected side. Encourage client to sit up as much as possible. Rationale: Promotes maximal inspiration; enhances lung expansion and ventilation in unaffected side.
• Maintain a calm attitude, assisting client to “take control” by using slower, deeper respirations. Rationale: Assists client to deal with the physiological effects of hypoxia, which may be manifested as anxiety or fear.

Read More

Acute Renal Failure

Acute renal failure is a syndrome of varying causation that results in a sudden decline in renal function. It is frequently associated with an increase in BUN and creatinine, oliguria (less than 500 mL urine/24 hours), hyperkalemia, and sodium retention.

Pathophysiology of Acute renal failure

Three well-defined stages: oliguric or anuric, diuretic, and convalescent.

1. Oliguric

• Filtration capability is reduced because of debris and damage to renal tubules.
• Output is greatly reduced may be less than 400 mL/day.
• If anuria present, catastrophic injury has likely occurred in both kidneys as in obstructive uropathy or, less commonly, in bilateral renal artery occlusion, acute cortical necrosis, or rapidly progressive glomerulonephritis (Agraharkar & Gupta, 2007).

2. Diuretic

• May skip oliguric phase and begin to make large quantities (may be several liters) of urine
• Client with oliguria will progress through diuretic phase during recovery.
• Urine is dilute because of kidney’s inability to concentrate.

3. Convalescent

• Renal blood flow and filtration improves.
• Process of recovery is gradual, often weeks to months; in many cases, some degree of renal insufficiency persists.

Acute renal failure Classification

Classification dependent on site:

1. Prerenal failure (azotemia): decreased renal perfusion manifested by reduced urine output because of decreased glomerular filtration rate (GFR)
2. Renal or intrinsic failure: associated with parenchymal changes with damage to the renal tubules (acute tubular necrosis [ATN]) caused by ischemia or nephrotoxic substances
3. Postrenal failure: results from an obstruction in the urinary tract anywhere from the tubules to the urethral meatus

Acute renal failure Clinical Manifestations

1. Prerenal decreased tissue turgor, dryness of mucous membranes, weight loss, hypotension, oliguria or anuria, flat neck veins, tachycardia
2. Postrenal obstruction to urine flow, obstructive symptoms of BPH, possible nephrolithiasis
3. Intrarenal presentation based on cause; edema usually present
4. Changes in urine volume and serum concentrations of BUN, creatinine, potassium, and so forth, as described above

ETIOLOGY

Multiple causes: ischemia and toxicity (most common), obstructions

• Prerenal failure: blood volume depletion due to hemorrhage, “third-space” sequestration of fluid as in edema or ascites in advanced liver disease, or burns; dehydration due to gastrointestinal (GI) losses or overuse of diuretics; septic or anaphylactic shock; heart failure (HF) with renal insufficiency, myocardial infarction (MI), trauma; renal artery obstruction; and use of certain drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase inhibitors, angiotensin-converting enzyme (ACE) inhibitors
• Intrinsic failure: ischemia and hypoperfusion similar to prerenal hypoperfusion (except that correction of the causative factor may be followed by continued oliguria for up to 30 days) associated with prolonged acute renal failure (ARF), blood transfusion reaction, or renal artery stenosis; and direct damage from nephrotoxic substances, such as radiocontrast media, cyclosporine, heavy metals (e.g., lead, mercury), cytotoxic drugs (e.g., certain chemotherapy agents), certain antibiotics (e.g., carbenicillins, aminoglycosides)
• Postrenal failure: most commonly occurs with stones in the ureters, bladder, or urethra; from trauma or edema associated with infection, prostatic hypertrophy, or cancer; cervical cancer; strictures of renal artery
• If underlying cause is corrected, the nephrons may recover; however, in some cases, damage is permanent and renal failure becomes chronic.

Community- or hospital-acquired

• Most community-acquired ARF is secondary to volume depletion; as many as 90% of cases are estimated to have a potentially reversible cause.
• Hospital-acquired ARF often occurs in the intensive care unit (ICU) setting and is commonly the end result of multiorgan failure.

Risk factors: advanced age, chronic infection, diabetes, hypertension, immune disorders such as lupus or scleroderma

COMPLICATIONS Acute Renal Failure

• Infection
• Arrhythmias due to hyperkalemia
• Electrolyte (sodium, potassium, calcium, phosphorus) abnormalities
• GI bleeding due to stress ulcers
• Multiple organ systems failure

Read More

Quitting Smoking Lowering Depressive Symptoms

A new study out of Brown University found that quitting smoking reduces symptoms of depression.1 From Brown's press release:

"Researchers tracked the symptoms of depression in people who were trying to quit and found that they were never happier than when they were being successful, for however long that was. The most illustrative and somewhat tragic subjects were the ones who only quit temporarily. Their moods were clearly brightest at the checkups when they were abstinent. After going back to smoking, their mood darkened, in some cases to higher levels of sadness than before. Subjects who never quit remained the unhappiest of all throughout the study. The ones who quit and stuck with abstinence were the happiest to begin with and remained at the same strong level of happiness throughout.

Looking at the data, (lead author Christopher Kahler) said, it is difficult to believe that smoking serves as an effective way to medicate negative feelings and depression, even if some people report using tobacco for that reason. In fact, he said, the opposite seems more likely — that quitting smoking eases depressive symptoms. “If they quit smoking their depressive symptoms go down and if they relapse, their mood goes back to where they were,” he said. “An effective antidepressant should look like that.”

Read More

Perfect Accuracy To Diagnose Autism with MRI Scans

Autism disorders affect one in 110 children in the U.S.--or perhaps more--but the method of diagnosing the condition, which is characterized by difficulties socializing and communicating, among other behavioral and emotional problems, is largely subjective. Now, researchers may have finally found a way to objectively and scientifically diagnose the condition early, with 94 percent accuracy, using simple MRI brain scans.

Autism is generally diagnosed during childhood, but it is often difficult to detect early, particularly among those suffering form a high-functioning form of the condition; those symptoms may be less overt. With a more scientific, biological means of testing children early, it may be possible to get them the proper therapy early when it can do them the most good.

The researchers at McLean Hospital in Belmont Massachusetts used an MRI machine to zero in on microscopic nuances in the brain’s circuitry. The technique, known as diffusion tensor imaging, allowed them to focus on areas of the brain that engage in social and emotional functioning, as well as language. They found that subjects suffering from autism show significant differences in their neural wiring from those without the disorder.

Read More

Patient Teaching for Bladder Cancer

Patient teaching, discharge and home healthcare guidelines for patient with Bladder Cancer. In early stages, bladders Cancer have no symptoms. Commonly, the first sign is gross, painless, intermittent hematuria. Patients with invasive lesions often have suprapubic pain after voiding. Other symptoms include bladder irritability, urinary frequency, nocturia, and dribbling. Provide complete information about disease, disease process and treatment. Provide complete preoperative teaching. Include an explanation of the operation the patient is to undergo. Discuss equipment and procedures that the patient can expect postoperatively. Teach the patient the specific procedure to catheterize the continent coetaneous pouch or reservoir.

Read More