Archive for March, 2011

Reporter in Iraq’s life cut short not by a bullet but a “blood clot”

March 6, 2011

According to the New York Times of June 10, 2008, when David Bloom went to Iraq to report on the war his wife was worried he be felled by a bullet or a bomb. He was a victim of a rare genetic abnormality, factor V Leiden, called, factor V that caused a “blood clot” that lodged in his lungs and ended his life. Mr. Bloom also had three additional risk factors: immobility from a long plane ride, irregular eating habits (grabbing a bite when he could) due to his intense schedule and cramped sleeping areas in Army vehicles. If he had not had this rare disorder or if he knew about the disorder he would have been able to take prophylaxis treatment. Factor V disorder is responsible for about a third of cases of D.V.T, deep vein thrombosis, resulting in the veinous thrombosis advancing to the pulmonary embolism and his death. After his death investigation of family shows a cousin who suffered an MI in her forties had Factor V. His grandmother died in pregnancy from a clotting event. The abnormality can increase the risk of CVA, MI, cholelithiasis, pre-eclampsia, etc. Chapter 51 in one of my textbooks discusses drugs used to prevent formation of thrombi and to dissolve thrombi that have already formed by suppressing coagulation, inhibit platelet aggregation and promote clot dissolution. The drugs fall into three major categories: anticoagulants, antiplatelet drugs and thrombolytic drugs. Mr. Bloom would have most likely taken an antiplatelet drug, aspirin, as a preventative, had he only known of his risk.

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Mental Health Assessment in Forensic Nursing

March 3, 2011

Chapter 7 of Health Assessment for Nursing Practice discusses mental health and mental status assessment. This chapter correlates with Forensic Nursing in that the Forensic Nurse’s assessment needs to indicate the mental status of the client he/she is subjectively and objectively assessing.

The Forensic Nurse determines the client’s mental status by examining the client’s behavior, appearance, risk factors, interpersonal relationships and cognitive function. Vital signs are indicated as well in order to ascertain whether medical treatment is required. Past medical history, family history, drug and alcohol abuse, and medications that the client is using is also added.

The nurse assesses the client’s behavior and cognitive function in order to ascertain the client’s mental status. Is the client alert and oriented to person, place and time? Does the client appear anxious, withdrawn, or does the client’s mood appear appropriate to the situation? Is the client’s emotional state appropriate to the situation? Is the client displaying signs of paranoia, delusions of grandeur, obsessive compulsive actions, or bipolar episodes?

Is the client appropriately dressed for the weather? What is the client wearing? Is the client wearing outlandish dress and makeup or does the client display a lack of hygiene. Assess the posture of the client – Is the patient slumped in a chair and looking to the ground or is the client sitting upright and smiling? Is the client fidgeting or pacing the room? Does the client’s tone of voice indicate anxiety, anger, or is the client rambling with inappropriate sentences?

Risk factors involved include the client’s age, gender, family history, psychosocial environment and personal characteristics. Has the client had a past history of trauma, sexual or physical abuse, or alcoholism? Does the client display evidence of low self esteem?

Interpersonal relationships are indicated to establish the client’s social surroundings. Is the client in an abusive relationship? Does the client have family and friends that are supportive and that the client is able to discuss with them his/her feelings and problems? Does the client have a social phobia which inhibits him/her to avoid social situations?

Elevated blood pressure and pulse may indicate severe anxiety or panic. Assess respirations for dyspnea, tachypnea, or labored breathing. Decreased respirations may indicate depression with evidence of frequent, deep sighs.

Mental Status assessment is one of many observations that the Forensic Nurse incorporates in her nursing assessment. It can give valuable evidence of victim abuse, sexual assault and mental trauma.

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