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Should Nurses Share Patient Stories With Their Children?

Should Nurses Share Patient Stories With Their Children?

By stephanie lefler

The big question is Should Nurses Share Patient Stories With Their Children?. My twin daughters once had a friend spend the night that wasn’t allowed to watch Disney movies.That was a stressful 24 hours for me because my husband and I found that we had to be very careful about things we said, conversations that we initiated, music played in the car, and TV shows on the screen in the background around the house. I mean, if you can’t watch Disney movies, I’m pretty sure that excludes the TV show Cops or conversations including stories about drunks in the emergency room or hospital politics.

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The Influence of Nursing in Parenthood

We are not radicals or free-spirited parents that allow their kids to discover the world without structure or borders; however, I think the fact that I am a nurse has had an enormous impact on the way I parent. From the time my girls were young, I have been very open and authentic about the tragedies, miracles, and politics I have encountered at work.

When they were toddlers, they sensed my emotions. I shared my heart with them and with that, they developed a trust and respect for my nursing career from a very young age. They learned to care for others without even knowing or seeing them. They gained a unique perspective of the preciousness of life. When they were little, it involved sitting on the couch with them on my lap and explaining that Mommy was sad because she had a patient die that day. It was a great time to express my love for them while showing them my vulnerability as a human being, my passion for my job and people, and my faith in God.




Being Open About Tragedies

Over time, I shared bits and pieces of my patient stories that they would be able to comprehend and process.
I could not hide my emotion when I walked in the door after caring for a teenage girl that had driven off the side of a country road while she was texting. She was brain dead, and her parents were in the middle of gathering family members, accepting their daughter’s fate, and making the hardest decision of their lives. She shared the same features as one of my twins; blonde hair, petite stature, and innocent blue eyes. It was surreal.

Even though my route home included the exact spot that this teenage girl had begun the fight for her life only hours earlier, I chose to continue my usual path home. The only thing that indicated a crash as I drove through the area were the orange spray paint marks made by the investigators that marked the travel of her car from the road to the ditch.

That night, I had an incredible and emotional conversation with my girls. It was an excellent opportunity to discuss the reality of death, driving, texting while driving, and our fears as parents. Every day on our drive to school, which included the same route as my drive to work and the crash scene, I took the opportunity to pay tribute to that teenage girl. I would verbalize, out loud to my daughters, the impact her death had on me as a nurse and a parent.

Would it Have a Positive or Negative Impact?

The results of my openness have been positive. Several times in the past, I have witnessed positive decisions they have made based on the knowledge they have gained through my stories. They have even shared stories and examples with their friends making it difficult for me to hold back from screaming, “Woo hoo! You listened!”.
They have even been known to question, not directly, the parenting decisions of some of their friend’s parents to allow their kids to do things that could result in tragedy.

It makes me chuckle how they have become just like me, “safety freaks”, as some would say. But I like to think we are not necessarily “safety freaks” but we just happen to be keenly aware of reality and the possibilities of not-so-wise decisions.

Protect our children from Disney movies? Nah… let’s empower them to make informed and wise decisions instead! Do you agree with this? Let us know your thoughts in the comment box below.

Nurses Diverting Narcotics

By: Anonymous

Today I caught a fellow co-worker diverting narcotics…. she’s an RN with a past history of doing this, but it couldn’t be proven, not even with a pop up Urine screening. She had patients complaining about not being given the correct pain pill…. she’s basically busted now…. so my question is, have you ever turned a fellow Nurse in for diversion of narcotics and how did it all turn out?

Night Shift and Nurses’ Health

Night Shift and Nurses’ Health

From: Medscape

The issue of night shift and nurses’ health is a very broad one but also very serious. Every week, another study tells us about the negative effects of working the night shift on health—cancer, diabetes, obesity. Recognizing that nursing is a 24-hour business and that we can’t do away with night shifts entirely, what else should we be doing to protect the health of nurses when we are asking them to risk their own health by working the night shift to take care of patients?

Dr Cipriano: We recently put out a position statement on nurse fatigue, and it includes some key points. One is that it’s always been important to make sure that when nurses are scheduled for rotating shifts, that there is an adequate recovery period. Employers are asked to ensure at least 10 consecutive hours per day of protected time off duty for nurses to obtain at least 7-9 hours of sleep. We know from all of the research done on all of the 24/7 occupations that there is a disruption of circadian rhythms when working nights. We have more research on nurses’ health, thanks to the Nurses’ Health Study, so we have been able to track the impact of working nights, to some extent.

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My sense is that the same health issues are seen with other types of workers, but we don’t have as much data on those groups. In addition to adequate recovery time after a night shift, we need to make sure that nurses are looking after their overall health and levels of fatigue and getting sufficient rest, making sure that as they plan their schedules, they are able to have adequate sleep periods and, when they are on the job, that they are able to take their breaks and meal breaks.




In the old days, when there used to be permanent night and evening shifts, people could acclimate to working at those times. Current data show that 36% of all nurses work 8-hour shifts, 19% work 10-hour shifts, and 27% work 12-hour shifts. The 2014-2015 ANA health risk appraisal data are consistent with these results. Hospitals tend to use 12-hour shifts as a conventional scheduling pattern, so nurses are typically working only 3 shifts weekly of 12-hour days or nights, but they are still switching back to a daytime schedule on their days off.

Most nurses would prefer to rotate than to work exclusively night shifts, so they are still switching around. If nurses were willing to look at the positive health benefits of more consistency, that could make a difference, but what we continue to see is that most nurses don’t like to work nights. We are in conflict with our inherent nature of wanting to operate in a daytime world, which is the way most people and families exist, but we need to recognize that there is a trade-off. The most important thing is to make sure that we have reasonable, appropriate scheduling and rest periods and that nurses are able to adhere to those.

Do you agree with Dr. Cipriano? Let us know your thoughts in the comment box below.

Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines

Sexually Transmitted Diseases: Summary of 2015 CDC Treatment Guidelines

These summary guidelines reflect the 2015 CDC Guidelines for the Treatment of Sexually Transmitted Diseases. They are intended as a source of clinical guidance. An important component of STD treatment is partner management.




Providers can arrange for the evaluation and treatment of sex partners either directly or with assistance from state and local health departments. Complete guidelines can be ordered online at www.cdc.gov/std/treatment or by calling 1 (800) CDC-INFO (1-800-232-4636).

Click here to see Summary of 2015 CDC Treatment Guidelines in PDF

How to Collect a Nasopharyngeal Swab

How to Collect a Nasopharyngeal Swab

Nasopharyngeal swab specimen are sample of secretions from the uppermost part of the throat, behind the nose, to detect organisms that can cause disease.
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Equipments

  • penlight
  • tongue blade
  • sterile swab and transport device
  • specimen label
  • personal protective equipment
  • patient chart
  • waste container




Essential Steps

  • Inform the patient that he may gag or feel the urge to sneeze during the swabbing but that the procedure takes less than 1 minute. The swabbing will take 10 to 15 seconds maximum, whereas the entire procedure will take approximately 1 minute.
  • Have the patient sit erect at the edge of the bed or on a chair, facing you.
  • Wash your hands and put on gloves.
  • Ask the patient to blow his nose to clear his nasal passages.
  • Check his nostrils for patency with a penlight.
  • Tell the patient to occlude one nostril and then the other as he exhales. Listen for the more patent nostril.
  • Ask the patient to cough to bring organisms to the nasopharynx.
  • While it’s still in the package, bend the sterile swab in a curve. Open the package without contaminating the swab.
  • Ask the patient to tilt his head back.
  • Gently pass the swab into the patent nostril about 3″ to 4″ (8–10 cm) into the nasopharynx. Keep the swab near the septum and floor of the nose. Rotate the swab quickly and remove it.
  • If the nostril is narrow, use a nasal speculum for better access. Alternatively, depress the patient’s tongue with a tongue blade, pass the bent swab up behind the uvula, then rotate the swab and withdraw it.
  • Remove the cap from the culture tube. Insert the swab, and break off the contaminated end. Then close the tube tightly.
  • Remove and discard your gloves, and wash your hands.
  • Label the specimen with the patient’s name and room number; the practitioner’ name; and the date, time, and site of collection.
  • Complete a laboratory request form.
  • Immediately send the specimen to the laboratory.
  • If the specimen is obtained to isolate a possible virus, check with the laboratory for the recommended collection technique.




Reference:
Brunner & Suddarth’s (2010). Handbook of laboratory and Diagnostic Test. New York: Lippincott Williams & Wilkins
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Managing a Transfusion Reaction

Acute transfusion reactions present as adverse signs or symptoms during or within 24 hours of a blood transfusion. The most frequent reactions are fever, chills, pruritus, or urticaria, which typically resolve promptly without specific treatment or complications. Other signs occurring in temporal relationship with a blood transfusion, such as severe shortness of breath, red urine, high fever, or loss of consciousness may be the first indication of a more severe potentially fatal reaction.

Below is the nursing checklists for the management of transfusion reaction.

Check (√) Yes or No

PROCEDURE STEPS Yes No COMMENTS
Before, during, and after the procedure, follows Principles-Based Checklist to Use With All Procedures, including: Identifies the patient according to hospital policy using two identifiers; attends appropriately to standard precautions, hand hygiene, safety, privacy, and body mechanics. - - -
1. Stops the transfusion immediately if signs or
symptoms of a transfusion reaction occur.
- - -
2. Do not flush the tubing. - - -
3. Disconnects the administration set from the
IV catheter.
- - -
4. Calls for help. - - -
5. Checks vital signs and auscultates heart and breath sounds. - - -
6. Maintains a patent IV catheter by hanging a new infusion
of normal saline solution, using new tubing.
- - -
7. Notifies primary provider as soon as the blood
has been stopped and patient has been assessed.
- - -
8. Places the administration set and blood product
container with the blood bank form attached inside a biohazard bag and
sends it to the blood bank immediately.
- - -
9. Obtains blood (in the extremity opposite the
transfusion site) and urine specimens according to hospital policy.
- - -
10. Continues to monitor vital signs frequently,
at least every 15 minutes.
- - -
11. Administers medications as prescribed. - - -

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Guidelines for Managing Chest Drainage Systems

There are many clinical conditions that may necessitate the use of chest tubes. When there is an accumulation of positive pressure in the chest cavity (where it should normally be negative pressure between pleurae), a patient will require chest drainage. Chest tubes may be inserted to drain body fluids or to facilitate the re-expansion of a lung. No matter what the reason or underlying cause, chest tubes help to resolve the problems associated with large volumes of air or fluid that have collected in the pleural space. When air or fluid enters the pleural space, the lung cannot expand properly. In some cases, chest tubes can also be used for certain therapy-related patient management as well. The use of chest tubes is not completely fail safe; complications can arise.

Indications for Chest Tubes (Chest Drainage Systems)

There are various reasons for excess air and/or fluid in the pleural space. Specific common indications for chest tubes include:

  • Pneumothorax (open and closed).
  • Tension pneumothorax.
  • Hemothorax.
  • Hemopneumothorax.
  • Pleural effusions.
  • Chylothorax (a type of pleural effusion that results from lymphatic fluid (chyle) accumulating in the pleural cavity).
  • Penetrating chest trauma.
  • Pleural empyema (collection of purulent material in the lungs).
    (Durai, Hoque, & Davies, 2010)



  • Other indications include:

  • Excess air and/or fluid accumulation in the pleural space. For example, chest tubes are often placed after cardiac surgery to drain blood associated with the surgery (Doelken, 2010).
  • Need for pleurodesis: Pleurodesis is a procedure used to treat patients with recurrent pleural effusions or recurrent pneumothorax. This procedure involves administering a sclerosing agent into the pleural space which causes the visceral and parietal pleura to adhere to each other without the thin coating of fluid between them. Chemical pleurodesis is a painful procedure, and patients are often pre-medicated with a sedative and analgesics. A local anesthetic may be instilled into the pleural space, or an epidural catheter may be placed for anesthesia.
  • Chemotherapy administration: May be administered through a chest tube.
  • Causes of Injury to the Chest Wall

    The causes of the indications previously mentioned collectively include:

  • Trauma
  • Lung disorders
  • Factors that compromise pulmonary function (e.g. COPD, smoking)
  • Invasive pulmonary procedures (bronchoscopy)
  • Cardiopulmonary resuscitation
  • Surgical complication
  • Complications from central line insertion v
  • Mechanical ventilation using positive end-expiratory pressure
  • Purulent substances from an infection
  • Any underlying clinical condition that results in excessive air/fluid in the pleural space (eg. pulmonary embolism and cancer)

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NURSING INTERVENTIONS

  • If using a chest drainage system with a water seal, fill the water seal chamber with sterile water to the level specified by the manufacturer.
  • When using suction in chest drainage systems with a water seal, fill the suction control chamber with sterile water to the 20-cm level or as prescribed. In systems without a water seal, set the regulator dial at the appropriate suction level.
  • Attach the drainage catheter exiting the thoracic cavity to the tubing coming from the collection chamber. Tape securely with adhesive tape.
  • If suction is used, connect the suction control chamber tubing to the suction unit. If using a wet suction system, turn on the suction unit and increase pressure until slow but steady bubbling appears in the suction control chamber. If using a chest drainage system with a dry suction control chamber, turn the regulator dial to 20 cm H2O.
  • Mark the drainage from the collection chamber with tape on the outside of the drainage unit. Mark hourly/daily increments (date and time) at the drainage level.
  • Ensure that the drainage tubing does not kink, loop, or interfere with the patient’s movements.
  • Encourage the patient to assume a comfortable position with good body alignment. With the lateral position, make sure that the patient’s body does not compress the tubing. The patient should be turned and repositioned every 1.5 to 2 hours. Provide adequate analgesia.
  • Assist the patient with range-of-motion exercises for the affected arm and shoulder several times daily. Provide adequate analgesia.
  • Gently “milk” the tubing in the direction of the drainage chamber as needed.
  • Make sure there is fluctuation (“tidaling”) of the fluid level in the water seal chamber (in wet systems), or check the air leak indicator for leaks (in dry systems with a one-way valve). Note: Fluid fluctuations in the water seal chamber or air leak indicator area will stop when:
    • The lung has reexpanded
    • The tubing is obstructed by blood clots, fibrin, or kinks
    • A loop of tubing hangs below the rest of the tubing
    • Suction motor or wall suction is not working properly
  • With a dry system, assess for the presence of the indicator (bellows or float device) when setting the regulator dial to the desired level of suction.
  • Observe for air leaks in the drainage system; they are indicated by constant bubbling in the water seal chamber, or by the air leak indicator in dry systems with a one-way valve. Also assess the chest tube system for correctable external leaks. Notify the physician immediately of excessive bubbling in the water seal chamber not due to external leaks.



  • When turning down the dry suction, depress the manual high negativity vent, and assess for a rise in the water level of the water seal chamber.
  • Observe and immediately report rapid and shallow breathing, cyanosis, pressure in the chest, subcutaneous emphysema, symptoms of hemorrhage, or significant changes in vital signs.
  • Encourage the patient to breathe deeply and cough at frequent intervals. Provide adequate analgesia. If needed, request an order for patient-controlled analgesia. Also teach the patient how to perform incentive spirometry.
  • If the patient is lying on a stretcher and must be transported to another area, place the drainage system below the chest level. If the tubing disconnects, cut off the contaminated tips of the chest tube and tubing, insert a sterile connector in the cut ends, and reattach to the drainage system. Do not clamp the chest tube during transport.
  • When assisting in the chest tube’s removal, instruct the patient to perform a gentle Valsalva maneuver or to breathe quietly. The chest tube is then clamped and quickly removed. Simultaneously, a small bandage is applied and made airtight with petrolatum gauze covered by a 4 ×4-inch gauze pad and thoroughly covered and sealed with nonporous tape.
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Nasogastric Intubation

Nasogastric Intubation

Nasogastric Intubation:- Gastric intubation via the nasal passage (i.e., nasogastric route) is a common procedure that provides access to the stomach for diagnostic and therapeutic purposes. A nasogastric (NG) tube is used for the procedure. The placement of an NG tube can be uncomfortable for the patient if the patient is not adequately prepared with anaesthesia to the nasal passages and specific instructions on how to cooperate with the operator during the procedure.

Indications

Diagnostic indications for Nasogastric Intubation include the following:

  • Evaluation of upper gastrointestinal (GI) bleeding (i.e., presence, volume)
  • Aspiration of gastric fluid content
  • Identification of the oesophagus and stomach on a chest radiograph
  • Administration of radiographic contrast to the GI tract




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Therapeutic indications for Nasogastric Intubation include the following:

  • Gastric decompression, including maintenance of a decompressed state after endotracheal intubation, often via the oropharynx
  • Relief of symptoms and bowel rest in the setting of small-bowel obstruction
  • Aspiration of gastric content from recent ingestion of toxic material
  • Administration of medication
  • Feeding
  • Bowel irrigation

Contraindications

Absolute contraindications for Nasogastric Intubation include the following:

  • Severe midface trauma
  • Recent nasal surgery

Relative contraindications for Nasogastric Intubation include the following:

  • Coagulation abnormality
  • Oesophageal varices or stricture
  • Recent banding or cautery of oesophageal varices
  • Alkaline ingestion




Complications

The main complications of Nasogastric Intubation include aspiration and tissue trauma. Placement of the catheter can induce gagging or vomiting, therefore suction should always be ready to use in the case of this happening.

Universal precautions:

The potential for contact with a patient’s blood/body fluids while starting an NG is present and increases with the inexperience of the operator. Gloves must be worn while starting an NG; and if the risk of vomiting is high, the operator should consider face and eye protection as well as a gown. Trauma protocol calls for all team members to wear gloves, face and eye protection and gowns.

Equipment:

All necessary equipment should be prepared, assembled and available at the bedside prior to starting the NG tube. Basic equipment includes:

  • Personal protective equipment
  • NG/OG tube
  • Catheter tip irrigation 60ml syringe
  • Water-soluble lubricant, preferably 2% Xylocaine jelly
  • Adhesive tape
  • Low powered suction device OR Drainage bag
  • Stethoscope
  • Cup of water (if necessary)/ ice chips
  • Emesis basin
  • pH indicator strips

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Procedures:

  • Gather equipment
  • Use sterile gloves.
  • Explain the procedure to the patient and show equipment.
  • If possible, sit patient upright for optimal neck/stomach alignment.
  • Examine nostrils for deformity/obstructions to determine best side for insertion.
  • Measure tubing from bridge of nose to earlobe, then to the point halfway between the end of the sternum and the navel.
  • Mark measured length with a marker or note the distance.
  • Lubricate 2-4 inches of tube with lubricant (preferably 2% Xylocaine). This procedure is very uncomfortable for many patients, so a squirt of Xylocaine jelly in the nostril, and a spray of Xylocaine to the back of the throat will help alleviate the discomfort.
  • Pass tube via either nare posteriorly, past the pharynx into the oesophagus and
    then the stomach.



  • Instruct the patient to swallow (you may offer ice chips/water) and advance the tube as the patient swallows. Swallowing of small sips of water may enhance passage of tube into oesophagus.

    If resistance is met, rotate tube slowly with downward advancement toward closes ear. Do not force.

  • Withdraw tube immediately if changes occur in patient’s respiratory status, if
    tube coils in mouth, if the patient begins to cough or turns pretty colours.
  • Advance tube until mark is reached.
  • Check for placement by attaching syringe to free end of the tube, aspirate sample of gastric contents. Do not inject an air bolus, as the best practice is to test the pH of the aspirated contents to ensure that the contents are acidic. The pH should be below 6. Obtain an x-ray to verify placement before instilling any feedings/medications or if you have concerns about the placement of the tube.
  • Secure tube with tape or commercially prepared tube holder.
  • If for suction, remove syringe from free end of tube; connect to suction; set machine on type of suction and pressure as prescribed.
  • Document the reason for the tube insertion, type & size of tube, the nature and amount of aspirate, the type of suction and pressure setting if for suction, the nature and amount of drainage, and the effectiveness of the intervention.

Sources:
Med Uottawa
Medscape

New overseas nurse rules will ’cause chaos’ for NHS

Nurse recruitment will be under increasing strain in the coming years as new government rules that require overseas workers to earn a minimum salary come into effect, the Royal College of Nursing has claimed. The new legislation requires migrant workers who have come from outside the European Economic Area to have a salary of at least £35,000 after five years of working in the UK if they want to remain in the country. But the RCN has claimed the law, which was amended in 2012, means that from 2017 thousands of overseas nurses could be forced to leave the UK and will create “chaos” for the NHS.

“The immigration rules for healthcare workers will cause chaos for the NHS and other care services”-Peter Carter
It noted that the £35,000 threshold was equivalent to a nurse being in the middle to upper part of Agenda for Change band 7 and claimed it was likely the majority of workers would not have reached this level of earnings within five years. In its report on international recruitment, unveiled this week at the union’s annual congress in Bournemouth, the RCN pointed to data from the Nursing and Midwifery Council, which showed that 3,365 nurses registered to work in the UK between April 2011 and March 2015.

All of these nurses were at risk of having to leave the UK from 2017 onwards due to the changes in immigration rules, according to the union. It would result in around £20m being wasted, based on the estimated cost of recruiting more than 3,000 nurses, said the RCN. A shortage of home-grown nurses and the government’s new measures to limit spending on agency workers meant overseas recruitment was expected to increase, which could lead to hundreds of millions of pounds being spent on nurses that were unable to remain in the UK, added the report.
Peter Carter, chief executive and general secretary of the RCN, said: “The immigration rules for healthcare workers will cause chaos for the NHS and other care services. At a time when demand is increasing, the UK is perversely making it harder to employ staff from overseas.”

“NHS trusts are being asked to provide safe staffing with both hands tied behind their backs,” he said. “Without a change to these immigration rules the NHS will continue to pay millions of pounds to temporarily rent nurses from overseas.” He added: “There are clear signs of a global nursing shortage, meaning an ongoing reliance on overseas recruitment is not just unreliable but unsustainable.”

Antibiotic Resistance Puts Your Life and Others at Risk

Antibiotic Resistance Puts Your Life and Others at Risk

The successful use of any therapeutic agent is compromised by the potential development of tolerance or resistance to that compound from the time it is first employed. This is true for agents used in the treatment of bacterial, fungal, parasitic, and viral infections and for treatment of chronic diseases such as cancer and diabetes; it applies to ailments caused or suffered by any living organisms, including humans, animals, fish, plants, insects, etc. A wide range of biochemical and physiological mechanisms may be responsible for resistance. In the specific case of antimicrobial agents, the complexity of the processes that contribute to emergence and dissemination of resistance cannot be overemphasized, and the lack of basic knowledge on these topics is one of the primary reasons that there has been so little significant achievement in the effective prevention and control of resistance development. Most international, national, and local agencies recognize this serious problem. Many resolutions and recommendations have been propounded, and numerous reports have been written, but to no avail: the development of antibiotic resistance is relentless.




What contributes to antibiotic resistance?

There are many factors that contribute to antibiotic resistance. Here are some of them that you should know to avoid making any of it.

  • Overuse of antibiotics – Just like using any other drugs, overuse of antibiotics will lead to antibiotic resistance. In future use, antibiotics will no longer be able to control or destroy the bacteria in your body because it is resistant already.
  • Antibiotic use is stopped early – often, patients do not follow what is prescribed to them by their doctors. This may cause to leaving behind some strains of the bacteria thus the illness will recur. The next medication may not be able to stop the bacteria anymore.
  • The dose or schedule instructions for the antibiotic are not followed – Some people take more than the dosage of antibiotic prescribed to them thinking this will make their recovery quick. There are also some who doubles it especially when they forget what time they should have intake their antibiotic. These practices lead only to antibiotic resistance because the effectiveness of the drugs doesn’t have the right impact anymore to the bacteria.



  • Taking antibiotics without proper consultation – As we’ve said, antibiotics are used to treat bacterial infection. So if antibiotics are taken to recover from flu, colds or coughs, it will not work because these are caused by viruses and not by bacteria. A person should always consult their doctors first before taking any medicine. It is better to have the proper healthcare worker prescribed the right medication than to take chances and make the illness much worse than before.
  • Reusing unfinished antibiotic for later use – Do not take left-over antibiotics to cure the same illness later. This is because you are not sure if you still have the same strain of bacteria when your doctor prescribed you that antibiotic. It is possible that this time, you have a different type of bacteria and that left-over antibiotics will not help you.

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It is still possible to slow or reverse resistance by being more responsible about the way we use antibiotics. This will help ensure that the antibiotics we now have can continue to be effective while medical researchers work to develop new types of antibiotics or other treatments for serious bacterial infections. Just remember to consult first your doctor before taking any medicine to cure whatever it is you are feeling.

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