Welcome to Episode 86

The Nursing Show is a proud member of the ProMed Podcast Network.

Listen to the show!

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Right Click to download (Macs Option Click)

Subscribe with iTunes here (need iTunes — it’s free)

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Click the arrow to play the Nursing Show

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News–

Australian Chief Nurse Proclaimed ICN President

Community Nursing Restructured in Scotland

FDA votes to Eliminate Combination Drugs

The different classifications of antidepressants are:

• Selective Serotonin Reuptake Inhibitors (SSRI)
  • eg. Prozac (fluoxetine), Paxil (paroxetine)

• Serotonin and Norepinephrine Reuptake Inhibitors (SSNIs)
  • eg. )Effexor (venlafaxine), Cymbalta (duloxetine)

• Tricyclic antidepressants (TCAs)
  • eg. Elavil (amitriptyline), Tofranil (imipramine)

• Monoamine Oxidase Inhibitors (MAOIs)
  • eg. Nardil (phenelzine), Parnate (tranylcypromine)

SSRI’s are regarded as first-line therapy for depression but TCAs remain to be widely used not only for depression but also for other conditions like anxiety disorders, ADD, pediatric enuresis and chronic pain disorders. Overdose from TCAs are among the most common causes of drug poisoning seen in emergency departments.

Tricyclics are identified as one of the most frequently ingested substances in poisoning along with paracetamol, benzodiazepines and alcohol. They are second to analgesics as most common drug taken in fatal drug overdose.

The clinical features of antidepressant overdose include the following:

CNS

• altered mental status, delirium, psychotic behavior, delirium and hallucinations and later proceeds to lethargy, stupor, and coma.
• generalized seizures within 1-2 hours of ingestion
• pyramidal signs
• rigidity

Cardiovascular

• Hypotension
• Dysrhythmias
• Conduction block
• Slowed ventricular conduction
• Sinus Tachycardia
• Hypertension (early)
• Cardiogenic shock

Respiratory

• Acute lung injury
• Hypoventilation
• Aspiration pneumonitis
• ARDS
• Hypoxia

Anticholinergic effects

• Hypothermia
• Agitation (early)
• Mydriasis
• Dry skin and/or mucous membranes
• Hyperthermia
• Decreased gastric motility/ileus
• Urinary retention

Management of antidepressant overdose includes measures to reduce absorption, alkalinisation, providing anti-arrhythmic treatment, management of hypotension and convulsions. Patients should also be closely monitored for risk of cardiac arrest and seizure precautions should be instituted.

Emergency Medicine Journal Review on Tricyclic Antidepressant Overdose

Understanding Antidepressant Medications

Article on Antidepressant Toxicity

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Don’t miss an episode! You can receive the Nursing Show Newsletter in your email inbox.

Comments@NursingShow.com

Other Podcasts from Jamie Davis:

• The MedicCast (for EMTs, Paramedics, EMS field work)
• MedicCast News (Weekly short medical news program)
• MedicCast Live (Monthly live call-in show with a single EMS topic)
  

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Song this week:

Music from The Podsafe Music Network

This week- ”No More Summertime Blues” by Geoff Smith

Click here to get Songs from the MedicCast at the iTunes Store.

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This work is licensed under a
Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.

Two representatives proposed legislation aimed at providing accessible and affordable health services to vulnerable populations in the US.  The Nurse  Managed Health Clinic Investment Act of 2009 would support clinics managed by nurses and nurse practitioners in the delivery of primary health care to the community.

According to Representative Capps, a nurse and vice-chair of the House Energy and Commerce Health Subcommittee. “Supporting the work of Nurse-Managed Health Clinics accomplishes this goal in two ways: first it increases access to vital primary health care and wellness services for vulnerable populations, helping to reduce the health disparities they too often experience.”

“Second, these clinics provide invaluable learning opportunities for nursing students and other health professionals, ensuring that the next generation of health care professionals have ‘real world’ training and a commitment to providing care to all populations and communities.”

Nurse-Managed Health Clinics will be managed by advanced practice nurses and operate in collaboration with different colleges and universities, nursing departments, health centers and non-profit organizations. Its selected locations, such as schools and community centers, make their facilities easily accessible and approachable. This way, health disparities in medically under-served communities will be reduced.

Read related article here.

Taking vital signs is a usual routine for nurses and student nurses. In an 8-hour shift, vital signs are taken at least twice and is regarded as the indicator of the patient’s health status.

After collecting the data, interpreting it, determining what is normal and what is not, and concluding that the patient is stable, what’s next?

Actually, you can do more during that brief period of time than just inflating a BP cuff and counting beats and breaths.  Using this time for a variety of assessments is a good use of a nurse’s time.

During that time, use your other senses to gather more information. Look at the facial expression and position. Grimacing and splinting of a body part indicates feelings of discomfort. Listen to your patient. Different audible breath sounds can tell a lot about the respiratory status of a patient. Moaning or groaning is another indication of discomfort.

Talk to your patient. Subjective data is just as important as objective data. Ask your patient how he is feeling.  If he is in pain, use the pain scale to rate the intensity of pain. Even if his BP, RR, PR, and temperature are in normal range, being in pain does not make him stable and is a problem that needs intervention. Engaging in conversation gives you the opportunity to establish rapport and gain trust.

Vital signs are important data in identifying client needs, but being nurses dedicated to patient care,we should see the patient as a whole. Even in the simple things, no matter how routine they already are, we should always remember that our goal is to provide quality patient care.

Learn more about vital signs and nurses in this episode of the Nursing Show podcast

Welcome to Episode 85

The Nursing Show is a proud member of the ProMed Podcast Network.

Listen to the show!

—

Right Click to download (Macs Option Click)

Subscribe with iTunes here (need iTunes — it’s free)

RSS Feed to subscribe (copy url to Juice, Zune Marketplace, or your favorite podcatcher)

Click the arrow to play the Nursing Show

—————————-

Sponsors

Lexi-Comp, the premium provider of mobile nursing software including new iPhone and iPod Touch apps for Lexi Nursing, and many other Lexi-Comp Products.

Visit www.Lexi.com/nursingshow and sign up to win a free iPod Touch and Lexi-Comp software.

and

Try out Go To My PC for free for 30 days, visit www.gotomypc.com/podcast

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News–

Profession Takes Emotional Toll on Nurses

Quality of Life and Environment Required from Nursing Homes

Congress Address Health Workforce Shortage

Tip of the Week– Anatomy of Abdominal Pain

Abdominal pain, otherwise known as  stomach pain, belly ache, and abdominal cramps is one of the most common complaints of patients seeking help inthe ER. In the U.S. Government Census Data on ER visits by diagnosis for the most recent year tracked (2005), Abdominal pain figures are high on the list for adults.

Abdominal pain is usually a symptom of an underlying problem. It can range in intensity from a mild stomach ache to severe acute pain. Since there are a lot of organs in the abdominal cavity, it is difficult to pinpoint right then and there the exact cause of the pain. Sometimes, other conditions not related to the organs in the abdominal region like shingles, pnuemonias, and black widow spider bite can cause pain in the abdomen.

There are some things to consider to further identify the cause of abdominal pain such as the characteristics (sharp, dull, stabbing, cramp-like, knifelike, twisting, or piercing), frequency ( brief, lasting for a few minutes, or it may persist for several hours and longer), intensity, or if it is accompanied by other symptoms like fever, vomiting or diarrhea.

In infants, prolonged unexplained crying (often called “colic”) may be caused by abdominal pain that may end with the passage of gas or stool. Colic is often worse in the evening. Cuddling and rocking the child may bring some relief.

Mild abdominal pain can be relieved by home remedies like taking sips of water, hot packs, temporary diet modification and taking over-the-counter medications including antacids and H2 Blockers.  However, these only treat the symptoms of abdominal pain, not the cause. Specific treatment can only be instituted after the specific cause has been identified through diagnostic tests.

For more information, click on the links below

Abdominal Pain in Children by eMedicineHealth

Abdominal Pain in Adults by eMedicineHealth

MedlinePlus Medical Encyclopedia

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Don’t miss an episode! You can receive the Nursing Show Newsletter in your email inbox.

Comments@NursingShow.com

Other Podcasts from Jamie Davis:

• The MedicCast (for EMTs, Paramedics, EMS field work)
• MedicCast News (Weekly short medical news program)
• MedicCast Live (Monthly live call-in show with a single EMS topic)
  

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Song this week:

Music from The Podsafe Music Network

This week- Winter Circle with, “Streetlight Flicker”

Click here to get Songs from the MedicCast at the iTunes Store.

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This work is licensed under a
Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.

After graduating from high school, students are usually faced with the dilemma of choosing a career. They weigh their options as to what they want to achieve, what is in demand or what would give them financial stability. To ease confusion, some schools conduct career assessments which will help students in the senior year choose a career that will fit their skills and interests.

In a high school in Nashville, Tennessee, students are given the opportunity to participate in a public health academy wherein those who join will take a series of courses designed to familiarize them with various health-related careers. The program also introduces students to an array of health care topics. All who are enrolled in the program become certified in CPR and First Aid. Many students also train to become Certified Nursing Assistants.

The academy gives students first-hand experience of what it is like to be a medical professional since it is part of the program to let them work alongside nurses and other professionals. Apart from this, guest speakers are invited and field trips are set up for the participants.

In another high school in California, a similar program is instituted for their students. One teacher said that the knowledge and skills they have gained are sufficient for any entry level position.

Through these health academies, students are encouraged to take medical related courses in college. The most popular option for them is nursing. Being exposed to the health care setting gives them  the thought of being in a career that is dedicated to helping others which draw students to become future nurses. But even if a student does not choose a health care career, the skills they gained will still benefit them in one way or another.

Read more here

Pressure ulcers, commonly known as bedsores, are widely prevalent among acute care patients whose mobility is limited. The serious ramification of pressure ulcers include increased incidence of infection, prolonged recovery periods, pain and extended hospital stays which result in significantly increased costs.

Prevention of pressure ulcers has become an even more critical issue with the announcement by the Centers for Medicare and Medicaid Services that treament of pressure ulcers would no longer be reimbursed because it has deemed them a preventable condition.

This prompted nurses nationwide to research the best practices and develop measures to prevent the occurrence of pressure ulcers.

Margaret Talley of Palomar Pomerado Health (PPH) in San Diego was given an award for her innovative pressure ulcer care and prevention program. She instituted a training program fo nurses and worked with them one-on-one to ensure they understand all facets of assessment and prevention. They had retreats where nurses can express which skills they need work on or they’d like to improve and demonstrate the newest and latest techniques to keep them up-to-date. Because of this project, PPH saw a dramatic decrease from 10% to 3% in the occurrence of pressure sores in acute care patients.

In the Northwest Community Hospital in Illinois, nurses worked on a comprehensve plan to reduce the incidence of decubitus ulcers. Upon admission, the Braden scale for predicting pressure ulcer risk is completed and updated 3 times a week. They also used skin-care products that relieved pressure from weight bearing areas and barrier protection products. Incontinence management was also focused on while turning clocks helped remind staff to reposition patients. The series of changes brought the rate from 16% down to between 2% and 5%.

These are just some examples of the many measures that nurses all over the country have taken to prevent the incidence of pressure ulcers. Although pressure ulcers and their prevention are not just nursing issues, nurses on the front lines must deal with them on a regular basis.

Welcome to Episode 84

The Nursing Show is a proud member of the ProMed Podcast Network.

Listen to the show!

—

Right Click to download (Macs Option Click)

Subscribe with iTunes here (need iTunes — it’s free)

RSS Feed to subscribe (copy url to Juice, Zune Marketplace, or your favorite podcatcher)

Click the arrow to play the Nursing Show

—————————-

Sponsors

Lexi-Comp, the premium provider of mobile nursing software including new iPhone and iPod Touch apps for Lexi Nursing, and many other Lexi-Comp Products.

Visit www.Lexi.com/nursingshow and sign up to win a free iPod Touch and Lexi-Comp software.

and

Try out Go To My PC for free for 30 days, visit www.gotomypc.com/podcast

———————————–

News–

New Studies on Essence of Nursing Workforce in Success of Health Reform

Nursing Voted as Most ‘Ethical and Honest’ Profession

MIHS Develop Protocol to Significantly Reduce Pressure Ulcers

Tip of the Week– Staging Pressure Ulcers For Nurses

Bedsores, more properly known as pressure ulcers or decubitus ulcers, are lesions caused by many factors such as: unrelieved pressure; friction; humidity; shearing forces; temperature; age; continence and medication; to any part of the body, especially portions over bony or cartilaginous areas such as sacrum, elbows, knees, ankles etc.

Stages

Stage I is the most superficial, indicated by non-blanchable redness that does not subside after pressure is relieved. This stage is visually similar to reactive hyperemia seen in skin after prolonged application of pressure.

Stage II is damage to the epidermis extending into, but no deeper than, the dermis. In this stage, the ulcer may be referred to as a blister or abrasion.

Stage III involves the full thickness of the skin and may extend into the subcutaneous tissue layer. This layer has a relatively poor blood supply and can be difficult to heal.

Stage IV is the deepest, extending into the muscle, tendon or even bone.

Unstageable pressure ulcers are covered with dead cells, or eschar and wound exudate, so the depth cannot be determined.

Suspected Deep tissue injury: Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

Interventions

Specific interventions depend on the stage of the pressure ulcer. Management includes wound care, debridement, and infection control.

Preventive measures comprise of turning or changing positions, skin care, early detection through proper risk assessment and more.

See more here

National Pressure Ulcer Advisory Panel

Risk Assessment and Prevention of Pressure Ulcers

CPEGC Prevention of Pressure Ulcers

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Don’t miss an episode! You can receive the Nursing Show Newsletter in your email inbox.

Comments@NursingShow.com

Other Podcasts from Jamie Davis:

• The MedicCast (for EMTs, Paramedics, EMS field work)
• MedicCast News (Weekly short medical news program)
• MedicCast Live (Monthly live call-in show with a single EMS topic)
  

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Song this week:

Music from The Podsafe Music Network

“Wasting My Time” by Matthew Ebel

Visit Matthew Ebel here — Let him know you heard it on the MedicCast

Or you can click on the link below to go right to iTunes to check out his music!

Click here to check out other Songs from the MedicCast Network Podcasts at the iTunes Store.

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This work is licensed under a
Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.

In research done by the CDC, they reported that MRSA central line-associated bloodstream infections among all ICU types (excluding pediatric units) declined by 50% over the past ten years. Though specific causes of the decline was not observed, they know that certain measures were done including central-line insertion safety and care practices to avoid transmission of MRSA among patients.

Read the MRSA article here.

The nursing department in one hospital developed a written protocol and a photo book so that every step of the process has a photo and a description below it and was made available in the hospital’s intranet so people can review it at any time.

They also arranged pre-packaged kits for central-line insertion which is more practical and lessens the risk of infection because instead of going to different shelves to get what they need, everything is already encased in a single package. In addition, the chlorhexidine antiseptic skin prep recommended by the CDC was used to replace the older 2% solution since it was more effective.

Nurses were also given the autonomy to stop the procedure while the central line was being inserted when aseptic technique was not followed. This helped diminish central-line associated infections considerably. The nurses played a crucial role in the implementation of the plan since its success depended on their vigilance to accomplish their goal.

This points again to the importance of nurses’ involvement in significant changes in positive patient outcomes and why support of a strong nursing workforce and education system is vital to the overall healthcare in the U.S.

In an American Nurses Association poll, registered nurses nationwide revealed their concerns on how staffing problems affect the quality of patient care and growing nurse shortage. The results show that adequate staffing is important in the delivery of quality patient care.

ANA President Rebecca M. Patton said,”Safe nurse staffing has been linked to more positive patient outcomes, decreased length of hospital stay, and decreased number of medical errors and patient falls. It has also been shown to improve nurse satisfaction and decrease burnout, both significant factors contributing to nurses leaving the profession.”

Staffing shortage is a common problem in most healthcare facilities. In this case, nurses are subjected to mandatory overtime and double- shifts. They become over worked and burned out and when this happens, errors may occur and the quality of nursing care may be compromised. These circumstances will take a toll to both nurse and patient. As said in the article, safe nurse staffing yields better results not only for patients and nurses but also for the health care facility.

Hospitals need to come up with a system wherein the most is made out of their current staff without straining them. Team nursing is a method that can be used in staffing shortage. In 1 team, specific tasks are assigned to specific nurses. Their individual responsibilities will be more routine, thus, they can do it in a longer period of time.

Example, being assigned to provide all nursing care to 10 patients in the period of 8 hours is more tiring than only having to give medications to 15 patients in a period of 12 hours. Having to take care of a single specified task is less stressful- both mentally and physically- as compared to handling a number of different responsibilities even in a lesser period of time.

Since staffing problems in the US, seem to arise from nurse shortage – which is the lack of experienced professional nurses- promotion of taking nursing as a profession may be a solution. Encouraging more individuals to be nurses may alleviate shortage. There are also countries that produce a large number of nurses. Hiring international nurses that are within the standards may also be an option for staffing problems.

Nurses nowadays may be complaining from doing more than what they should. But as a professional nurse, to deliver quality patient care is the top priority. May it be in a low- paying, congested, cramped up public hospital or an international state-of-the-art facility, providing care and promoting wellness should never be compromised. This is our calling, this is our life.

Listener Annette left me this email recently:

Hi Jamie, I love your podcasts and the wealth of knowledge you have.  Please give me some tips on how to prepare for Nursing school; I start in August and I do not know any nurses in my personal life.  I would like to get some tips and need to know what to expect, study tips, etc…  Thanks.  Annette.

I emailed her back, I always return emails to listeners (hint, hint).  I thought that it would be important to share my thoughts with the rest of you and invite others to comment and share their Nursing School Survival Tips!  Don’t be like the student in the picture here, follow some of these tips.

Here is a bit more advice for new Nursing Students:

Get yourself a good calendar (paper, electronic, or software).  One of the biggest challenges for many nursing students is managing the various tasks, assignments, clinical dates, due dates, and exam schedules.  I remember more than one person failing out of the first semester because they couldn’t stay organized.

I think that nursing schools do this on purpose because planning and prioritizing are such important nursing skills.  By requiring the students to “sink or swim” in a difficult planning environment, they are better able to make decisions and schedule the various patient care duties during their shifts later on.

Get to know your classmates.  Create a phone chain, get an email list together and try to meet others in the class so that you can help each other along the way.  I can’t tell you how many times I was saved by a classmate who noticed a last minute assignment update that I failed to see and because I was in touch with the group, I was able to complete an assignment I might have missed otherwise.

The other side of this is that you need to understand that nursing school is a very demanding program.  If you are in a traditional 4 year college setting, you might become discouraged because some of your friends with other majors seem to be able to party more frequently than you.  I assure you that this is not because you are doing anything wrong.

Schedule yourself some downtime.  Just as it is important to schedule your work and study time, I urge you to set aside some time in your week, every week for some down time.  I gave myself two hours of TV a week and while I lost touch with some of my favorite shows, I was able to really enjoy two of them because I made time for myself.

Which brings me back to my starting point.  Get a good calendar.  You will have some time to have fun, but you will need to make sure you schedule it so that you don’t find yourself behind when you have a major assignment due.  One glance at your calendar with scheduled study times, class and clinical dates, and exams will allow you to find those precious blocks of “me time” and allow you to find some time to blow off steam.

I hope that helps.  Share your own thoughts on surviving nursing school by leaving a comment below.

Jamie Davis, the Podmedic