Traditional Chinese Medicine in Rehabilitation Nursing Practice Dorothy C. Sherwin, MS RN TraditionalChinesemedicine (TCM)employs methodsof treatmentsuchasacupuncture, acupressure, and Qi Gong (treatment based on meditation).The nurse using TCM can affect rehabilitationpatient outcomes positively. With TCM training, nurses have an opportunity to learn the nuances of the Oriental environment and integrate them into their skills to nurse the spirit, mind, and body of patients in a holistic manner.
T
he American woman pulled up a chair and sat before the Chinese doctor, who also was a Taoist monk. He was old and thin, with scraggly wisps of a gray beard hanging limp to his waist. Silently, he greeted her with a traditional Chinese low head nod. At the request of the doctor, an interpreter asked the woman to open her mouth and extend her tongue. Peering at her tongue, the doctor took 12 radial pulses, six in each wrist. The pulsesthree superficial, three deep along the radial artery-were not timed, but the depth, rhythm, volume, strength, and frequency were noted. After this 5-minute examination, the doctor asked for an explanation of the woman’s problem and wrote her “prescription” in Chinese characters: a combination of many herbs to be prepared and brewed like a tea and taken once a day for 3 days. The woman, an American traveler, had a history of a ruptured liver and had felt dizzy and light-headed that morning. The Taoist doctor diagnosed “fluid in the abdomen,” “stomach problems,” and “problems in her head.” The doctor refused payment but was happy to accept a contribution to the temple. Later, the prescription was filled in three small packages, the contents of which were ready to be brewed. In the United States, most people expect temporary symptomatic relief of the diagnosed ailment. For some, this relief might be all they want or need; others, however, want their health problems eliminated. As about 85% of health problems are chronic, inherited, and/or occur as a result of a traumatic accident or addiction (Ingelfinger, 1980), perhaps a change of lifestyle would offer benefits. For many centuries, Chinese methods-xcept for acupunctur-have featured noninvasiveways of relieving symptoms of disease, such as the American woman’s being treated with herbs. These methods are known as traditional Chinese medicine (TCM).
Traditional Chinese medicine Traditional Chinese medicine is based on the fundamental theory of balance among yin and yang, five basic elements(wood, fire, air, light, and water), and a relationship between humans and nature. People’s body, mind, and external environment constantly influence each other to create this balance. Each person
also has Qi (pronounced chee), a vital force or energy, and a number of body channels for the flow of Qi. The Chinese believe that Qi is located approximately2 inches below the navel, an area known as the body’s center of gravity. Chinese application of TCM attempts to come to terms with nature rather than simply to relax or strengthen the body. In the 1st and 2nd centuries, Hua Tuo based “exercise” movements on those of five animals: deer, stork, tiger, bear, and monkey. Now these movements have been refined to be used specifically to heal, cure, and relieve health problems.These movementscollectively are called Tai Qi Chuan, also known as tai chi. Each slow, gentle movement of an arm or leg and twist of the body is done with total concentration.Specific patterns of posture are believed to bring Qi, the vital force, under control. The Chinese believe that energy needed to live a full day is best mobilizedearly in the day, when life’s forces are strongest. It is at this time that onecangainorreceiveenergy: energy to heal, energy to live the day, energy to be more aware of one’s surroundings. Roleofthenurse inTCM:TCMeducationforChinesenurses includes acupuncture, certain massage techniques, breathing exercises, specific diets, and herb remedies. Even without this formaleducation,Westemnursescan incorporateTCMintotheir efforts to care for a person’s body, mind, and spirit in a holistic way. The method of healing called therapeutic touch, for example, is derived from ancient healing methods including the traditional Chinese measures. Therapeutic touch is effective in treating stress-relateddisordersand headaches, in reinforcing the body’s own healing resources, in soothing women during childbirth, in calming fretful patients (particularly children), and in giving support to the seriously ill (Macrae, 1988). A Westerner’s firsthand observations: As a member of a study delegation from the United States to the People’s Republic of China in spring 1990 in conjunction‘witha global conference in Shanghai, I visited the Zhejiang Academy of Traditional Chinese Medicine in Hangzhow (pronounced hang jo), talked with physicians, nurses, and patients, observed methods of TCM, photographed the activity, and observed the formulation and packaging of herbal prescriptions in the Chinese pharmacy. My observations follow.
Address correspondence to Dorothy C . Sherwin, Box 273, Sturgeon Bay, WI 54235.
TCM treatments We observed three primary forms of TCM: acupuncture, acupressure, and Qi Gong. Vol. 17, No. S/Rehabilitation NursingJSep-Oct 1992/253
Traditional Chinese Medicine
Acupuncture: Acupuncture, a primary application of traditional Chinese medicine, is the insertion of needles into specific acupuncturepoints along channels ormeridianlines. Thereare 12 major meridian lines, 15 collaterals, 8 extra channels, and hundreds of points for insertingneedles. The channels interdigitateso that the termination of one is the beginning of another. Each channel corresponds to a specific body organ or system (e.g., the bladder channel and the stomach channel). In TCM, it is believed that stimulation of certain points can relieve pain or treat disease. Stimulation of acupuncture points involves three methods: needle insertion,pressure, or heat. The needle insertionprocedure is acupuncture. The use of finger pressure is therapeutic Chinese massage. Heat applications,called maxibustion,usually are in the form of slow-burning sticks of herbs. At the time of our visit to Zhejiang Academy, several people were receiving acupuncture treatments-most of them for facial paralysis, one for a spastic hand condition, and another for low back pain. The deputy director of the academy explained the process as he performed it: The patient is placed on an examining table, and the physician, after discussing the patient’s problems with colleagues and the patient, inserts thin 3- to 4-inch needles that are twirled or used to conduct a weak electric current. The patients receive treatment at a minimum of twice a week for 5 weeks. The insertionof the needles causes sharppain and feelings of numbness, heaviness, dizziness, and sour taste and/or distention. We were told that as these symptomsdisappear,so also does the primary complaint. Acupressure: In another room, acupressure massage was being administeredto a young man for a work-related injury that had resulted in numbness of the legs. This patient had been receiving massage for several weeks and was relieved of the numbness. Well on his way to recovery, he smiled and walked around the room. Acupressure massage, or therapeutic Chinese massage, is the palpitating, rubbing, and kneading of the flesh along meridian lines depending on the health problem of the patient. The skin is literally picked up with the fingers and rubbed together. The doctor doing the massage uses only the fingers and the heel of the hand. The massage treatment lasts about an hour. Afterwards all pain is gone, leaving a feeling of warmth and relaxation. However, this feeling does not last. Qi Gong: In a large well-lighted room upstairs, a group of men and women were seated in a circle in the lotus position and were receiving the Qi Gong treatment. When we entered, everyone became quiet. The atmosphere felt most .mystical. The patients had their eyes closed and their hands in the open, receiving lotus posture. The doctor walked behind them, stopping to extend his hands, but without touching them, so that they could receive his healing energy. Qi Gong is an ancient practice. It begins with the patient achieving a meditative state by means of a breafhing exercise and maintaining it while the Qi Gong master gathers his vital energy, which he emits from his fingertips and uses to direct the Qi, or vital energy, of the patient. Patients then gather the Qi-the doctor’s energy and theirs-into a healing state. The Qi Gong
masters only treat four or five patients a day, as the practice of Qi Gong is exhausting emotionally and physically.
Expanding the use of TCM The doctors at this research hospital (most trained in both Western and Chinese medicine) stated that substantial, welldocumented research studies must be performed before this Chinese method of treatment attains total acceptance by the medical profession throughout the world. A study similar to one described by Eisenberg (1985) that aims to demonstrate TCM’s effectiveness with chronic diseases by using Qi Gong to treat high blood pressure is in progress at the academy. Another promising study, also similar to one discussed by Eisenberg (1983, reveals that patients with diabetes who practice the Qi Gong, breathing and meditation, diet, herb prescriptions, and exercise in true Chinese methods are able to lower their blood sugar by 100 mg/dl or more within weeks. TCM in rehabilitation nursing: Because rehabilitative programs are designed to achieve the highest level of physical, mental, social, spiritual, and economic self-sufficiency,methods of TCM can enhance the nursing care plan to benefit the patient. However different Chinese medicine is from Western medicine, the goals of the two are the same: to heal and to enable the patient to use methods of self-care.Many of the Chinese methods can be adopted by the Western rehabilitation nurse. Three major potential problems related to the nursing diagnoses for the rehabilitation patient are (a) potential alteration in comfort, (b) potential self-care deficit, and (c) potential spiritual distress. Several TCM methods-including Chinese massage, use of herbs, tai chi exercise, and meditation (Koptsheck & Croucher, 1987)-can be used as nursing interventions for these diagnoses. The rehabilitationnurse has a pivotal role in facilitating patients’ use of noninvasive self-healing methods. It is not unusual for the Chinese patient, in the tradition of early morning exercise, to spend time in some way with tai chi. The benefits of a full range-of-motion exercise such as tai chi are well known. Forms of tai chi that the rehabilitation nurse can encourage the patient to use are singing softly, reciting poetry, and meditating. If practiced regularly, these methods-which constitute a form of self-hypnosis-are a source of energy to improve patients’ concentration and mindfulness. Acupressure massage along the meridian lines can bring comfort to the disabled patient. Different from effleurage and flagellation, the kneading and friction of Chinese massage has a greater potential to alleviate pain and is a technique that is easy to learn. The Chinese use herbs for medicinal purposes as well as for flavoringfood. Such herbs can increase the palatability of a lowfat, low-cholesterol diet such as that followed by many types of rehabilitation patients.Long-termpatients can grow, harvest, and dry their own herbs in a window box garden. Involvement in such an activity promotes self-care. The rehabilitation nurse is best equipped to assess the impact of alternative methods of health care. Using TCM offers the nurse an opportunity to affect rehabilitation patient outcomes positively. WithTCMtraining,nurseshaveanopportunitytoleam the
254/Sep-Oct 1992/Rehabilitation NursingJVol. 17, No. 5
ot promise. nuances of the Oriental environment and integrate them into their skills to nurse the spirit, mind, and body of patients in a holistic manner. Dorothy Sherwin is an instructor in the health occupation division of Northeast Wisconsin Technical College in Sturgeon Bay, WI.
References Eisenberg, D. (1985). Encounter with Qi:Exploring Chinese medicine. New York: William Norton. Ingelfinger, F. (1980). Arrogance. New EnglandJournal ofMedicine, 303, 1506-1511. Koptsheck, T., & Croucher, M. (1987). The healing arts. New York: Summit Books. Macrae, J. (1988). Therapeutic touch: A practical guide. New York: Alfred A. Knopf.
Parkview Memorial Hospital has always provided the highest qualityofhealthcare.Toensurethatwecontinuethattradition, we're working with some of today's most sophisticated high tech equipment. But, we also know we couldn't succeed without caring people.
Rehabilitation Educator Full-time/Days You will be responsible for develo ing, implementing and evaluatingalleducationalservicesanfprogramsfor staff nurses, in- and out-patients and patient families. This will include adin as a consultantto healthcare staff, planning and providingcinical educationand orientationprograms, settingnursin ractice standards, providing some direct patient care an$ Eelping to update and enhance all aspects of rehab nursing practice, technology and equipment.
To qualify, ou must be a graduate of an accredited school of nursin witx current Indiana RN licensure and recordation a Baccakureate degree in nursing (or active pursuit OD, and 3 years' clinical nursing experience includin 2 ears in rehab nursing. We also require that you be a !RR& (or actively pursuing such status) with demonstrated background in formal teaching.
To make us a part of your future, please send your resume or call: Kathy Eastman, Nurse Recruiter, Parkview Memorial Hospital,2200Randallia Dn've,Fort Wayne, IN46fI05,1-800727-8439, ext. 6319. EOEIAA
Metronidazole U s e continued from page 245 McMullen, D. (1990, June). Topical metronidazole use in malodorous ulcerating skin lesions. Paper presented at the 22nd Annual International Association of Enterostomal Therapists Conference, Las Vegas. Newman, V., Allwood, M., & Oakes, R.A. (1989). The use of metronidazole gel to control the smell of malodorous lesions. Palliative Medicine, 3,303-305. Pierleoni, E.E. (1984). Topical metronidazole therapy for infected decubitus ulcers. Journal of the American Geriatrics Society, 32, 775. Rosenblatt, J.E., & Edson, R.S. (1987). Metronidazole. Mayo Clinic Proceedings, 62, 1013-1017. Rotimi, V., & Durosinmi-Etti, F. (1984). The bacteriology of infected malignant ulcers. Journal of Clinical Pathology, 37,592-595. Sparrow, G., Minton, M., Rubens, R.D., Simmons, M.A., &Aubrey, C. (1980). Metronidazole in smelly tumours. Lancet, I, 1185. Thomlinson, R.H. (1980). Kitchen remedy for necrotic malignant breast ulcers. Lancet, 2,707. Whitehead, D.J. (1982, October). Metronidazole solution for ulcers. Nursing 82,9.
This purse size voice amplifier is perfect 1 for those with soft speech or those who need to be heard by a largegroup-speakto1 or 100.Makes communication easier for speaker and listener. Helps prevent throat damage. Features a long lasting rechargeable Nlcad battery. Detachable shoulder strap. &O Available Cooper-RandArtlflclal Larynx - Speech for
-
...
/entilatorpatients andotherswho arevolceless.Forpost-oporlongterm. Aght weight. can be adapted for hands-freeuse.
8688 Tyler Blvd. Mentor, OH 44060 216-255-9082 See us at Booth 222
Vol. 17, No. Smehabilitation NursindSep-Oct 1992/255
T
he American woman pulled up a chair and sat before the Chinese doctor, who also was a Taoist monk. He was old and thin, with scraggly wisps of a gray beard hanging limp to his waist. Silently, he greeted her with a traditional Chinese low head nod. At the request of the doctor, an interpreter asked the woman to open her mouth and extend her tongue. Peering at her tongue, the doctor took 12 radial pulses, six in each wrist. The pulsesthree superficial, three deep along the radial artery-were not timed, but the depth, rhythm, volume, strength, and frequency were noted. After this 5-minute examination, the doctor asked for an explanation of the woman’s problem and wrote her “prescription” in Chinese characters: a combination of many herbs to be prepared and brewed like a tea and taken once a day for 3 days. The woman, an American traveler, had a history of a ruptured liver and had felt dizzy and light-headed that morning. The Taoist doctor diagnosed “fluid in the abdomen,” “stomach problems,” and “problems in her head.” The doctor refused payment but was happy to accept a contribution to the temple. Later, the prescription was filled in three small packages, the contents of which were ready to be brewed. In the United States, most people expect temporary symptomatic relief of the diagnosed ailment. For some, this relief might be all they want or need; others, however, want their health problems eliminated. As about 85% of health problems are chronic, inherited, and/or occur as a result of a traumatic accident or addiction (Ingelfinger, 1980), perhaps a change of lifestyle would offer benefits. For many centuries, Chinese methods-xcept for acupunctur-have featured noninvasiveways of relieving symptoms of disease, such as the American woman’s being treated with herbs. These methods are known as traditional Chinese medicine (TCM).
Traditional Chinese medicine Traditional Chinese medicine is based on the fundamental theory of balance among yin and yang, five basic elements(wood, fire, air, light, and water), and a relationship between humans and nature. People’s body, mind, and external environment constantly influence each other to create this balance. Each person
also has Qi (pronounced chee), a vital force or energy, and a number of body channels for the flow of Qi. The Chinese believe that Qi is located approximately2 inches below the navel, an area known as the body’s center of gravity. Chinese application of TCM attempts to come to terms with nature rather than simply to relax or strengthen the body. In the 1st and 2nd centuries, Hua Tuo based “exercise” movements on those of five animals: deer, stork, tiger, bear, and monkey. Now these movements have been refined to be used specifically to heal, cure, and relieve health problems.These movementscollectively are called Tai Qi Chuan, also known as tai chi. Each slow, gentle movement of an arm or leg and twist of the body is done with total concentration.Specific patterns of posture are believed to bring Qi, the vital force, under control. The Chinese believe that energy needed to live a full day is best mobilizedearly in the day, when life’s forces are strongest. It is at this time that onecangainorreceiveenergy: energy to heal, energy to live the day, energy to be more aware of one’s surroundings. Roleofthenurse inTCM:TCMeducationforChinesenurses includes acupuncture, certain massage techniques, breathing exercises, specific diets, and herb remedies. Even without this formaleducation,Westemnursescan incorporateTCMintotheir efforts to care for a person’s body, mind, and spirit in a holistic way. The method of healing called therapeutic touch, for example, is derived from ancient healing methods including the traditional Chinese measures. Therapeutic touch is effective in treating stress-relateddisordersand headaches, in reinforcing the body’s own healing resources, in soothing women during childbirth, in calming fretful patients (particularly children), and in giving support to the seriously ill (Macrae, 1988). A Westerner’s firsthand observations: As a member of a study delegation from the United States to the People’s Republic of China in spring 1990 in conjunction‘witha global conference in Shanghai, I visited the Zhejiang Academy of Traditional Chinese Medicine in Hangzhow (pronounced hang jo), talked with physicians, nurses, and patients, observed methods of TCM, photographed the activity, and observed the formulation and packaging of herbal prescriptions in the Chinese pharmacy. My observations follow.
Address correspondence to Dorothy C . Sherwin, Box 273, Sturgeon Bay, WI 54235.
TCM treatments We observed three primary forms of TCM: acupuncture, acupressure, and Qi Gong. Vol. 17, No. S/Rehabilitation NursingJSep-Oct 1992/253
Traditional Chinese Medicine
Acupuncture: Acupuncture, a primary application of traditional Chinese medicine, is the insertion of needles into specific acupuncturepoints along channels ormeridianlines. Thereare 12 major meridian lines, 15 collaterals, 8 extra channels, and hundreds of points for insertingneedles. The channels interdigitateso that the termination of one is the beginning of another. Each channel corresponds to a specific body organ or system (e.g., the bladder channel and the stomach channel). In TCM, it is believed that stimulation of certain points can relieve pain or treat disease. Stimulation of acupuncture points involves three methods: needle insertion,pressure, or heat. The needle insertionprocedure is acupuncture. The use of finger pressure is therapeutic Chinese massage. Heat applications,called maxibustion,usually are in the form of slow-burning sticks of herbs. At the time of our visit to Zhejiang Academy, several people were receiving acupuncture treatments-most of them for facial paralysis, one for a spastic hand condition, and another for low back pain. The deputy director of the academy explained the process as he performed it: The patient is placed on an examining table, and the physician, after discussing the patient’s problems with colleagues and the patient, inserts thin 3- to 4-inch needles that are twirled or used to conduct a weak electric current. The patients receive treatment at a minimum of twice a week for 5 weeks. The insertionof the needles causes sharppain and feelings of numbness, heaviness, dizziness, and sour taste and/or distention. We were told that as these symptomsdisappear,so also does the primary complaint. Acupressure: In another room, acupressure massage was being administeredto a young man for a work-related injury that had resulted in numbness of the legs. This patient had been receiving massage for several weeks and was relieved of the numbness. Well on his way to recovery, he smiled and walked around the room. Acupressure massage, or therapeutic Chinese massage, is the palpitating, rubbing, and kneading of the flesh along meridian lines depending on the health problem of the patient. The skin is literally picked up with the fingers and rubbed together. The doctor doing the massage uses only the fingers and the heel of the hand. The massage treatment lasts about an hour. Afterwards all pain is gone, leaving a feeling of warmth and relaxation. However, this feeling does not last. Qi Gong: In a large well-lighted room upstairs, a group of men and women were seated in a circle in the lotus position and were receiving the Qi Gong treatment. When we entered, everyone became quiet. The atmosphere felt most .mystical. The patients had their eyes closed and their hands in the open, receiving lotus posture. The doctor walked behind them, stopping to extend his hands, but without touching them, so that they could receive his healing energy. Qi Gong is an ancient practice. It begins with the patient achieving a meditative state by means of a breafhing exercise and maintaining it while the Qi Gong master gathers his vital energy, which he emits from his fingertips and uses to direct the Qi, or vital energy, of the patient. Patients then gather the Qi-the doctor’s energy and theirs-into a healing state. The Qi Gong
masters only treat four or five patients a day, as the practice of Qi Gong is exhausting emotionally and physically.
Expanding the use of TCM The doctors at this research hospital (most trained in both Western and Chinese medicine) stated that substantial, welldocumented research studies must be performed before this Chinese method of treatment attains total acceptance by the medical profession throughout the world. A study similar to one described by Eisenberg (1985) that aims to demonstrate TCM’s effectiveness with chronic diseases by using Qi Gong to treat high blood pressure is in progress at the academy. Another promising study, also similar to one discussed by Eisenberg (1983, reveals that patients with diabetes who practice the Qi Gong, breathing and meditation, diet, herb prescriptions, and exercise in true Chinese methods are able to lower their blood sugar by 100 mg/dl or more within weeks. TCM in rehabilitation nursing: Because rehabilitative programs are designed to achieve the highest level of physical, mental, social, spiritual, and economic self-sufficiency,methods of TCM can enhance the nursing care plan to benefit the patient. However different Chinese medicine is from Western medicine, the goals of the two are the same: to heal and to enable the patient to use methods of self-care.Many of the Chinese methods can be adopted by the Western rehabilitation nurse. Three major potential problems related to the nursing diagnoses for the rehabilitation patient are (a) potential alteration in comfort, (b) potential self-care deficit, and (c) potential spiritual distress. Several TCM methods-including Chinese massage, use of herbs, tai chi exercise, and meditation (Koptsheck & Croucher, 1987)-can be used as nursing interventions for these diagnoses. The rehabilitationnurse has a pivotal role in facilitating patients’ use of noninvasive self-healing methods. It is not unusual for the Chinese patient, in the tradition of early morning exercise, to spend time in some way with tai chi. The benefits of a full range-of-motion exercise such as tai chi are well known. Forms of tai chi that the rehabilitation nurse can encourage the patient to use are singing softly, reciting poetry, and meditating. If practiced regularly, these methods-which constitute a form of self-hypnosis-are a source of energy to improve patients’ concentration and mindfulness. Acupressure massage along the meridian lines can bring comfort to the disabled patient. Different from effleurage and flagellation, the kneading and friction of Chinese massage has a greater potential to alleviate pain and is a technique that is easy to learn. The Chinese use herbs for medicinal purposes as well as for flavoringfood. Such herbs can increase the palatability of a lowfat, low-cholesterol diet such as that followed by many types of rehabilitation patients.Long-termpatients can grow, harvest, and dry their own herbs in a window box garden. Involvement in such an activity promotes self-care. The rehabilitation nurse is best equipped to assess the impact of alternative methods of health care. Using TCM offers the nurse an opportunity to affect rehabilitation patient outcomes positively. WithTCMtraining,nurseshaveanopportunitytoleam the
254/Sep-Oct 1992/Rehabilitation NursingJVol. 17, No. 5
ot promise. nuances of the Oriental environment and integrate them into their skills to nurse the spirit, mind, and body of patients in a holistic manner. Dorothy Sherwin is an instructor in the health occupation division of Northeast Wisconsin Technical College in Sturgeon Bay, WI.
References Eisenberg, D. (1985). Encounter with Qi:Exploring Chinese medicine. New York: William Norton. Ingelfinger, F. (1980). Arrogance. New EnglandJournal ofMedicine, 303, 1506-1511. Koptsheck, T., & Croucher, M. (1987). The healing arts. New York: Summit Books. Macrae, J. (1988). Therapeutic touch: A practical guide. New York: Alfred A. Knopf.
Parkview Memorial Hospital has always provided the highest qualityofhealthcare.Toensurethatwecontinuethattradition, we're working with some of today's most sophisticated high tech equipment. But, we also know we couldn't succeed without caring people.
Rehabilitation Educator Full-time/Days You will be responsible for develo ing, implementing and evaluatingalleducationalservicesanfprogramsfor staff nurses, in- and out-patients and patient families. This will include adin as a consultantto healthcare staff, planning and providingcinical educationand orientationprograms, settingnursin ractice standards, providing some direct patient care an$ Eelping to update and enhance all aspects of rehab nursing practice, technology and equipment.
To qualify, ou must be a graduate of an accredited school of nursin witx current Indiana RN licensure and recordation a Baccakureate degree in nursing (or active pursuit OD, and 3 years' clinical nursing experience includin 2 ears in rehab nursing. We also require that you be a !RR& (or actively pursuing such status) with demonstrated background in formal teaching.
To make us a part of your future, please send your resume or call: Kathy Eastman, Nurse Recruiter, Parkview Memorial Hospital,2200Randallia Dn've,Fort Wayne, IN46fI05,1-800727-8439, ext. 6319. EOEIAA
Metronidazole U s e continued from page 245 McMullen, D. (1990, June). Topical metronidazole use in malodorous ulcerating skin lesions. Paper presented at the 22nd Annual International Association of Enterostomal Therapists Conference, Las Vegas. Newman, V., Allwood, M., & Oakes, R.A. (1989). The use of metronidazole gel to control the smell of malodorous lesions. Palliative Medicine, 3,303-305. Pierleoni, E.E. (1984). Topical metronidazole therapy for infected decubitus ulcers. Journal of the American Geriatrics Society, 32, 775. Rosenblatt, J.E., & Edson, R.S. (1987). Metronidazole. Mayo Clinic Proceedings, 62, 1013-1017. Rotimi, V., & Durosinmi-Etti, F. (1984). The bacteriology of infected malignant ulcers. Journal of Clinical Pathology, 37,592-595. Sparrow, G., Minton, M., Rubens, R.D., Simmons, M.A., &Aubrey, C. (1980). Metronidazole in smelly tumours. Lancet, I, 1185. Thomlinson, R.H. (1980). Kitchen remedy for necrotic malignant breast ulcers. Lancet, 2,707. Whitehead, D.J. (1982, October). Metronidazole solution for ulcers. Nursing 82,9.
This purse size voice amplifier is perfect 1 for those with soft speech or those who need to be heard by a largegroup-speakto1 or 100.Makes communication easier for speaker and listener. Helps prevent throat damage. Features a long lasting rechargeable Nlcad battery. Detachable shoulder strap. &O Available Cooper-RandArtlflclal Larynx - Speech for
-
...
/entilatorpatients andotherswho arevolceless.Forpost-oporlongterm. Aght weight. can be adapted for hands-freeuse.
8688 Tyler Blvd. Mentor, OH 44060 216-255-9082 See us at Booth 222
Vol. 17, No. Smehabilitation NursindSep-Oct 1992/255
