Forensic Nursing Chronicles

Pharmacology has many major sub principles, Biochemical, Cardiovascular, Molecular, Neuropharmacology, Chemotherapy, Pharmokinetics, Immunopharmacology, Clinical and last but not least Behavioral.
Behavioral pharmacology is the study of the effect of drugs on behavior. This includes the effects psychoactive
drugs have on learning, memory, drug addiction and neurotransmitter levels.
Recently there has been a steady increase in the use of Ritalin and similar drugs on children diagnosed with different forms of Attention deficit disorder. To some this is a miraculous discovery but to many others the effects of continued use of these drugs over extended periods of time is a cause for great concern. There is a whole generation coming up that have been on this drug and we can not be certain of what the long term effects will be. The other concern is that it may be over prescribed. In Reno, it is estimated that 1 in 10 children are being given this drug for “over-activity” some without counseling follow up. Some question whether it is becoming a “fashion” drug and parents are using the drug to manage behavior that may not be extreme enough to actually warrant medication.
The eventual outcomes will only be seen over time as these children grow up. Regardless of the future problems the current problem of medicating any child that may simply be difficult to manage is one, which needs to be more closely regulated.

Includes topics such as the effects of psychoactive drugs on the phenomena of learning, memory, wakefulness, sleep and drug addiction, and the behavioral consequences of experimental intervention in enzyme activity and brain neurotransmitter levels and metabolism.

In June 2004, the Government of Ontario announced that meningococcal vaccine would be a free vaccine available to eligible individuals. This program was phased in between July 2004 and January 2005.

Statistics identified two high-risk groups: infants under 1 year of age and persons aged 18 to 23 years. Most of the outbreaks of meningococcal infections in Canada occurred in high school and university students, with up to 25% fatality rate and 20% of survivors suffering from permanent damage such as hearing loss, loss of a limb, kidney problems and/or neurologic disabilities. This statistical data supported the evidence-based practice for the new vaccination program.

Meningococcal C bacterium causes severe infections. Although outbreaks are rare, they are serious when they do occur. Meningococcal C (MenC) is found in the nose and throat, often in otherwise healthy individuals. The bacteria are spread from person-to-person through coughing, sneezing, kissing or sharing foods, drinks, toothbrushes, lipsticks or lip-gloss.

The bacteria can cause serious infection of the covering of the brain (meningitis) or also a blood infection (septicemia). Antibiotic treatment has been demonstrated to be successful; however treatment may not prevent permanent damage or death in all cases.

MenC vaccine is now part of the school vaccination program being administered to Grade 10 or 15-16 year old students. In Ontario, immunization of school age children is not mandatory. Parents may choose not to immunize their children for Conscience, Religious, Cultural or Personal reasons. The Immunization of School Pupils Act (ISPA) requires parents choosing not to vaccinate their children, to provide signed and notarized documentation – Legal Exemption Form – to their local Public Health Unit.

As part of a University Health Centre staff, we have worked hard to ensure that all students who are eligible for the free vaccine and have not received it, be given it, since the highest incidence rate was found among freshmen living in residences/dormitories. To date Public Health has permitted free catch-up vaccinations for youth up to their 20th birthday. We are now feeling content that the majority of our college youth will soon be protected should an outbreak occur since the vaccine has demonstrated immunity in almost 100% of teens and young adults.

One consideration that health care professionals must continue to keep in mind when evaluating youth is that not all young people have been vaccinated for meningitis, whether intentionally or by being missed in the school-based programs. It may happen that in a busy health center, health care professionals assume that all students now will have received their meningitis vaccination and nurses may entirely overlook or pay little attention to obvious signs & symptoms of meningitis. In fact, in a recent meningitis vaccine catch-up campaign, I found that approximately 40% of our college/university students questioned, had not been vaccinated. It would be easy to confuse a student’s presenting clinical signs as common effects of the lifestyle (such as substance or alcohol overuse, poor nutrition and lack of sleep) and the stresses of this population. Underestimating the severity of the condition can lead to late stage diagnosis and the increase potential for fatality or permanent disability. With this in mind, health care nurses will need to continue to complete concise client assessments – including the vaccination and travel history of a client.

Health care professionals should be alert to clients presenting non-specific illness symptoms such as:
· Non-blanching rash with fever (or history of fever) – 30% of cases start with macular rash.
· Neck stiffness
· Headache
· Photophobia
· Combative, confused or aggressive – may appear as drug abuse
· Changes in level of consciousness
· Dilated, unequal or poorly reacting pupils
· Changes in vital signs

Should some of these symptoms be present, further assessment should include asking questions related to:
· Pain – in joint and muscles, or in a specific limb
severity – may be very severe

· GI disturbance -vomiting or diarrhea
-abdominal pain is common

· Rigors – in septicemic clients

· Fever – or history of fever if afebrile on presentation.

It would be important for the health care professional to be mindful of a deteriorating condition, which often occurs rapidly and seek medical assessment and hospitalization promptly.