Archive for August, 2007

Response to post on 5-15-07 “heart attack”

August 31, 2007

In response to the posting on 5-15-07 about heart attacks, I also would like to mention the fact that women usually have less symptoms than the typical chest pain, nausea, vomiting, etc. Women are less likely to feel the severe chest pain and are more likely to report heartburn in the upper abdomen or pain in the breast, or sometimes just a dull ache in the jaw area, thus making a delay in getting to the hospital promptly for treatment. Physicians may also have a harder time diagnosing a woman having a heart attack because of the atypical symptoms. Women’s heart attacks may be more damaging or associated with more severe medical complications, possibly because of the underreporting and late diagnosis that may result from presenting with atypical symptoms.


Infancy and Stressors

August 30, 2007

Infancy is perhaps the most vulnerable phase in the human cycle. Not only is it associated with the most rapidly developing time, but it is also associated with the most helpless period of development. The infant is at the mercy of another human for its feeding and basic comfort elements. At some stages the infant cannot even turn over in its bed to protect itself. At least a toddler can run away. The family stressors that can occur in the infant’s family can impact all future elements of its life. For example, if an infant’s parents are divorcing, the baby may not get held or cuddled enough. This will influence future feelings and emotions associated with being close to another individual.
The infant does not understand harm. It will unknowingly pull off a hot cup of coffee or touch a stove just in its basic curiosity phase of understanding the world. An infant does not understand that it’s crying to communicate needs is a big stressor for the care giver. A young mother may become stressed from the crying and sleep deprivation she is experiencing and batter the baby.
The infant is in no position to advocate for itself. The nurse must assume this role. The goal would be to maintain health and future well being of the child. The infancy period produces many stressors for the family unit.



August 29, 2007

The nursing shortage has impacted many areas of nursing. Burnout and lower retention rates are increased. A major area of impact is that of medication errors. Due to the increased workload for nurses because of the shortage, nurses make more medication errors. A recent study reported that at least half of nurses don’t get their scheduled breaks and lunch. The medication errors for these nurses were significantly higher than those nurses who took breaks during their shift. The longer the nurse works the more likely she is to make med errors. With the shortage, nurses also work extra shifts. This all leads to more medication errors.



August 28, 2007

It is estimated that by the year 2010, we will need one million new nurses. Where will these come from? One answer may lie with changing the traditional role of nursing. Nursing has always been primarily female. With more opportunities open to females now, no as many women choose nursing. This is adding to the nursing shortage and the nursing faculty shortage. As long as there is a shortage, more nurses will burn out and make more medication errors. With the field becoming more appealing to men, maybe they are our answer. The pay is certainly good as well as the opportunities and diversity. The only way to decrease med errors is for the nurses not to be overworked. The only way to accomplish this is to find more nurses. Male nurses may be the answer.


“Doctor Shopping”

August 24, 2007

I have recently learned that there are many people that have several different doctors, receiving several different medications. I work in a jail and am pretty new in this setting, so I learn something new every day! I believe there should somehow be a universal computer program that tracks these patients using the different pharmacies, doctors, and emergency rooms getting narcotics prescribed to them, just to turn around and be sold on the streets. Of course I’m sure someone would find a way around the system and use a different name. I believe this would take some of the drugs (narcotics) off the streets, excluding cocaine, marijuana, heroine, etc. I have had several patients tell me they “doctor shop” to get what they want from each doctor. They also have told me that they use different pharmacies each time so they don’t get caught. I would think this would be a job for detectives to check in at each pharmacy and get lists of names of people receiving narcotics, so these people who are doing this type of illegal activity may be put under surveillance.


Assessment for Drug Abuse, Understanding the Impact of Culture and Gender

August 23, 2007

Assessment comprises a medical and psychological history along with family, social, sexual, and drug use histories and a physical examination.

Who should assess? Clinical nurse specialist with experience in empathic motivational interviewing may perform intensive assessment after receiving training in, the signs and symptoms, biopsychosocial effect of drugs and likely progression of the disease, common comorbid conditions and medical consequences of abuse, use of the Diagnostic and Statistical Manual of Mental disorders, and their relationships to the findings the emerge during the assessment history, and the appropriate use, scoring, and interpretation of standardized assessment instruments.

Focusing on the in-depth assessment:

The Clinician should understand how patients’ gender and cultural background bear on the characteristics and severity of the disease. Studies have shown that more males than females abuse alcohol and drugs. Older women are more likely than older men to abuse prescription drugs.

Culture influence the patients’ recognition of their problems, norms may accept or condone male drunkenness, and their reaction to the assessment process and recommended treatment interventions. Substantial stigma may be associated with substance abuse treatment, especially for women and older patients of either sex.

The Clinician needs to be aware of the influence of their own gender and cultural background and their response to patients with suspected substance abuse problems.

Understanding of typical patterns is useful in anticipating problem areas, experienced clinicians resist the temptation to stereo type patients and subsume them within a broad categories based on language, ethnicity, age, education, and appearance.

In conclusion, when referring patients for assessment, Clinicians should consider whether a particular patient will relate more readily to a male or female assessor similar cultural backgrounds or if a patient who speaks English as a second language will respond more easily to question posed in his native tongue.


Forensic Nursing And Charting

August 22, 2007

Documentation in the nurse’s notes is essential in evaluating patient care and outcomes. It is a legal document and will be used in a court of law if a lawsuit is initiated by a patient or family member.

The Forensic Nurse uses nurse’s notes as a means to obtaining evidence in court pertaining to the patient involved. As I read through the “Basic Pharmacology for Nurses” textbook, it is evident in each chapter that charting is documented proof of patient care. Evidence of patient care and treatments, outcome of treatment, health teaching and effectiveness of teaching needs to be documented. We learn this all in nursing school.

Marianne DeMilliano BSN, JN describes “Eight Common Mistakes to Avoid when Charting” which is available at

These mistakes can be avoided and definitely will help a nurse if she ever winds up in court.

With regards to Pharmacology and Nurses, the sixth right of medication preparation and administration is “Documentation”. As discussed in one of my previous posts called “Medication Errors”, documentation of date, time, drug name, dose, site and route of administration is important. Further documentation is required in the nurse’s notes to indicate a patient’s response from the medication. Was the drug effective? Did the patient exhibit any adverse effects (psychologically or physiologically) from the drug? Was there any reaction to the site where the drug was administered? Is the patient’s level of pain pre and post medication documented as per a pain level scale? Was the physician notified of the patient’s response to the medication? Did the physician assess the patient and change the medication order? When a new medication was administered, what was the effect of the medication?

Failing to record nursing actions and failure to record reactions or changes in the patient’s condition is just one of many mistakes Marianne DeMilliano discusses in her article. Other mistakes she notes is failing to record pertinent health or drug information, failing to record that meds have been given, recording on the wrong chart, failing to document a discontinued medication and transcribing illegible or incomplete orders.

Nurse’s notes will aid the Forensic Nurse in obtaining specific content relevant to evidence required for investigational purposes and for use in a court of law.

Forgetting to document patient information means “If you didn’t chart it, it didn’t happen”.


Medication Errors

August 21, 2007

I believe that the electronic systems of medication ordering and administration are going to be best thing for the prevention of medication errors.

At the facility where I am working, we have not yet moved to the electronic systems of ordering medications, but we are using a computer system for obtaining medications, ones that are both scheduled and new orders. There are several problems with this system though. One is there are still orders that are written by hand, but the medication orders are only entered into the computer system by the Pharmacist D. This has aided in finding medication errors that are written or drug-drug interactions. Even though the Pharmacist D enters the orders, they still have to decipher the handwriting, which always seems to be problematic. Another problem with this current system is that there are Pharmacy Technicians who fill the computer machine dispenser. There were times when the wrong medication or the wrong dose was in the wrong drawer and expired medications were in the drawer. One last problem that can occur is that the nurse may take the medication out of the wrong drawer.

Although electronic systems are one of the best ways to decrease medication errors, anytime that you have a human that is involved, there will always be a risk for error.

This would relate to patient education by when the nurse is administering medications and is teaching about them, he/she can show what the pills look like so that the patient is able to differentiate them from their other medications.


NCLEX-RN(r) Examination

August 20, 2007

Does the NCLEX-RN Exam contain questions about forensic nursing?


Medication Errors

August 19, 2007

I am interested to know if any other nurses out there are experiencing the same problems that I do in my facility.

I am a charge nurse a County Detention Center. I have experienced a wide range of dynamic and challenging nursing related problems while in this facility. But one of the worst is the medication error. When an inmate is arrested he/she MUST be screen by a registered nurse in booking. In about 10 minutes a complete health and physical must be obtained, as well as a mental health screen. When there are hundreds of arrests made in one shift, mistakes are made. First of all getting accurate information from an inmate that is under the influence of controlled substances, they are either not competent enough to discuss their medical history or their memory is impaired. Also, even if an inmate reveals a chronic medical condition they are usually ignorant to the names and uses of any medications they have recently been taking.

With such a rough start to providing someone medical care; often inmates are not started on the correct medications if they are started on them at all. This is a major problem with inmates diagnosed with physical AND mental disorders.

I also believe some of the medication errors that are made are so because all the medications in our facility are labeled by generic name. But, all the medications are ordered by BRAND name. This causes quite a bit of confusion with the med pass nurses. Sometimes they have as many as 200-400 inmates to pass meds to at one time. They are rushed, have little time to cross reference names of the medications, and don’t realize they are making errors.

I have suggested to our corporate office to send medications labeled as they are ordered by their brand name. Also I have stated my belief that using a paper based system to manage the healthcare of approximately 4,000 inmates (that may be housed in jail for a couple of days to a year) is not appropriate. A computer system of ordering medications and using MAR’s that are printed instead of hand written should dramatically reduce the amount of medication errors made.


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