Welcome to Episode 52

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Nursing News –

Hospitals ease ER crowding

Finding a cure for the nursing shortage

American Nephrology Nurses’ Association Hosts Successful Meeting

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Tip of the Week — Urinary Tract Infections (UTI)

MedlinePlus Medical Encyclopedia: Urinary tract infection - chronic

MedlinePlus Medical Encyclopedia: Urinary tract infection

Female Urinary Tract Infection Patient/Family Resources

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Stay informed as a nurse:

Subscribe to American Journal of Nursing via Amazon.com here

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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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Song this week: Curtis Peoples  - Tell Me I’m Wrong

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.

Medication errors are one of the horrors that can haunt a nurse’s career. Many nurses believe it’s not a case of if you will make a medication error but when will you make a medication error.

Tools from the content experts at Lexi-Comp will help reduce your risk of making a medication error.

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Nursing Show features Lexi-Comp Med Minutes

Pharmacist Liz Tomsik from Lexi-Comp has recorded 11 segments on different medication concerns for nurses.  As one of the content specialists behind Lexi-Comp’s innovative nursing suite of applications for PDA’s and smart phones, Liz is responsible for providing up to date information on medications for subscribers to Lexi-Comp’s pocket informatics tools.

You can hear Liz’s Lexi-Comp Med Minute segments in each Nursing Show episode through the end of November.  Check out Lexi-Comp’s excellent products and save 10% as a listener to the Nursing Show by visiting this special landing page for the Nursing Show at www.Lexi.com/NursingShow.

Providing pain management via prescribed medications is one solution for helping our patients overcome their pain. The risk/benefit ratio of some pain meds, however, and the fact that giving general anesthesia is overkill requires us to be familiar with other forms of pain management. This is especially true for children. An adult may understand the reason why the pain lessens but doesn’t go away but a child just feels uncomfortable and doesn’t know why.

Non-Drug Pain Management

According to one pain management survey, only 4 out of 177 nurses used non-drug pain management to assist patients with pain (Wessman & McDonand, 1999). There is certainly room for all nurses and nursing students to invest more time into learning about alternative pain management methods.

Methods with strong research backing their efficacy in adults (Tracey et al., 2006):

• Massage
• Music
• Guided Imagery
• Distraction
• Patient Education

Which methods translate well to pediatric pain management? Are some more effective or time-efficient than others?

Patient Education

Having a well informed patient should be every nurse’s goal but with pediatric patients, that may not be practical. Depending on the developmental level of the child, however, some level of understanding of their illness and the causes of their pain may be attainable.

Older children can be informed of various pain management methods and may be able to self treat pain. They will be able to understand more complex instructions and be able to follow up on those instructions. Younger children possess varying levels of understanding but even toddlers can be taught to communicate to caregivers about their pain.

The key is to devise an instructional program that is age and developmentally appropriate, involves family members or care givers, teaches that pain is manageable through a variety of treatments, encourages open communication regarding intensity and quality of pain.

Massage

Massage is a time honored intervention used by nurses. There is ample evidence that it is a useful tool for pain management in children when combined as part of an integrated pain management plan (Van Cleve et al., 2004).

Massage may range from a foot or hand massage to a back or scalp massage. It is essential to explain what you are planning in terms the child understands such as calling it a “foot rub” instead of a massage. As with many other non-drug pain management interventions, this can be taught and subsequently delegated to other caregivers including family members. Giving this and other tasks to family members may also offer them a feeling of having more control over an out of control situation with their children.

Distraction

Distraction as a pain management tool encompasses a host of possible interventions. This includes music, guided imagery, game playing, and watching TV. One nurse involved in pediatric pain studies found that the use of distraction was so effective that the research became contaminated by caregivers using it more frequently than called for in the study (Stubenrauch, 2007).

It makes sense to anyone who works with kids. They are easily distracted (especially the younger ones). This may explain the mistaken belief dating back to the 60’s that children didn’t experience pain in the same way as adults and therefore didn’t need aggressive pain management (Swafford & Allen, 1968).  That children can be temporarily distracted from their pain doesn’t mean that they don’t experience pain or that the pain doesn’t return once the distraction is removed.

Distraction has varying levels of effectiveness depending on the patient. It does have the benefit that it can be utilized by every member of the pediatric patient’s care team, including the patient herself. In fact, providing the patient with a choice of distractions may allow for the most effective distraction to be chosen.

Distractions that have shown promising results as a pain management intervention include:

• Game playing
• Singing
• Storytelling
• Reading
• Watching a favorite video
• Blowing bubbles
• Favorite Toys

The use of this pain management tool is not limited to the treatment of existing and chronic pain. Distraction prior to and during a painful procedure has shown promise in lessening reported and observable pain levels (Stubenrauch, 2007).

Conclusions

Pediatric pain management requires an integrated approach using a variety of interventions. Non-drug interventions start with patient education to their level of comprehension and follow with massage, and various methods of distraction.

Involving the entire care team including family members and friends will improve the effectiveness and response of these methods. A planned approach, documentation of interventions and their effect, and continuity of care between the care team will ensure the best methods for each individual have been used and the goal of adequate pain management has been met.

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Check out the first article in our pediatric pain series here at the Nursing Show, Pediatric Pain Assessment Tips for Nurses and Nursing Students.

Also, listen to this episode of the MedicCast EMS podcast on Pediatric Sports Injuries featuring an interview segment with Pediatrician Dr. Mike of the Pediacast podcast.

Written by Jamie Davis, RN, EMT-P, B.A., A.S. Jamie is the host of the popular online radio programs for medical professionals, the MedicCast and the Nursing Show. He is also a nationally recognized speaker on the use of online media and web tools in higher education and a consultant on new media and podcasting for organizations and business. Contact Jamie to comment on this article here.

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References:

• Stubenrauch, J. M. (2007). Striving for distraction: Two nurses are honored for research on an innovative approach to pain management. American Journal of Nursing, 107(3), 94-95.
• Swafford, L. I. & Allen D. (1968). Pain relief in the pediatric patient. Medical Clinics of North America, 52(1), 131-135.
• Tracey, S., Dufault, M., Kogut, S., & Valerie, M., Rossi, S., Willey-Temkin, C. (2006). Translating best practices in nondrug postoperative pain management. Nursing Research, 55(28), S57-S67.
• Van Cleve, L., Bossert, E., Beecroft, P., & Adlard, K., Alvarez, O., Savedra, M. (2004). The pain experience of children with leukemia during the first year after diagnosis. Nursing Research, 53(1), 1-10.
• Wessman, A.C., & McDonald, D. D. (1999). Nurses’ personal pain experiences and their pain management knowledge. Journal of Continuing Education in Nursing, 30(4), 152-157.

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Photo Credits

• photo 1: U.S. Department of Defense, (1998). Jones, Erika N. Project Hope Volunteer Registered Nurse (RN), Diane Speranza.
• photo 2: U.S. Department of Defense, (2008). Unknown.
  

According to the National Institute of Neurological Disorders and Stroke, approximately 250,000 to 350,000 Americans suffer from Multiple Sclerosis with 200 cases diagnosed each week. Multiple Sclerosis, also known as MS, disseminated sclerosis, or encephalomyelitis disseminate, is a chronic, potentially debilitating auto-immune disease which affects the central nervous system.

An unpredictable disease which varies in severity from person to person, MS may manifest itself through any number of symptoms including, but not limited to, numbness, weakness, tingling or pain, loss of vision, tremors, loss of coordination, fatigue, dizziness, cognitive difficulties, sexual dysfunction, urinary and bowel problems, and depression.

To date, there is no definitive cause for MS although factors such as genetics, diet, gender, environment, and stress are believed to influence whether or not an individual develops this condition. As regards prognosis, most individuals with MS have a relatively normal life span with two-thirds of patients remaining mobile 25 after the onset of the disease. Eventually, about 70% of patients report some physical limitations.

There is no cure for MS. Conventional treatment may include medication to address the various symptoms, and physical therapy when necessary. However, as most of the medications available also carry potentially dangerous side effects, many choose to manage the disease through diet and exercise (both of which have proven beneficial).

In addition to lifestyle changes, a number of individuals seek alternative treatment. Despite the fact that there is “unclear or conflicting evidence” supporting the clinical efficacy of any single alternative treatment for MS, there are several which have been shown to be potentially beneficial.

One such treatment of particular interest is magnetic therapy. To date, several clinical trials have explored its use in the treatment of MS. In one double-blind study performed by researchers at the Department of Radiology, University of Washington, Seattle, which evaluated the efficacy of a magnetic pulsing device in the treatment of MS, it was found that the (Enermed) device had an statistically significant effect both on patient performance scales and on alpha EEG magnitude during a language task.

Another randomized, placebo-controlled, double-blind crossover study evaluating data gathered from multiple research institutes found that, although use of the device did not significantly increase bladder control, it did significantly decrease fatigue in individuals with MS. In their conclusion, researchers stated that that the device should be considered as a treatment for the fatigue associated with MS.

In addition to magnetic therapy, other Integrative, Complementary, and Alternative Medical (ICAM) therapies that have shown promise in the treatment of MS. These include colostrum, creatine, evening primrose oil, ginkgo biloba, vitamin B-12, massage, vitamin D, yoga, acupressure (Shiatsu), acupuncture, the alexander technique, astragalus, bee pollen, boswellia, calcium, chiropractic therapy, detoxification therapy, DHEA, healing touch, Kundalini yoga, liver extract, meditation, music therapy, organic food, ozone therapy, phosphorus, qi gong, reflexology, reishi mushroom, resveratrol, rutin, SAMe, spiritual healing, tai chi, TENS (transcutaneous electrical nerve stimulation), therapeutic touch, and thymus extract. More studies on these and other therapies are ongoing.

References

1. rVita: Alternative Medicine
2. http://www.ninds.nih.gov/disorders/multiple_sclerosis
3. http://www.ncbi.nlm.nih.gov/pubmed/12185153
4. http://faculty.washington.edu/toddr/magnetic
5. http://www.ncbi.nlm.nih.gov/pubmed/17613606

Danielle Grilli is the Content Director of rVita.com

Recently, I have received some requests for a review of complementary medicine practices and research and information on the Nursing Show podcast and blog. This topic area is so broad as to require it’s own series of podcasts. However, I think that there are some good resources for authoritative information out there on alternative and complimentary medicine.

One that has recently come to mind is rVita.com. The site presents information is an easy to read format, features links to authoritative studies and seems to tell it like it is. We all know that some of the claims of the herbal and complementary medicine producers lack scientific backing and thorough research, but there are products out there that have a positive effect on health and wellness, when used as directed.

The biggest question for most nurses is “who and what do you believe?” I think rVita solves this problem. They summarize the currently available research and provide links back to their sources so that you can check for yourself. They include links to specific studies as well as to reports from the NIH and CDC. There is also an option to provide feedback directly from visitors so that you may supply your own opinion.

I am talking with the content director for rVita and hope that she will be able to occasionally post pertinent information here on the Nursing Show site about complementary medicine and alternative therapies for you to use in your nursing practices every day.

My goal is that this will continue to expand the information available here at the Nursing Show and provide the listeners and visitors a chance to learn more about this area of patient care.

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Full disclosure: I was asked to review this site by it’s authors but did not receive any compensation to do so.

From the American Heart Association:

CPR and AED Awareness Week (Click Here for Info)

June 1–7

Heroes aren’t born. They’re trained.

Each year an estimated 166,000 lives are claimed by Sudden Cardiac Arrest, an electronic malfunction that causes rapid and chaotic heart activity.

• Only about 6 percent of out-of-hospital sudden cardiac arrest victims survive.
• Fewer than 1/3 of cardiac arrest victims receive CPR.
• Effective CPR can DOUBLE or TRIPLE survival rates.
• A recent AHA survey shows few Americans are confident they could actually perform CPR and use an AED to help save a life in an emergency cardiac situation.

In many parts of the world, access to the newer medical imaging machines or techniques is nonexistent. Xray, CT Scans, PET scans, MRI’s are all just science fiction to medical personnel in other parts of the world. The reason, of course, is the cost of these large pieces of equipment.

Check out this article from Medical News Today.

This article cites the increased costs involved partly related to the three functions of the device.

1. Imaging
2. Storing and Transmitting Images
3. Displaying Images

But the author points out that only one of these really has to do with the taking of the picture, the imaging process itself. The two other functions could be taken care of by other methods. The average cell phone out there possesses the ability to receive, transmit, and store images as well as display images. The cost of these machines could be greatly decreased by using a standardized interface that would allow any cell phone to upload, download, or display the images taken remotely.

This could change the way rural or remote medicine is handled with a central doctor or specialist reading the images and determining the urgency of a given medical problem.

Listener Tim (our Australian nurse contact) sent me an article link about updates to the CPR guidelines in the news lately. The importance of compressions and adequate CPR is of paramount importance to survivability of cardiac arrest.

Here’s the link he sent my way.

The article here talks about the importance of priming the heart before it will be receptive to shock. The article talks about 200 compressions being the magic number.

This has been in the works for some time and actually jives with what we’ve been implementing since the 2005 rollout. Studies show that when compressions stop for more than 10 seconds, the myocardium rapidly loses the ability to receive a shock. By association then, the unwitnessed arrests out there need to re-prime the cardiac muscle before a shock is delivered.

In the prehospital arena with EMTs and paramedics we accomplish this by getting right on the chest and performing good CPR while getting the pads on and checking the rhythm. The time to get the defibrillator out and deployed is at least two minutes (200 compressions at the CPR rate of 100 per minute).

The assistant U.S. Surgeon General has released the strongest statement yet about the lack of credible scientific links between Autism and the vaccine preservative, Thimerosal.

Read the whole press release here.

I have talked about this issue here and over at the MedicCast site numerous times. I have also talked with other medical podcasters, like Dr. Mike of the Pediacast podcast. We all agree that knowledge is power and access to thoroughly researched information is the best way to educate our patients. I urge you to read this article and share the information inside with others in the healthcare arena.

Here is my MedicCast Episode link on Thimerosal and Autism for EMT and Paramedics.

Nurses can listen, too, of course.

I got this information via Maryland Poison Control’s monthly newsletter Toxtidbits.

You can download your own copy or subscribe here:

http://www.mdpoison.com/publications/current.html

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Phenytoin (commonly known by the brand name Dilantin® ) has been used since the 1930’s as an anticonvulsant and is still a first-line drug used for some seizure disorders. Many overdoses with phenytoin are reported to poison centers, but fatalities are rare.

Absorption of oral doses of phenytoin is often erratic and delayed. It’s not unusual to see gastrointestinal absorption continue for several days. Phenytoin is highly protein bound and rapidly distributed to all tissues. Therapeutic levels are 10-20 mcg/mL.. Labs routinely test for total phenytoin; however, only free or unbound phenytoin is responsible for clinical effects. More than 95% of the drug is metabolized by the liver. The half-life of phenytoin is 6-24 hours with therapeutic doses but is prolonged in overdoses, to 20-60 hours.

Acute phenytoin toxicity produces mainly neurologic symptoms that may persist for days to a week or more. Phenytoin concentrations greater than 15-20 mcg/mL are associated with horizontal and/or vertical nystagmus, ataxia is seen with levels greater than 30 mcg/mL , and slurred speech, confusion and lethargy appear at levels greater than 40-50 mcg/mL. Large overdoses may also result in tremor, delirium, hyperreflexia, dyskinesias, hallucinations, and coma. Nausea and vomiting can occur following phenytoin ingestions because of the large amount of undissolved drug in the stomach. Respiratory depression rarely occurs. High doses of intravenous phenytoin or rapid infusions can result in hypotension, bradycardia and dysrhythmias due to myocardial conduction depression. These cardiovascular effects are thought to be due to the propylene glycol diluent in the parenteral form of phenytoin. Cardiovascular toxicity following oral overdoses has not been reported; therefore, patients who ingest large amounts of phenytoin do not need cardiac monitoring.

Treatment consists of supportive care and activated charcoal. Repeat doses of charcoal are often recommended to prevent further absorption of any drug that persists in the GI tract. Ataxic patients should be observed closely and steps taken to prevent falls. Because of its erratic absorption, phenytoin levels should be repeated every six hours after an acute overdose.

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)

Buprenorphine OD

Poison Control Centers

Poison Center Nursing Careers