Archive for December, 2009

Forensic Nursing Assessment

December 30, 2009

One of the many reasons why I love nursing is because it has so many fields to dive into. Being a new student, I had no clue about forensic nursing. Now that I do, I am very interested. The job is quite meaningful, requiring nurses to be able to examine the unique cases involved in the criminal justice system. Definitely nurses are better trained to deal with the whole person, instead of just the case. Everyone cannot do this efficiently and this is why we have one of the most important jobs on earth. The skin assessment, in my opinion, is the most important of all. Any type of abuse or violence can normally be revealed after a thorough skin assessment. These assessment skills should be reviewed often.

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Substance Abuse

December 30, 2009

Although there are mild cases, substance abuse can be a major problem that leads to other issues such as child abuse, elder abuse, or sexual assault. These issues are reasons that make substance abuse a serious problem. Substance abusers should put this under control as soon as possible. Alcohol treatment programs are designed to help those that want and need help be successful at this. As a nurse, assessment skills are imperative in diagnosing a substance abuse problem. Skills in the assessment of mental health cannot be forgotten, since they focus on emotional and psychological well being. A good mental health assessment could reveal the underlying problem(s) of substance abuse.

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Medication Errors

December 29, 2009

Medication administration continues to be a high risk task for nurses. Errors can occur throughout the process – from the actual written order, pharmacy transcription, and nursing verification/review, to the administration of the medication. Breaks in the process are often caught and an error doesn’t reach the patient. In those cases where an error actually reaches the patient, most nurses feel badly about making the error and need support and a thorough analysis of the system and how it may have contributed to the error. I recently encountered a situation where a new nurse entered a patient weight in pounds instead of kilograms in a computerized program that had a field for kilograms only. In other words, the patient weighed 230 pounds and the nurse entered 230 kilograms. Doses of Vancomycin were given based on this weight. The patient developed acute renal failure before this error was caught. After doing a root cause analysis, several breaks in the process were identified and have been corrected. Our facility had recently changed the computer program to have a kilogram field only. Prior to this, the nurse would enter the number of pounds and the computer would convert that number to kilograms and populate the kilogram field. The other issue was the pharmacist not questioning the weight. This patient would have been over 500 pounds. After discussing the error with the nurse, I found her crying in the nurses’ lounge. As a manager, this incident reinforced my belief that nurses take their role very seriously and are deeply affected when a patient is harmed. Fixing the broken system was my focus and reassuring this nurse that identifying the error was not meant to punish but to identify where the system failed her. I am glad that most health care organizations have adopted a non-punitive approach to medical errors. By focusing on the process instead of the person, changes can occur that truly protect the patient from harm.

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School Nurses and Advanced Health Assessment

December 24, 2009

Today more than ever before, school nurses need advanced assessment skills. While nurses in all settings are more independent and more accountable, school nurses are even more so. Budget cuts have necessitated the elimination of nursing coordinators or school doctors on a full-time basis so very often school nurses are the only medical personnel in their building. This becomes a major responsibility when you’re the one who everyone is turning to for answers on child abuse, substance abuse, blood borne pathogens and asthma just to name a few issues. School nurses must rely on themselves and on their own nursing skills. And one of the most important and sophisticated skills nurses must master is assessment. One of the most challenging issues a school nurse faces is serving children who lack health care. More often than not, the school nurse is the only medical personnel the child has seen in some time. Correct assessment of a child’s complaint and knowing when or when not to refer for medical care becomes extremely important. In today’s economic climate, families are under great pressures of all kinds which affect their children. Lack of jobs, health insurance and money all help to create pressures in families which many times leads to abuse within families. In these situations, school nurses must rely on their assessment skills, very often acting as forensic nurses in investigating a suspected incident of child abuse which has presented itself in her health office. Determining whether an incident should be considered child abuse necessitates the collection of subjective and objective data in a thorough, systemic fashion in order to formulate a diagnostic impression. Whether the issue is a pandemic flu, lack of health care or child abuse, school nurses are expected to know and respond to a host of many complicated issues and advanced health assessment skills is a must for practicing school nurses today.

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Deep Vein Thrombosis, comment

December 24, 2009

Three years ago my mother had a severe reaction to two vaccines which were given at the same. Her body had a severe immunological response to the vaccines which resulted in myocarditis. After being treated in the ICU a deep vein thrombosis was detected and she was treated with Heprin, an anticoagulant drug. As a result of having both immunizations simultaneously it was difficult to decipher which one her body responded to so violently. It is therefore essential to not give more than one immunization at one time so as to be able to detect what the individual’s adverse affects are due to.

Original Post
February 11, 2009
Title: Deep Vein Thrombosis
In regards to forensic science, a DVT can have an affect on the cause of death. If a thrombi is not discovered and treated in time it will continue to flow through the artery and finally make its way to the heart which may results in a possible death. If a coroner is trying to decide the cause of death, if they come across the thrombi, they will most likely have found the cause of death for the individual.

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Suicide, comment

December 24, 2009

Suicide is a very serious issue which needs to be treated with great precaution when the possibility of suicide is suspected. Around the time of the holidays suicide rates often rise. This is typically attributed to the stress many people feel around this time of year. My younger sister’s best friend’s father committed suicide last month and greatly affected my family personally. The girl’s father had been diagnosed with bipolar disorder and was being treated with medication but had recently been laid off from his job and ceased his medication treatment and ultimately committed suicide leaving three children and a wife behind. When I heard this news it struck me as extremely sad, as any suicide does. However this seemed even more upsetting to me because it was known that the man suffered from a mental disorder which was being treated. It brought to my attention how crucial it is that people have a strong support system they can turn to at all times, especially those who are treated for mental illness. It is important for signs of suicide to be taken with the utmost seriousness. Bipolar disorder is a chemical imbalance in the brain and may be caused by varying function of the structure and function of certain brain circuits. Bipolar disorder is highly associated with suicide and it is important to look for signs of depression or suicide so as to help the person as soon as possible.

Original Post
July 15, 2009
Title: Suicide, comment
Suicide is known to be associated with mental disorder. It may be in form of major depression or some sudden trigger which causes an individual to act irrationally. The ideation of suicide can be very subtle especially when nurses do not detect the signs. some patients are very crafty and may disguise very professionally as well. So the duty is on the nurses to pry deeply on the patients when assessing life stresssors which may likely make patients to contemplate suicide. Often, known patients with mental illnesses are protected by HIPPA except cases that are already committed to psychiatric settings. For adolescents, they often display their emotions which helps nurses to quickly act on the information observed or stated but when it becomes a case of prolonged ideation for which the patient has had a means and time to do the act then nurses must still be vigilant. One cannot overemphasis the pivotal importance of detailed assessment and constant reevaluation of any event or attitude which may suggest that a patient is in danger of committing suicide. Once at a psychiatric hospital, a room mate committed suicide suddenly. Nurses were surprised because the patient most have acted within the spur of the moment while disguising the traits associated with suicide ideation. Quality and risk analysis in hospital settings are still open to these investigations. Nurses can also use support groups as well.

Original Post:
June 5, 2009
Title: Suicide
Suicidal ideation is more common than completed suicide. Most persons who commit suicide have a psychiatric disorder at the time of death. Because many clients with psychiatric disorders are seen by family physicians and other primary care practitioners rather than by psychiatrists, it is important that these practitioners recognize the signs and symptoms of the psychiatric disorders (particularly alcohol abuse and major depression) that are associated with suicide. Although most patients with suicidal ideation do not ultimately commit suicide, the extent of suicidal ideation must be determined, including the presence of a suicide plan and the patient’s means to commit suicide.
Many clients who commit suicide have seen their primary care physician within several months before their death and many of these physicians were unaware of the clients’ intentions or that the clients had previously attempted suicide.
The best way to prevent suicide is to ask clients with symptoms of these disorders more specific questions about recent stressors and their thoughts about suicide, excellent history taking is essential to help diagnose clients with suicidal ideation. Reviewing the clients medical history for chronic illness, obtain a drug history and ask the client about family…listen for clues!

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Child Abuse in Cultural Diversity Context, comment

December 24, 2009

This person’s comment greatly reminded me of a book I once read. The Spirit Catches You and You Fall Down is a book by Anne Fadiman which tells the story of a young Hmong girl who has epilepsy. The book capitalized on the importance of listening to the patient’s concerns and understanding conflicting cultures. In the Hmong culture seizures are seen as having a strong connection with the spirit world. For this reason, the girl’s family did not initially see the need to treat her condition. The book tells the sad but true story of how conflicting cultures and beliefs can affect how a person is treated. I think it is of the utmost importance to remember that although here in the United States we see our way of medicine as superior, other cultures have varying beliefs and customs which stray from our Western way of medicine. It is important for people in the medical field to take the time to understand a patient’s culture so as to be able to treat them better and make compromises when necessary. Through studying Pathology throughout this course it is amazing to me the knowledge which we have of medicine and the human body. It is important to take the time to understand different cultures to be able to apply our knowledge in a way which compliments their beliefs and cultures so as to be able to treat the patient successfully.

Original Post
October 15, 2009
Title: Child Abuse in Cultural Diversity Context, comment
Our hospital is located in one of the country’s largest immigration and refugee processing centers. To date, our language assistant coordinator has estimated over 30 different languages or dialects are currently being used throughout our local community. We had to change our Interpreter Policy a few years back following an incident that involved a child. A woman came into the ER with her thirteen year old daughter. She had severe abdominal pain, n/v, pelvic tenderness and was bleeding heavily. She did not speak or understand English. A call was placed to our language assistant coordinator, but it would be some time before assistance would arrive. Suspecting the woman was miscarrying, the doctors and nurses questioned the child -who did speak English as a secondary language. They asked pertinent medical questions in regards to their physical assessment findings. A few days later, our coordinator was contacted by a staff member from the local refugee center explaining that when the child went home that night she was severely beaten by her father. By discussing her mother’s personal medical history, the child had shamed the family. Her culture did not allow for children – certainly not females- to discuss topics that could be termed as sexual, regardless of the circumstances. The policy has since been updated and we can only gather information from a minor sixteen years old or older. We are to use children under 18 only in emergent situations. We need to be cognitive of the fact that even though we have rights and laws in our country – that once that front door closes at night, the laws and customs of the native country’s often prevail.

Original Post
June 4, 2009
Title: Child abuse in Cultural Diversity Context
While studying the chapter on cultural diversity, it made more sense to elaborate on some aspects of cultural diversity which still has a fine line between child abuse and cultural practice. One significant area is the right of African culture where parents make use of spanking as a means of corrective action or discipline. In Nigeria for instance, spanking takes the form of stroking with sticks, ruler or any linear object. Blending this tradition into the American context is another issue altogether. Law enforcement in America sees this type of traditional practice as child abuse and often send social services and child protective cases after parents. Many African families are in dilemma as to how to raise their children when it comes to drawing the line between discipline and child abuse. On observation so far, many families are forced to send their children back to Africa where the society upholds the saying "spare the rod and spoil the child". In recent social gatherings, African families are still debating over this controversy. They believe that the end result is better off if the parents spank the children rather than have the children sent to juvenile camps when their actions get criminal or turns into felonies. They often cite examples from the Bible as the foundation of wisdom and authority when it comes to raising responsible children in today’s society.

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Female Genital Mutilation, comment

December 24, 2009

Female Genital Mutilation is form of ritual that has been performed in many countries for centuries. Female genital mutilation is a form of female circumcision in which the female’s clitorus is completely removed. This procedure often leads to infection, scaring, and both physical and emotional trauma. Having such an invasive procedure done on a women’s genitalia leaves a greater possibility for infection and disease to set in. As the previous post states, it is looked down upon by most of the world and is seen as criminal in the global perspective. However, women around the world are still having this procedure performed on them despite the negative side effects. In my opinion this is a form of abuse towards women and a means of keeping women in submission to their society. I think that women who are seen in health care need to be very sensitive to this issue and work to understand where the patients are coming from both emotionally, mentally, and any physical issues they may be dealing with.

Original Post
May 26, 2009
Title: Female Genital Mutilation
Female Genital Mutilation is a religious ritual which dates back hundreds of years making it very obsolete and presently viewed as criminal on a global perspective. The practice has been addressed through many forums such as the Universal Declaration of Human Rights, 1948; United Nations convention on the Right of the Child, 1959; African Charter on Rights and Welfare of the Child, 1990; Declaration on Violence Against Women in 1993; High Commission on Refugees Statement against Gender Based violence, 1996. All forums strongly disagree with the practice and encourage the enforcement of the law. There is no easy solution to female genital mutilation. Respect for lives at risk must take precedence over a cultural tradition. And the communities need to be educated to such. I can see the need in health care for education to the professionals who take care of these patients. Education on the ritual and the possible complications. And education regarding the sensitivity of the situation when approaching these patients for they are probably affected physically, psychology, and socially.

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Physical dependence vs addiction

December 24, 2009

Interesting in this unit is the difference between physical dependence and addiction. addiction: A disease process characterized by continued use of a specific psychoactive substance despite physical, psychological or social harm. physical dependence: Defined as a state in which an abstinence syndrome will occur if drug use is discontinued. Physical dependence is the result of neuroadaptive processes that take place in response to prolonged drug exposure. I would find it easy to pass judgement in a clinical setting having never been in that situation myself. Pain management and psychosis must be areas of great concern for physicians and nurses alike. In these circumstances, the whole picture must be realized and perhaps this is where psychological counseling should be a part of the treatment plan. I believe the health care field as a whole is beginning to realize the importance of not just treatment with drugs, but by more holistic approaches.

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Second puzzling case of autism reported, comment

December 23, 2009

There are many theories as to what the cause of Autism is, yet no definitive answers have yet emerged. Although many believe vaccines are the cause of autism, research has failed to show this correlation. However, Thimerosal, which is a mercury containing organic compound used as a preservative in many vaccines, is implicated in the cause of Autism based on the fact that mercury as a known neurotoxin. In fact, as a result, manufactures such as the Eli Lilly Company, have worked towards decreasing or eliminating the use of Thimerosal in vaccines. As of October 5th the incidence of Autism is 1 in 91 individuals. As vaccines become Thimerosal free it would be interesting to see if the incidence of Autism reflects this change. 

Original Post

November 26, 2009

Title: Second puzzling case of autism reported, comment

As governmental funds for researching the causes and eventual cure of Autism increase, it has naturally gained more attention from the public. I agree that this has its pros and cons. More parents are considering the possible ramifications of dosing their children with multiple vaccines. Parents are becoming more proactive and accountable when it comes to decisions regarding the medical care of their children. It is shedding light on a disease that has been, up until recently, misunderstood by most. On the flip side there isn’t a whole lot of concrete evidence linking autism directly to vaccine administration, yet there is a multitude of evidence that suggests that vaccines have saved lives, prevented the spread of potentially fatal disease and in some cases has eradicated the disease all together. I have a family member that became adamant that her children were never going to receive any type of vaccine – she executed extensive research on vaccines and homeopathic alternatives. To date her children have not received a single vaccine, they take multiple vitamins and herbal supplements on a daily basis and their diet is quite restricted. Sadly and ironically, her 13 year old son was diagnosised with autism at 3 years old.

Original Post
July 1, 2009
Title: Second puzzling case of autism reported
Federal health officials at an upcoming conference the controversial cases of a 9-year-old girl who became autistic after receiving numerous vaccinations. In January a 6-year-old girl received a flu vaccine and a week later became ill requiring hospitalization and ultimately died. Study after study has failed to show a link between vaccines and autism but many parents of autistic children claim that childhood vaccinations they received are responsible. In 1986 a National Vaccine injury compensation program was introduced to compensate injured children from vaccines. Many deadly epidemics have been prevented by vaccination. For the parent of a child injured following vaccination, grief and ambivalence would prevail. The questions that continue regarding these very complicated situations cause great concern for parents trying to decide whether to immunize a child.

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