Would you be willing to step forward and eat a chocolate bar at day for science?

I love science. It’s great to learn how things interact with each other and the cause and effect basis of the world around and within us. With that said, I found the headlines and lead-off sentences of this article very interesting.

Scientists at the University of East Anglia in the U.K. are conducting a research study to look at the effects of bio flavinoids in chocolates on post-menopausal women with diabetes. The study is looking for 150 women to volunteer for the tough task of having to eat chocolate every day while having their cardiac status evaluated over the course of a year.

The team their is wondering whether some chocolates, richer in bio-flavinoids, are more effective than others in helping maintain good cardiac health as we grow older. Post menopausal women have a greater risk of cardiac death than pre-menopausal women. When you add in the effects of those women who also develop Type II diabetes and you increase their risk factors again.

This study hopes to determine if enriched chocolates would be a good way to get elderly persons with decreased appetites to consume necessary nutrients to assist in health maintenance.

This article made a bit of a news splash recently and as a nurse, you may get questions from patients about eating chocolate for health. They are looking for a excuse to go ahead and eat that Hershey bar despite their diabetes.

Chances are that they are not managing their disease very well anyway, but it makes a good excuse for you to start with some re-education about their disease. Perhaps you can refer them to a community education program for diabetics. That’s one of the things that articles and headlines like this one are good for. They give us a doorway into learning and assessing our patients, especially those who are at risk for increased mortality rates from preventable causes.

Everyone in the nursing career field knows that nursing documentation is often the bane of a nurse’s workload. In many cases, nurses seem to spend more time documenting patient care than performing patient care. This is the point of this article on the status of nursing chart writing from the U.K.

This article says that nurses charting are wasting their time on charting when they could be taking care of their patients. I have to disagree with this point. Charting takes care of patients, too. It’s not as hands-on or glamorous as inserting a naso-gastric tube or assisting in surgery, but without it, patients would surely die.

Am I just being sensationalist? I don’t think so.

Let’s look at what proper nursing assessment documentation does for patient care. By carefully documenting what is observed and assessed, the nurse provides valuable trending information for the other members of the patient’s care team from the nurse’s aides all the way up to the patient’s physician.

When the nurse charts his interventions for the patient and evaluates the effects of those interventions, he creates a trending record that gives a very clear picture of the scope of the plan of care for that patient. The article from the U.K. above infers that someone else can help out with the nurse documentation duties. Should someone other than the nurse document that nurse’s actions?

No, because that would be a medication or patient safety error waiting to happen. With the Joint Commission focusing on patient safety and medication errors, having someone else document interventions, progress notes, and even medication adminstration is a recipe for disaster. I’m a firm believer of the credo that the buck stops here.

If I do something, I’m going to make sure it is documented — by ME!

Over the last year, several research papers have been presented about the failure of abstinence only sex education to provide any significant changes in teen pregnancy or sexually transmitted disease rates. Despite this, the White House and conservatives in Congress have been holding the line that it is the only way to teach sex education in our schools and the only way that schools will get funding to try and reduce teen pregnancy rates.

17 States have so far declined to participate in this political hot button program, citing the failure to back up the requirement with any proof of its effectiveness. Now, in a recent article over at WebMD, I see that medical and education leaders have met with congressional leaders to urge them to scrap the funding for the abstinence only programs in favor of broader programs that have been shown to be more effective.

I will issue a disclaimer now that I am a moderate liberal. That said, I don’t see why this comes as a surprise to anyone. NOTHING the current administration has done for the last seven years has anything to do with hard science. Every one of their initiatives has been based in conservative policy and platform, regardless of the science involved.

Let’s give a rundown of what I mean:

• Environmental Protection Agency loses key controls over Clean Air Act in favor of Energy Industry complaints
• Global warming is still just a liberal hoax despite the fact that the entire (credible) scientific community reports that is exists
• Giving middle class children without insurance access to health care encourages their parents not to work
• Providing universal health care will cost more (despite the fact that we already spend more per person than anywhere else in the world)

and on the sex education issue:

• Non-abstinence only sex education actually encourages teens to run out and breed like rabbits

What do you think about this?

Feel free to email me your views on this issue and I will share them with the readers and listeners here at the Nursing Show nursing podcast.

comments@nursingshow.com

Welcome to Episode 22

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

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A podcast for Nurses, Nursing Students, and others interested in what it takes to be a Nurse

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News:

Rerouting ER Traffic to Clinics and PCPs

Poison Spiders Shut Down Hospital (no, really!)

Concerns About Proposed Standard

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Tip/Trick of the Week — Parkinson’s Disease

NINDS Parkinson’s Disease Information Page

Medline Plus Parkinson’s Disease Page

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Don’t miss an episode! Get the Nursing Show Newsletter by email. Fill out the email form in the right hand column of the site. Get it now!

Comment or share ideas here on the comment link below or by email:

Comment@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)
  
• Headliner News Roundup (Weekly single new item with facts and commentary)
  

Contact Me!

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This week –”Streetlight Flicker” by the band Winter Circle

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.

Nurses around the world are often the leaders in seeking changes in the healthcare system for their patients.  This leadership tradition dates back to the earliest days of nursing when Florence Nightingale effected change in care for the soldiers in her care.

In the U.S., the organizations representing nurses are at the forefront of the drive to create meaningful change in our health care system. Nurses in Australia are leading the way there, too.

In this article from down under, the Australian Nurses Federation (ANF) is asking for equal health care for all Australians including the under-served indigenous population. The initiative is based on the success of nursing programs in indigenous communities.  It’s exciting to see how nurses world-wide work to create a healthier population among the patients they serve.

Welcome to Episode 21

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

Right Click to download (Macs Option Click)

Subscribe with iTunes here (must have iTunes installed — 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

A podcast for Nurses, Nursing Students, and others interested in what it takes to be a Nurse

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Sponsors

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News:

Vioxx Details Manipulated?

Can Drug Trials Be Trusted

Drug Companies Disclose Payments

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Tip/Trick of the Week –Lung Sounds

Colorado State University Breath Sound Page

Littman / 3M site on Heart and Lung Sounds

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Don’t miss an episode! Get the Nursing Show Newsletter by email. Fill out the email form in the right hand column of the site. Get it now!

Comment or share ideas here on the comment link below or by email:

Comment@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)
  
• Headliner News Roundup (Weekly single new item with facts and commentary)
  

Contact Me!

————————————————

This week – “Esperanza” by Sophia Ramos

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.

Our good friend, Tim Pruyn from Australia sent in this information on poisonous snakes in Australia and how they compare to poisonous snakes from around the world. This was a follow-up to Episode 20 with the interview segment with Lisa Booze of Maryland Poison Control.  Here’s what he had to say:

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G’Day Jamie,

Australia is home to 11 of the world’s most venomous snakes. Out of the top 25 most venomous snakes in the world, Australia is home to 20 of them (see table). According to the Australian Venom Research Unit (AVRU), there are approx 3000 snakes bite victims per year in Australia, with between 200 and 500 victims receiving anti-venom. Between 1979 to 1998 there were 53 fatalities due to snake bites in Australia. (source: Australian bureau of statistics)

World’s Most Venomous Snakes

Which snake species is the most venomous depends on the measure used. The average or the maximum venom yield from milking could be suggested, but these measures can be criticised as not reflecting the impact of a real bite. The measure generally acknowledged as best reflecting how dangerous a snake’s venom is is that of LD50. The lower this number, the less venom is required to cause death.

By that measure, the most venomous snake in the world is Australia’s inland taipan (Oxyuranus microlepidotus). The table below gives the top 25 species in order, their LD50, and their distribution.

Snake Species LD50* Distribution
1. Inland taipan 0.025 Australia
2. Eastern brown snake 0.053 Australia
3. Coastal taipan 0.099 Australia
4. Tiger snake 0.118 Australia
5. Black tiger snake 0.131 Australia
6. Beaked sea snake 0.164 Australia
7. Black tiger snake 0.194 - 0.338 Australia
8. Death adder 0.400 Australia
9. Gwardar 0.473 Australia
10. Spotted brown snake 0.360 (in bovine serum albumin) Australia
11. Australian copperhead 0.560 Australia
12. Cobra 0.565 Asia
13. Dugite 0.660 Australia
14. Papuan black snake 1.09 New Guinea
15. Stephens’ banded snake 1.36 Australia
16. Rough scaled snake 1.36 Australia
17. King cobra 1.80 Asia
18. Blue-bellied black snake 2.13 Australia
19. Collett’s snake 2.38 Australia
20. Mulga snake 2.38 Australia
21. Red-bellied black snake 2.52 Australia
22. Small eyed snake 2.67 Australia
23. Eastern diamond-backed rattlesnake 11.4 North America
24. Black whipsnake >14.2 Australia
25. Fer-de-lance >27.8 South America
*LD50: mg/kg in saline by subcutaneous injection in mice

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See Also - these poisoning and overdose segments on the Nursing Show:

Insecticide Poisonings

Household Cleaner Poisonings

Dextromethorphan OD

Snakebites (pt 2)

Buprenorphine OD

Phenytoin OD (Dilantin)

Poison Control Centers

Poison Center Nursing Careers

This is from the most recent Maryland Poison Control ToxTidbits Newsletter. You can subscribe by email here.

Author Bryan Hayes was interviewed on the Nursing Show last month.

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Buprenorphine ingestions in pediatric patients are usually well tolerated, but can cause serious toxicity. The few published cases show conflicting outcomes.

In one case report a 4-year-old girl who ingested 4 mg of buprenorphine experienced only miosis. In another published report, a 2-year-old boy experienced 1 episode of spontaneous emesis and became drowsy en route to the emergency department (ED) 30 minutes after an ingestion of up to 8 mg. He was observed in the ED, no interventions were necessary, and the child was discharged asymptomatic and stable 6 hours post ingestion.

More serious toxicity developed in a small case series in which 5 children <2 years of age ingested buprenorphine doses estimated to be between 4 and 10 mg. All of them developed respiratory and CNS depression. Naloxone was administered in 4 patients, and the fifth patient required intubation with mechanical ventilation.

This month, a much larger case series out of the Maryland Poison Center was published (Hayes BD, Klein-Schwartz W, Doyon S. Toxicity of buprenorphine overdoses in children. Pediatrics. 2008;121(4):e782-6).

This retrospective analysis of national poison center cases reported on 86 patients <6 years of age who unintentionally ingested buprenorphine. Thirty-two patients (37%) remained asymptomatic, 48 patients (56%) had a minor effect, and 6 patients (7%) developed severe effects (respiratory depression and significant CNS depression). There were no fatalities.

The most common clinical effects in patients who developed toxicity were drowsiness/lethargy (55%), vomiting (21%), and miosis (21%). The study analyzed dose data and concluded that any child ingesting >2 mg (in the form of Suboxone® or Subutex®) or an unknown amount should be referred to the ED. Additionally, children <2 years of age ingesting more than a lick or taste should be referred to the ED.

Pediatric patients with a suspected buprenorphine exposure should be monitored in an ED setting for a minimum of 6 hours. Naloxone can be used to reverse respiratory depression, although more than one dose may be required.

The Maryland Poison Center is available 24-7 to answer all questions and assist in the management of all poisoned patients. Please call 1-800-222-1222 to reach one of our certified specialists in poison information.

Bryan D. Hayes, PharmD, Clinical Toxicology Fellow

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See Also - these poisoning and overdose segments on the Nursing Show:

Insecticide Poisonings

Household Cleaner Poisonings

Dextromethorphan OD

Snakebites and Venom (pt 1)

Snakebites (pt 2)

Phenytoin OD (Dilantin)

Poison Control Centers

Poison Center Nursing Careers

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Listener Eric sent this tidbit in from a California newspaper. It examines the trends in geriatric health care. It discusses some alarming statistics brought up in a report from a professor at the University of California San Francisco. In this report, Retooling for an Aging America: Building the Health Care Workforce, the following points are made:

• One Geriatric Doctor per 2500 elderly patients
• Fewer than 1% of nurses are trained in geriatric care
• Nursing aide job turnover at 71%
• 90% of home health aides leave within two years
• National average pay for home health aides is $8.50 per hour

The gist of the article is that major change needs to occur in the training and pay for healthcare workers involved in care for the elderly or the system will continue to collapse under the increasing weight of the aging population. Registered nurse specialists in geriatric care need to be trained. Additional training and financial resources need to be arranged for the aides that assist nurses in the facilities and home environments.