Introduction
Vancomycin-resistant enterococcus (VRE) is a bacteria or what is also known as germ is a bacteria that causes bad infections. The first strains of this bacteria first appeared in Europe by the year 1986 and three years after (1989) the first incidence in America was reported and between the year 1989 to 1993 a significant increase in the cases was reported from 0.3% to 7.9%. This bacteria lives in the stomach of the person and is only causing infection when the person does not feel well. VRE is not limited to affecting the stomach alone it may also affect the different parts of the body. Caregivers and many healthy people may have the bacteria but is unaware of it. The bacteria may also lodge and survive in the person’s skin and throat. This is what we call as colonization the person may become the carrier of the bacteria that may cause disease to others (Vancomycin-Resistant Enterococcus).
The name Vancomycin-resistant enterococcus is also given to a group of bacteria that are resistant to vancomycin. The bacteria was first discovered in 1985 and was found to be dangerous to person’s who are immunocompromised. This bacteria has 6 different types which are classified as follows: Van-A, Van-B, Van-C, Van-D, Van-E and Van-F. So far in the clinical practice only Van-A to C are seen and their only difference is their resistance to drugs as teicoplanin and vancomycin.
Healthy people can be carriers of the bacteria and could pass them on to people who comes in contact with the bacteria. Infections of this bacteria may be likely to occur in the hospital, and in intensively-farmed chicken where a significant percentage was found.
This study would cover the discussion on what VRE is and what are the characteristics of the disease it carries and what the treatment is for the infection. A discussion on how the infection is prevented would also be discussed.
What is Vancomycin-resistant enterococcus (VRE)?
Vancomycin-resistant enterococcus (VRE) is the bacteria that grabbed the attention of public health officials in the 1980’s because of its survival ability in the human beings and animals. These bacteria is unfamiliar to many compared to staph or E. coli but the infections caused by these bacteria are commonly acquired in the hospital. However, this bacteria only cause infections to those who are already ill individuals such as patients in the intensive care Units, persons who have diabetes mellitus, and those who have chronic kidney failure. An epidemic is unlikely to occur because Enterococcus is a not a concern among healthy people.
Enterococci are of great interest because of its resistance and evasion to several forms of antibiotic therapy including vancomycin which is a last resort to most infections that are resistant to antibiotic therapy.
If the infection results in the human disease it has a fatal result particularly caused by VRE especially when infection occurs with the very young, old and the very ill whose immune system is compromised (VRE). As this bacteria can transmit resistance genes to other bacteria, chances are it may transmit these resistance genes to staph and strep which are more dangerous which may cause serious infections to healthy people (VRE).
What are the disease characteristics of the infection caused by VRE?
Symptoms of VRE infection may vary from patient to patient depending on where the infection is located. If an infection occurs in the wound, the affected part may be red and tender. When the infection is located in the urinary tract, symptoms may be back pain, burning sensation when urinating, and sometimes frequent urinating compared to the usual pattern of urination (VRE Infections). Other symptoms associated with VRE may include the following: diarrhea, weakness, excessive sweating, hypothermia, weakness, fever, chills, prolonged capillary refill, rapid heartbeat, increased respiration rate, low blood pressure, cool and clammy extremities, deficient oxygenation of the blood, shortness of breath, nausea, vomiting, pain and tenderness in the abdomen, coma, rashes, delirium, and confusion (Symptoms of Vancomycin).
What are the treatment for Vancomycin-Resistant Enterococcus?
If a person develops an infection involving VRE bacteria, isolation is the first and foremost action of the medical team to reduce the possibility of spreading the infection to other patients. However difficult the treatment is for VRE infections due to its resistance of the bacteria to many antibiotics, a cure is still possible. Antibiotics may be given orally or intravenously for treating the said infection (VRE Infections). But there is a need to test which antibiotic would be used to treat the infection and see which antibiotic works well in clearing the infection. If person develops VRE infection along with the usage of a urinary catheter, the catheter removal may also clear the infection but treatment is not required when infection does not follow colonization (Vancomycin-Resistant).
Treatments, however, for the VRE infection may be delayed because of the antibiotic testing. It may take some time because of the wide range of antibiotics that will be tested on the strains of the bacteria and laboratory results for the said testing may take quite some time (Vancomycin-resistant Enterococci – VRE).
How can we avoid the spread of VRE Infection?
VRE infection may cause serious problems among infected people and it is a contagious infection that may be passed on to by direct contact with the patient. Even if it not transferred by sneezing or coughing, people, especially caregivers should be watchful with patients infected with VRE.
VRE infection can be prevented by properly using the antibiotics such as vancomycin, teicoplanin, and cephalosporins to those patients who are prescribed with the medicine. Also a limitation in the use antibiotics which have actions like vancomycin in veterinary practice to reduce the possibility of its colonization in the animals that may later result in spreading it to human beings (Vancomycin-Resistant Enterococci – VRE).
In the hospitals, handwashing is a primary action and a must after caring for a patient with the VRE infection. Thorough cleaning may be necessary especially decontaminating of the equipment would be helpful in eliminating the chances of spreading the bacteria. Staff in the hospital must take precautions such as wearing of gloves and gowns while taking care of the patients because of the high probability of transfer of bacteria from patient to the hospital staff to other patients in the hospital if preventive measures are not taken. Upon the discharge of a patient with VRE, ll the linens and other clinical waste that were used by the patient should be disposed in bags which would indicate that it is contagious (Vancomycin-Resistant Enterococci – VRE).
Conclusion
As VRE is a very contagious disease, it is not impossible to limit or even zero out the transmission of the bacteria from one person to another. Through proper hygiene practices and prevention measures, the spread of the bacteria can be controlled. Educating patients or even the people with the proper use of the antibiotics may also help in preventing the said infection to occur. If the people would be aware of what would result if antibiotics are used improperly, they may also be cautious enough to consult a physician first before taking any antibiotics and thus the prevention of a possible VRE infection.
References
Methicillin-Resistant Staphylococcus aureus (MRSA). 2007. Web.
VRE – Vancomycin-Resistant Enterococcus. 2008. Web.
Vancomycin-resistant enterococci (VRE). Association of Medical Microbiologists. 1997. Web.
Vancomycin-Resistant Enterococci (VRE). 2008. Web.
VRE Infections. Parker Waichman Alonso LLP. 2008. Web.
Symptoms of Vancomycin resistant enterococcal bacteremia. 2008. Web.
Vancomycin-Resistant Enterococcus. US Pharmacist. 2008. Web.
The Concept Of Artificial Hydration
Introduction
Artificial hydration refers to the medical practice of introducing nutritional fluids and water into a patient’s body by means of tubes, catheters or needles. The issue of artificial hydration in the context of patients who are terminally ill is an emotional one for many patients and families because giving or withdrawing fluids plays can mean the difference between life or death (Ferrell and Coyle, 2006). Caregivers get worried when patients are unable to take fluids on their own and know they are on the route to dying. The decision to give artificial fluids in such cases is easy to take, but the decision to stop is generally a hard one as it involves the emotions of various parties concerned. Ethical, moral and religious viewpoints do not distinguish between withholding and withdrawing a treatment such as artificial hydration (Ferrell and Coyle, 2006). Most patients and families are aware that without artificial hydration in the case of terminally ill patients, death may happen quickly. The decision to give to stop artificial hydration should be based on careful individual assessment.
Thesis: The uniqueness of the individual situation, the goals of care and the comfort of the patient must be considered while deciding on the issue of artificial hydration.
Main body
According to Zerwekh (1983), the following factors may be considered while evaluating the decision to initiate or continue artificial hydration: the probable increase in the patient’s well being as a result of hydration, identification of symptoms that would be relieved, side effects, effect on consciousness of the patient, the patient’s goals and personal wishes in the context of end of life care, probability of prolonging the patient’s life and effect of artificial hydration on the family members and caregivers (Ferrell and Coyle, 2006). Regarding hydration, some researchers argue that patients may sometimes benefit from dehydration because dehydration allows an individual to slip into a coma (Lacey, 2006), whereas artificial hydration may prolong the dying process, cause painful swelling, and worsen other symptoms associated with hydration (Huang & Ahronheim, 2000). Dunlop and Ellershaw have found that intravenous fluids in the terminally ill patients can cause pulmonary edema, acites and peripheral edema and moreover, there is evidence that patients who die without hydration die more peacefully than patients who are hydrated (Finegan et al, 2007). Thus from the patient’s point of view, artificial hydration may mean endless suffering.
Religion also plays a role in the decision for or against artificial hydration. Studies show that Christian patients and families often demand aggressive treatment and fluids at the end of life as they are positive that they would receive help from God in the form of miracles (Brett and Jersild, 2003). Relatives of Jewish patients demand that life is maintained as long as possible and they find that artificial hydration is required even in the case of patients in coma. Islam regards life as sacred and hence anything that is seen to hasten death will be resisted.
In 2004, the General Medical Council stated that “life has a natural end” and this should be allowed. Kevin D. O’Rourke (2000) says that artificial provision of hydration and nutrition is a medical treatment rather than a nursing procedure and good medical practice entails intiating hydration and nutrition when the patient’s prognosis is uncertain but allows for termination if the patient’s condition is hopeless and the patient’s family has consented to withdrawal. O’Rourke suggests that decisions regarding artificial hydration may be taken as per principles governing other forms of medical treatment and taken on the basis of “the patient’s diagnosis and prognosis, the prospective benefits and burdens of the treatment and the stated preferences of the patient and family” (O’Rourke, 2000, p. 118). He further strongly concludes that when medical treatment is futile and does not contribute to a patient’s well being, there is no ethical obligation to provide it and this includes artificial hydration.
Conclusion
Thus there are different perspectives on the issue of artificial hydration and the decision needs to be taken in consideration of viewpoints of the patient, his close family and caregivers and the medical fraternity.
Bibliography
Brett, Allan and Jersild, P. Inappropriate treatment near the end of life: conflict between religious convictions and clinical judgment. Arch Intern Med. 2003. Vol. 163, p. 1645-9.
Dunlop R. J. and Ellershaw, J. E. On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far? J. Med. Ethics. 1995. Volume 21. p. 141
Ferrell, Betty and Coyle, Nessa (2006). Textbook of Palliative Nursing. Oxford University Press.
Finegan, C. Wesley; Rogernson, Elizabeth and McGurk, Angela (2007). Care of the Cancer Patient. Radcliffe Publishing.
Huang, Z. B., & Ahronheim, J. C. (2000). Nutrition and hydration in terminally ill patients: An update. Clinics in Geriatric Medicine, Vol. 16, p. 313-325.
Lacey, Debra. End-of-Life Decision Making for Nursing Home Residents with Dementia: A Survey of Nursing Home Social Services Staff. Health and Social Work, 2006. Vol. 31.
O’Rourke, D. Kevin. A Primer for Health Care Ethics: Essays for a Pluralistic Society. Georgetown University Press. 2000.
Zerwekh, C. Joyce. The Dehydration Question. Nursing, Jan. 1983, p. 47-51
Good Wife Penelope In Homer’s “The Odyssey”
The character of Ulysses is very famous and it is mainly associated with two epics namely the Iliad and the Odyssey both these great epics were written by homer. Ulysses was a Greek king who went on an expedition in the later parts of his life leaving his kingdom, his wife Penelope and his son Telemachus all alone. His son was born just when he was about to leave for the Trojan War which was supposed to be a bloody battle. This paper will throw light upon the character of Penelope and the way she reacted in the absence of Ulysses to safeguard the kingdom against the suitors. A comprehensive analysis of her reactions will be presented in this paper.
“Shrewd Penelope, has she heard you’re home?” (Homer, P1325, Vol 24). This quote shows that Penelope the faithful wife of Ulysses and she stood really strong in his absence. Women were known for the deeds of their sons and by their own deeds early on, Ulysses wanted his wife to be really faithful to him without looking at his own track record and Penelope certainly fulfilled this desire of Ulysses in his absence. Even though Ulysses goes on an expedition for many years, Penelope always spoke about him with respect and gratitude and the relationship between Ulysses and Penelope form the base of the story, the whole story revolves around these two most important characters. Women have always taken a back seat in most of the early stories but Ulysses is a bit different from the other stories, Penelope stands all alone protecting the kingdom of Ulysses changes the whole image of women taking a back seat.
Penelope could have easily married some suitor and the kingdom would have gone to the suitor but she did not do this in order to ensure that she protects the kingdom of her husband even in his absence and she stood by his wishes, he wanted her not to get married and she did exactly the same. “What good sense resided in your Penelope” (Homer, P1306, Vol 24). She waited for twenty long years for her husband to come back, this clearly goes to show that she was a woman of character and self control, had it been any other woman, she would have surely failed to resist the temptation of getting married again. She had a lot of persistence and composure, her image had been overshadowed because of Ulysses, and this is because he is the protagonist in the play and the contribution of his wife Penelope has never come to the limelight. It is very fair to say that she never gets the appreciation that she deserves because of the overshadowing nature of the character of Ulysses.
“What other wife could have a spirit so unbending?” (Homer, P1268, Vol 23).This quote from the book goes to show her faithfulness and her thoughtful attitude, she decides to protect the kingdom against all odds and she succeeds in doing so, the Poem is also about the struggle of Ulysses and Penelope to get back together after twenty years of long gap.Penelope wove during the day to keep her suitors at bay and removed it at night so as to buy herself some time. She certainly succeeded in keeping all her suitors at bay and in protecting the kingdom in the absence of the king for twenty long years. Penelope’s loyalty has been discovered by the people off late and she features in many paintings, poems, prose etc.
“After bearing twenty years of brutal struggle.” (Homer, P1268, Vol 23). Penelope’s character is personified with the help of this by Robert; she has redefined the term ideal wife. She was consistently persistent in protecting the territory of her husband. She faced many challenges but she overcame every challenge and proved herself against all odds. One of the biggest challenges for her was to keep the suitors at a distance and she did so by coming up with a trick which worked perfectly in her favour. The book gives an impression that women are valued much less than men but Penelope’s character forces the readers to think over this statement. Penelope shows no desperation in spite of the absence of her husband for twenty long years, this is immaculate control personified by Robert in the book. Had it been any other woman, she would have broken down and married a suitor and faced devastating circumstances but she did not do so, earning the respect of the readers. Women are personified as the objects of lust in the book but the character of Penelope is extremely different and unique. The extraordinary zest displayed by Penelope in protecting her husband’s kingdom becomes the highlight of the book and many more characters have been inspired by the character of Penelope and even more will be inspired by this extraordinary character.
References
Fagles Robert. The Odyssey. P 1325 Vol 24.
Fagles Robert. The Odyssey. P 1306 Vol 24.
Fagles Robert. The Odyssey. P 1268 Vol 23.
Fagles Robert. The Odyssey. P 1268 Vol 23.