Archive for May, 2007

Forensic Nursing and Neurological, Musculoskeletal and Head to Toe Assessments

May 31, 2007

As we know, with forensic nursing most areas of nursing assessment will be performed and with detail.

Many times in an assault situation the need for a neurological assessment will be warranted. This could be due to injury or early post traumatic stress symptoms that lead to questions about the victim’s orientation and mental status. I would imagine this could be difficult to differentiate at first and the need for further and even extensive assessment into this area would need to be done.

Also due to injury from the assault a thorough musculoskeletal assessment will need to take place to rule out any sprains, strains or fractures.

A head to toes assessment will need to be completed before the client leaves the emergency room to be sure no areas of injury or problems are overlooked. Time will need to be taken to reassure the client that all the personal assessments need to be performed to determine presence and extent of any and all injuries related to the attack. Photographs may become necessary to document precisely the extent of injury, which could assist with client’s possible court case related to the assault.

All of this would be overwhelming for any client but especially a client who was recently a victim of a violent crime. Forensic nurses need to take the time to build a rapport with the client and display patience when clients are apprehensive about the assessment.

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Ethnic and Cultural Considerations in Forensic Nursing – Comment

May 30, 2007

Becoming culturally aware is something we all as nurses need to work on. In my area of work you have to be and you have to be nonjudgmental. It does not take a license to have a baby. Some of the nurses on my staff, particularly to younger ones are always saying, “we can’t let that Mom take that baby home”. It may not be the way we would live. It may not be upper middle class. They need not personalize it so much and give the parent the best tools that we can to help them care for the child. We are not going to change with way some people live and their culture, but we can give them ways to help themselves in our culture that will fit theirs.

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Medication error- comment

May 29, 2007

I worked in a place that had BCMA (bar code medication administration). Our medication errors almost went down to nothing. If we had a medication error, it was because someone manually entered something into the computer that was not supposed to be done anyway. I thought the system was great, other than when the system would go down. I found it very hard to go back to the old system of using the MAR and verifying the DR’s orders, taking verbal orders, etc. Each doctor would put his or her orders into the computer, which would then be sent to the pharmacy and the pharmacist would verify the order and then make the order active so that the nurse could give the medication. Each patient wore a bar coded wrist band that you would scan and bring up their profile on the computer system on the med cart. Each medication would have a bar code and have to be scanned. If you did not scan the right medication or scanned it at the wrong time, there was a box that would pop up and make you aware that this was not the right medication or the wrong time to be given, or the wrong dosage. We had a lot of foreign doctors where I worked so this system was great because you knew exactly what order was wrote and the doctor was the one responsible for putting them in the computer. It did take a long time to get all the docs trained on this system, as this was new for all of us. Also all of our nursing notes and docs progress notes were computerized. The BCMA made it almost error proof when it came to med errors.

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Postpartum Depression, comment to 9/16/2006 post

May 24, 2007

As a nurse, mom, and someone who has experience premenopausal symptoms I can say that the hormonal changes are unbelievably weird. This is coming from someone who has always been mentally stable. I do agree there should be follow up in the community or at your follow up appointment with your doctor. In Andrea Yate’s case she was probably mentally unstable to some degree to begin with. Maybe this should be assessed prior to and throughout the pregnancy.

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Rape Victim Examination

May 23, 2007

Forensic Nursing and Assessment of Female Genitalia and Reproductive System

Forensic Nursing when doing a rape case will be using all of her assessment skills during an extensive yet gentle pelvic exam.

Having a calming yet professional attitude would be a must for these nurses when performing this exam. The attention to detail must be such to be able to collect all the data and incorporate it in such a way to help the victim build her case.

Along with this embarrassing exam during a very traumatic time in this person’s life, time must to taken to provide for the client’s emotional needs as well.

Again, forensic nursing, utilizes a nurse’s assessment skills in such a way as not only to retrieve necessary data but also help to piece together a crime scene in such a way that it can hold up in court if necessary and hopefully get a person off the street that could be capable of committing such a terrible crime.

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Anthrax

May 16, 2007

* Anthrax is an acute infectious disease caused by spores of bacterium, Bacillus anthracis. Anthrax can be found globally. It is in developing countries without veterinary public heath programs. The United States military views anthrax as potential biological terrorism threat because the spores are resistant to destruction and can be easily spread by release in the air. Foreign countries have been documented for development of anthrax as a biological weapon.

* The B. anthracis spores are often present in the soil . Goat, sheep and cattle are examples of animals that may become infected. Human infection occur by three routes of exposure to anthrax spores: cutaneous ( skin), gastrointestinal (by ingestion), and pulmonary ( inhalation).

– Symptoms usually occur after 7 to 17 days:

+ Cutaneous: Most anthrax infections occur when the bacterium enters a cut or abrasion on the skin. Skin infection begins the painless ulcers with characteristic black necrotic area in the center. Lymph gland in the adjacent area may swell. Anthrax will result in death with untreated case of cutaneous infection.

+ Inhalation: Symptoms are a common cold. After few days, the symptoms are progress to breathing problems and shock. Inhalation anthrax is usually fatal. At autopsy, there were numerous foci of hemorrhage of the mediastinum. The hilar and peribronchial lympth nodes are enlarged, soft, confluent, and hemorrhagic. This death from inhalation anthrax demonstrates the ability of this infection to mimic other diseases: congestive heart failure, influenza, and community-acquired pneumonias.

+ Intestinal: Initial signs of nausea, loss of appetite, vomiting, and fever are followed by abdominal pain. Intestinal anthrax results in death in 60% of cases.

* The prevention anthrax is the anthrax vaccine. The vaccine is a cell-free filtrate vaccine, which means it contains no dead or live bacteria in the preparation. Anthrax vaccines intended for animals should not be used in humans. There is a list for who should get vaccinated against anthrax:

– Persons who work with the organism in the laboratory.

– Persons who work with imported animal hides or furs.

– Military personnel deployed to areas with high risk for exposure to the organism.

Treatment should be initiated early, if left untreated the disease can be fatal.

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Heart Attack

May 15, 2007

HEART ATTACK

* A heart attack occurs when the blood supply and oxygen to an area of heart muscle is blocked, often by a clot in a coronary artery. This blockage leads to arrhythmias that causes decrease in the pumping function of the heart and may bring sudden death. A heart attack is an emergency case. A heart attack can occur any time at work or play. Some heart attack strike suddenly, but many people who experience a heart attack have warning signs and symptoms hours, or days in advance.

* Warning signs and symptoms of a heart attack include:

– Pressure, squeezing pain in the center of chest

– Pain extending chest to shoulder , arm, back, or jaw.

– Prolong pain in the upper abdomen.

– Shortness of breath.

– Sweating.

– Lightheadedness

– Nausea and Vomiting.

* Acute myocardial infraction known as a heart attack. This is a disease state that occurs when the blood supply to a part of the heart is interrupted. At autopsy, under the microscope, myocardial infraction presents as a circumscribed area of ischemic, coagulative necrosis (cell death)

There are things which increase the risk of heart attack:

– older age

– male gender

– cigarette smoking

– hypercholesterolemia

– diabetes

– high blood pressure

– obesity

* A heart attack is a life threatening event, so everyone should know the warning signs of heart attack and how to get emergency help. Many people suffer permanent damage to their hearts or die because they do not get help immediately.

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Cocaine

May 11, 2007

* Cocaine is a powerfully addictive stimulant that directly affects the brain. Cocaine (C17H21NO4)is an alkaloid prepared from the leaves of the Erythroxylon coca plant, which grows mainly in South Africa, and the Far East. Cocaine hydrochloride is prepared by dissolving the alkaloid in hydrochloric acid, forming a water soluble salt. It is sold illicitly as a white powder, or as crystals or granules. Cocaine is not a new drug. Cocaine abuse has a long history.

* Cocaine’s effects appear almost immediately after a single dose, and disappear within hours. Taking in small amounts (up to 100mg), cocaine usually makes the user feel energetic, talkative, and mentally alert, sensation of the sight, sound, and touch. It is also decrease the need for food and sleep. Some users find that the drug helps them perform simple physical and intellectual tasks more quickly, while others experience the opposite effect. The effects of cocaine include constricted blood vessels, dilated pupils and increased temperature, heart rate, and blood pressure. Some users of cocaine report feeling of restlessness, irritability, and anxiety. In rare instances, sudden death can occur on the first use of cocaine or unexpectedly. Cocaine related deaths are often a result of cardiac arrest seizures followed by respiratory arrest.

* Control over wholesale cocaine distribution by Mexican DTOs and criminal groups have increasing for several years. Cocaine abuse and addiction are problems that plague our nation. We now know more about where and how cocaine acts in the brain, including how the drug produces its pleasurable effects and why it is so addictive. In order to help the public better understand drug abuse and addiction, and to develop more effective strategies for their prevention and treatment. We hope that this compilation of scientific information on cocaine will help to inform everyone about the harmful effects of cocaine abuse, and that it will assist in prevention and treatment efforts.

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The Amish Country Killing

May 10, 2007

Edward Gingerich killed his wife Katie, on March 18, 1993. It was a cold gray Tuesday at dusk preceded by several days of snow.

The 28-year-old Amish man attacked his spouse, Katie, in front of two of their children who witnessed the scene in stunned amazement and horror. In the kitchen of their western Pennsylvania farmhouse, he knocked her down to the ground, crushed her skull by stomping on her face, ripped off her clothes, and then opened up her stomach with a kitchen knife. After he open up her stomach, he relentlessly removed her heart, spleen, lungs, liver, ovaries, and intestines through the seven inch gash from the knife, stacking them one by one in a neat pile next to her dead body. Within an hour, volunteer ambulance personnel from a nearby village stared at the bloody body without organs nude on the kitchen floor and at the knife plunged into the dripping mounds of organs.

Edward Gingerich a tall, pale skinned, lumber mill operator was arrested by the Pennsylvania state Police at a dirt road intersection near his farmhouse. When arrested by the police officers he was covered in blood, was wide-eyed and virtually incoherent. The Amish man continued to mumble biblical passages and made vague remarks to and about the devil.

The killing of his wife amazed Gingerich’s non-Amish neighbors. The told reporters and police investigators that he did indeed suffer from a mental illness, but had never exhibited any tendencies or reaction toward violence.

For the first time in American history, an Amish man stood accused of homicide, raising a host of bewildering questioning. What had driven this quiet, easy going man to commit such a crime so ghastly as to defy description? Questions were raised very easily and very fast. Who was Edward Gingerich? What was or what is he? How would his family, the Amish community and Pennsylvania’s criminal justice system deal with this unique and definitely disturbing case? In the end, Edward Gingerich was found guilty of involuntary manslaughter and sentenced to imprisonment at the State Correctional Institution in Pittsburgh, Pennsylvania for only a minimum of two and a half years to a maximum of five years. I do not understand this sentence.
I have Amish relatives from Pennsylvania. When I spoke with my Uncle, the thoughts still haunt the Amish community to this day. Edward Gingerich, his name is not spoken of easily. Knowing what he put his wife through, his kids through, and definitely the Amish community.

As a forensic nurse it would most likely be psychologically devastating. Children were involved. Was he on some type of medication or illegal drugs? Was an urinalysis or blood sample taken? Does he have a history of psychological problems? Did he have any marks on him, from a struggle from his wife? What were the kids doing? What type of knife did he use? Did it match the type of cutting wounds that were on his wife? Did he cut her anywhere else? What exactly happened to make him do this? A forensic nurse needs to find the answers to these questions. Maybe nobody really identified these issues, and that’s why he only got a short term. Did anyone do any of these things listed? What was actually presented in front of the judge, to make him only get a short time?

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Organ Donation

May 9, 2007

In Ohio we are asked the question “would you like to be an organ donor?” every time we renew our drivers license. I believe at that time if you decide you would like to donate any organs after time of death, there should be some sort of social worker there to find out exactly what organs you would like to donate. A relative of mine died unexpectedly one month ago, and after her death her husband received a phone call about 1/2 hour after she had expired from the hospital asking what organs he would like to have donated from her body. I just found this not to be the right time to call someone that just lost his or her spouse. They also had called back several times that evening for more questions for him about donating organs. In an autopsy report does the medical examiner report what organs were donated and to whom? And do they use these donations for science?

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