Archive for April, 2009

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Medication Errors

April 29, 2009

I am a nurse educator and I find it very scary, the amount of medication errors that occur in the hospital. It is usually from little things such as not reading the order carefully or clarifying it, to simple things such as the 5 patient rights. It is really scary when the nurse passes the medication to the wrong patients. I think it is a great thing to double check high alert medications such as insulin. I know there have been mistakes caught by double-checking subcut. insulin. Some mistakes still happen because I think nurses just sign their names, which is very scary. When you talk to the nurses they always say it is because they are to busy and have to many patients, but medications need to be the main focus and quality time spent on.

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Pharmaceutical companies & adverse drug reactions

April 29, 2009

In Chapter 7 of Pharmacology for Nursing Care 6th Edition by Richard Lehne, it discusses adverse drug reactions – noxious, unintended and undesired effects of medication. In the New York Times article of March 17, 2008 by Janet Maslin in which she reviews a book written by Melody Peterson entitled “Our Daily Meds” she discusses serious consequences of Americans’ prescription drug dependency and how this dependency is encouraged by the pharmaceutical companies. Ms. Peterson’s book states researched findings such as amount people pay for cars since 1980 has doubled but amount spent on drugs has increased 17 times. She highlights the fact that more elderly take sleeping pills and antidepressants raising their risk of falling so companies have come up with drugs to increase bone strength. Ms. Maslin discusses Detrol, advertised cure for overactive bladder that can cause hallucinations as a side effect. Our text book defines as “nearly unavoidable drug effect” – from running to urinate to having hallucinations – no thanks.

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Using the Internet to Assist in End of Life Decisions

April 27, 2009

After reading one previous posting it brought me back to a situation that had occurred about 4 years ago.  A close friend of mine died unexpectedly at the age of 35.  After her husband had been told that she was not going to make it he was faced with the very tough decision about organ donation. Unfortunately, he was so overwhelmed and emotional at the time that he denied organ donation.  Knowing my friend and how caring and giving she was I believe if she had the chance to make the decision she would have donated.

I believe that a short question on the back of a license is not enough for people to become organ donors.  Having detailed information available on the Internet gives much needed information about the process so people can make an educated decision prior to a crisis.  This also takes the burden off the family if individuals make the decision for them.  End of life is such an emotional time especially if it is unexpected; it is our duty as individuals to help our families by making the tough decisions about our own care for them.

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When Injuries Speak, Who Will Listen?

April 27, 2009

Any good forensic nurse learns very quickly to interpret what injuries are telling them. What those injuries actually say may answer some truly horrible questions. The rapidly-growing field of forensic nursing is routinely involved with cases of sexual assault, domestic violence, child abuse and neglect, elder abuse and other traumatic violence. At the Johns Hopkins University School of Nursing, Daniel Sheridan, RN, PhD, is the architect of a new master’s specialty in forensic nursing aimed at preparing a new generation of leaders in the rapidly evolving field. “The forensic nurse needs to have a little bit of detective in him, to be able to do some deductive reasoning, and to be able to put all the pieces together in order to solve the puzzle.” Forensic nursing students can expect to take a variety of classes ranging from Ethics of Health Care to Family Violence. Forensics is sometimes a collision between law and medicine. Although the medical, legal and social authorities are working together, everyone’s focused on their own priorities. Nurses are in an ideal position to bridge these worlds; “it’s easier to train a nurse in the principles of evidence collection, preservation and crime scene analysis than it is to train cops in health care principles. Labrecque, J. (2003). When injuries speak who will listen? John Hopkins Nursing, Vol. 1, No. 1

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Inflammation

April 23, 2009

Inflammation could relate to forensic nursing in that forensic nurses sometimes take tissue samples from the bodies they are performing autopsies on or patients they are working on that may be criminals or victims for evidence of a crime that has been committed. If the mechanism of injury or death was from trauma, there may be lasting evidence of acute inflammation in the tissues. Some signs of acute inflammation are swelling, redness, pain, heat, and loss of function. Obviously if someone is dead, they would probably no longer have those signs I just mentioned. They may however have increased neutrophil or eosinophil levels and possibly an increased amount of macrophages out of the venules and into the interstitial tissues. If there is evidence of MBP (major basic protein) present, that could serve as evidence that the person’s body was trying to fight off a parasite.

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The Forensic Evaluation of Burned Skeletal Remains: A Synthesis

April 22, 2009

    After reading this article I gained a better understanding of the affect of extreme heat on skeletal remains.  Forensic Anthropologists have many barriers they must overcome in order to identify skeletal remains.  Burned skeletal remains is one of a number of hurdles they must climb.  This article discusses in further detail the affect of different temperatures of heat, and the duration of the heat.  There are several issues in bone recovery.  Two major issues are fragmentation and context.  Since burning can lead to extreme bone fragmentation, great care must be taken at the site.  This is why it is important for the anthropologist to be part of the team in the recovery of the skeletal remains. First they must determine if the remains are human or non-human.  Non skeletal inclusions can be useful in the identification.  Some example are dental restoration, surgical materials and identification tags.  These would not get destroyed in the fire.  The hotter the temperature the more shrinkage is involved, causing it to be harder to identify.  Shrinkage will occur between 700 degrees Celsius  and 800 degrees Celsius.  At temperatures above sixteen hundred degrees Celsius melting of bone mineral can occur with recrystallization after cooling. There has been some success of DNA recovery from burned remains.  They can get DNA from the pulp of teeth with a temperature of up to three hundred degrees Celsius.  Over the past decades ability to recognize continues to increase immensely.

Forensic Science International Volume 183 , 1-5  (2009)
http://www.elsevier.com/locate/forsciint

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Skeletal Remains Identification by Facial Reconstruction

April 22, 2009

    I round this article to be extremely informative about positive Identification using facial reconstruction.  The blend of science and art amalgamate as one.  This article discussed three cases of positive identification through facial reconstruction in the Cape Province of South Africa.  The case involved the skeletal remains of six unnatural deaths.  This method is frequently used as a last resort to identify the skeletal remains of an unidentified person.  Facial reconstruction is not used as the  primary means of positive identification.  It is often used as a last resort when other identification methods have failed.
   
     Facial reconstruction is a complex process combining knowledge of human anatomy with artistic ability.  It is used in Forensic Anthropology to help identify skeletal remains.  The reconstruction is based upon the average soft tissue thickness of skull and jaws.  There are critical differences in the thickness of soft tissues of males and females of different races.  The sculpture method of facial reconstruction produces great results.  Some people state that these methods are useful, but insufficiently reliable to serve as evidence of positive identification in a court of law.

Forensic Science Communications, Jan. 2001, Volume 3 Number 1

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Forensic Evidence in Ramsey Case: Investigating the Unsolved Case of JonBenet Ramsey

April 16, 2009

After reading the article on the Ramsey case, I was left with a felling of disappointment in our criminal justice system.  It was apparent that a 6 year old was sexually assaulted based on the DNA trace evidence.  Body fluids were analyzed, blood and buccal samples were taken, in order to compare DNA with relatives and other people.  None of this evidnece pointed towards the Ramsey’s.  A lot of the evidence was contaminated by both parents, friends and relatives.  This cross contamination of trace evidence created a lot of problems in the case.  Forensic experts analyzed the handwriting on the ransom note, since no two people have the same writing style.  The note was found to be a bit odd, since there were conflicting writing styles with in the note.  It is the experts belief that it was done on purpose, to throw them off.  Shoe prints were found at the scene and investigators were able to identify the shoe size, but again, so many people contaminatedt he scene, they can’t be sure that it was the murders foot print.
I feel this case ended up being over publicized, and many poor choices and mistakes were made during the investigation, by parents, police, and investigators.  The case was never solved, which is unfortunate for the Ramsey’s.  They lost their child, and due to the ineptofficers involved, they will never be able to put this grief to rest and find closure.  It is so imperative that procedures msut be followed at all times, or our victims suffer twice.

Forensicscience.suite.com: Jan. 1,  2009

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National Site Helps ID remains, Find the Lost

April 16, 2009

I found this article to be very enlightening and hopeful to those whose have someone missing in their lives.   The article is about missing cases in the U.S..  At this time there are over 100,000 active cases.  This number is absurdly high, and a system that the National missing persons site has begun should begin to help reduce this number.  The site is called “NamUs”.  It is a combination of 2 new bases, combined to be more efficient in matching information about the unidentified remains to missing persons.  Not only can officials get on the site, but the average person can too.  They can put in information about the person which can help solve the mystery.  This helps take a load off the officers, and increase the possibilities of solving the case.

If you have ever lost someone, you know that you can’t grieve properly and move on without knowing what happened.  Finding the body can help others have more closure and allow them to grieve properly.  I believe this is a step in the right direction in finding a missing person.

Pittsburgh Post Gazette, Feb. 22, 2009
http://www.post-gazette.com

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Drub Abuse, comment

April 8, 2009

Naturopathic physicians who perform clinical interventions need to be aware of the possibility of illegal drug use and drug abuse by their patients, prior to embarking on a treatment protocol.
Certain medications and overdosed supplement can alter the body’s response to naturopathic therapies and prevent the patient from remembering specific instructions, which can lead to ineffective outcomes and possible complications, including possible litigation. Naturopathic physicians need to be aware of the clinical manifestations of inappropriate drug use drugs interactions as they perform their histories and physical examinations, since many patients are either afraid or embarrassed to reveal that they are using recreational herbal formulas in their medical histories.
People always think that natural products are safer than conventional medications, and they have not much side effects whatsoever. This is totally wrong, as semi-natural or all-natural compounds can be as dangerous as chemically made compounds. Botanicals may alter drug Biotransformation and it also may alter other drugs interactions. Many of these over- dosed substances may have toxic element components that are part of the drug manufacturing process. This can affect the patient’s overall general health in addition to the drug reactions stemming from the recreational use of these substances.

Original Post:
March 16, 2009
Drug abuse Substance abuse is the number one national health problem, causing more deaths, illness, and disabilities then any other health condition.So, whom does this affect and why is it important for the forensic nurse to be aware of substance abuse history. It can affect anyone, neonates can die from a mothers drug abuse, children and spouses, strangers can be beaten to death by an abuser. The abuser can die from substance abuse, mixing of medications, the list is endless. I wonder how many deaths are actually investigated for potential abuse or is the victim actually written off as dying of natural causes. How important is this anyway, if we are to change the system and teach the population the dangers of abuse it is critical that we have the facts.

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