Topic of the Day: Nursing Implications

Again pulling from Mosby’s Memory Cards

Nursing Implications -

Only administer medications you prepared.Read medications label carefully, not all formulations of parenteral* medications are appropriate for IV administration (e.g.. regular insulin for IV use.)Know your medications – Why is the patient receiving this medication? What nursing observations will tell you the desired medication action is occurring? What are the nursing implications to this medication?Do not leave medications at the bedside.Check medication compatibility if administering IV.Medications prepare for one route may differ in concentration for another route (e.e. epinephrine SC is concentrated; whereas IV preparation is diluted)   Administering an SC epinepherine preparation IV could be fatal before of an overstimulation of the cardiac system.Always check the patient’s armband before administering any type of medication.Have another nurse check medication calculationsIM injections — Do not inject more than 3ml at one time/ Use the smallest needle necessary to administer medication correctly.

*injected into blood or body tissues IV**, IM** or SC**   (**See yesterday’s post  for  what these abbreviations definitions)

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Free Toxicology Book

The book “A Small Dose of Toxicology”  is authored by Dr. Steven G. Gilbert, PhD, DABT; and provided as electronic book freely on toxipedia.org.

Who are interested in the toxicology can download this introductory toxicology book  .

Dr. Gilbert is director and founder of the Institute of Neurotoxicology and Neurological Disorders (INND), Seattle, Washington and Affiliate Professor in the Department of Environmental and Occupational Health Sciences, University of Washington. INND is a non-profit (501(c)3) institute dedicated to research and education in the field of toxicology.

Source: www.toxipedia.org

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Marijuana: The Next Diabetes Drug?

Toking up may help marijuana users to stay slim and lower their risk of developing diabetes, according to the latest study, which suggests that cannabis compounds may help in controlling blood sugar.

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Palmitoylethanolamide Is a Disease-Modifying Agent in Peripheral Neuropathy: Pain Relief and Neuroprotection Share a PPAR-Alpha-Mediated Mechanism

L. Di Cesare Mannelli and colleagues studied the mechanism of action of PEA in a sciatic pain model and published their findings in an open access Journal:

Mediators of InflammationVolume 2013 (2013), Article ID 328797, 12 pageshttp://dx.doi.org/10.1155/2013/328797

under the titel:

In the attachment the PDF of this important article.

The conclusion was:

The present results demonstrate the neuroprotective properties of PEA in a preclinical model of neuropathic pain. Antihyperalgesic and neuroprotective properties are related to the anti-inflammatory effect of PEA and its ability to prevent macrophage infiltration in the nerve. 

2013-Palmitoylethanolamide Is a Disease-Modifying Agent in Peripheral Neuropathy- Pain Relief and Neuroprotection Share a PPAR-Alpha-Mediated Mechanism

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Beta Blockers: Take a Chill Pill

Beta antagonists, which pretty much everyone just calls beta blockers (and which one of my favorite teachers calls “The Wall”), reduce cardiac output by affecting the heart.  Some of the newest ones, like carvedilol, actually cause vasodilation (can you guess how?), but our prototypes, propanolol and metoprolol, do not.  They are more correctly secondary vasorelaxers (which is a phrase I just made up).  Remember, beta-1 receptors increase cardiac output by making the heart work harder. This also forces more blood through the blood vessels and causes them to resist.  When they are blocked, the heart doesn’t pump blood quite as forcefully.  So, a pure beta blocker, among other things, prevents the smooth muscle from feeling the need to squeeze the heck out of your arteries.  This allows blood to flow more freely!

You may also remember that beta blockers are negative dromotropic, that is, they block some of the electrical conductivity of the heart at the sinoatrial (SA) and atrioventricular (AV) nodes.

Don’t forget that beta-2 is really important for the lungs!  So beta blockers that are non-selective, that is, block both beta-1 and beta-2 receptors, can bronchoconstrict.  We have to be very careful that no one with breathing problems gets these by mistake!

In this section is your overview of three of the various sympatholytics:  the three generations of beta blockers.

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News from the Health Blog

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Please bookmark the Journal’s Health and Wellness page for daily updates on health news and analysis.

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How Often for Mammograms?

Changing recommendations for when women should get mammograms have created conflict and confusion. Not only do recommendations from different sources vary, but some have moved in opposite directions.

The U.S. Preventive Services Task Force scaled back its recommendation in 2009, saying women at average risk should begin screening at age 50 and repeat the test every two years. The group, the government’s independent panel of preventive-health experts, said women in their 40s should discuss the pros and cons of screening, including possible false positives and follow-up tests, with their physicians. Previously the task force had  recommended mammograms every one to two years starting at age 40.

In contrast, the American College of Obstetricians and Gynecologists increased its recommendation in 2011, saying women should be offered a mammogram every year starting at age 40. The group previously advised women to get the test every one to two years in their 40s and then annually starting at age 50.

What do you think? Register your vote and leave us your comments. We may use them in print in a coming special report.

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Nurse Practitioners and Primary Care

One of the big problems in the U.S. health-care system is the shortage of primary-care physicians, especially in rural areas. And the shortages may worsen as more patients seek care under the Affordable Care Act.

One candidate to help fill that shortage: nurse practitioners.

Nurse practitioners are trained to perform clinical care, including ordering lab work and X-rays, and are especially useful in assisting patients with chronic conditions such as diabetes and high blood pressure. About a third of states allow nurse practitioners to practice without the supervision of a physician, freeing up doctors to do more.

Have you received medical care from nurse practitioners, and do you/would you have confidence in them? Vote and enter your comments, which may be excerpted in a coming Wall Street Journal special report.

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Vote: Should men get PSA tests to screen for prostate cancer?

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Prostate cancer hits one in six American men in their lifetimes, though in most cases it progresses so slowly that it would never cause problems. PSA tests can give an early warning of prostate cancer. But PSA tests also give many false alarms, prompting more than one million unnecessary biopsies every year. And when prostate cancer is found, more than 80% of men opt to have surgery, radiation or hormone therapy that sometimes leaves them incontinent or impotent, even though their cancer was probably never life-threatening.

The U.S. Preventive Services Task Force, a nongovernmental panel of independent experts in prevention and evidence-based medicine, recently recommended that doctors stop using PSA tests to screen men with no symptoms of prostate cancer. That prompted an outcry from some experts and advocacy groups concerned that prostate cancer would be missed, and many physicians have continued to order the tests.

What do you think?  Vote totals and some of your comments will be used in an upcoming special report.

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How Well Does Your Doctor Communicate with You?

Patients have long complained that doctors are rude, they’re bad listeners and they don’t explain things clearly.

Those complaints are finally being taken seriously, as poor communication is increasingly understood to be at the root of many of health care’s failures—and a leading culprit in rising costs. Research shows that when doctors don’t listen to patients, they miss important health cues and misdiagnose illness. Meanwhile, patients who don’t understand what their doctors say fail to follow their regimens, leading to preventable hospitalizations, complications and poor outcomes.

With new Medicare payments tied to patient-satisfaction scores, and concern growing over malpractice costs, medical schools, health systems, malpractice insurers and hospitals are trying to help doctors bolster their bedside manner. They’re setting up education programs for everyone from medical students to seasoned pros who have spent years talking to patients.

Are you satisfied with how your doctor communicates with you and your family? If not, what is your biggest concern? Vote and let us know what you think. Your comment may be included in a special report we’ll be publishing in The Wall Street Journal.

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What Motivates Doctors

Physician pay accounts for about 20% of total health-care spending, and in many specialties it has increased much faster than inflation in recent years.

Some critics say that’s because most doctors get paid for every service they perform, which creates an incentive to order unnecessary tests and hospitalize people who don’t need it.

That critique is the basis for a push to tie physician pay to performance, evaluating doctors on how well they follow procedures for patient care and how well they score on patient satisfaction surveys, among other things.

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Vote: Are ADHD Medications Overprescribed?

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The number of children being treated with prescription medication for attention deficit hyperactivity disorder has soared in recent years.

Some doctors, parents and child advocates have become concerned that many children are taking medication unnecessarily. These critics suggest that ADHD is a mistaken diagnosis in many cases. And even when the diagnosis is correct, they say, many children who are taking medication for ADHD could do as well or better with alternative treatments.

Others say the critics greatly exaggerate the number of incorrect diagnoses. Heightened awareness of the disorder has fueled the rapid growth of ADHD cases, they say, not a rush to judgment. And ADHD medications have proved effective, their proponents say, to a degree that alternative treatments have not.

What do you think?  Let us hear from you with your vote and comment, and we’ll publish highlights in an upcoming special report.

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Organic Food and Your Health

Proponents of organic food extol its health virtues. One example: a finding that children who switched from conventional to mostly organic produce had no traces of pesticides in their urine within a matter of five days.

But organic food is typically more expensive and harder to find than traditional food. And skeptics say the health benefits haven’t been demonstrated in published studies.

Have you made it a point to eat as much organic food as possible? Did you feel better? Vote and post your comments, which may get excerpted in a coming Wall Street Journal special report.

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How Companies Can Foster Healthy Employees

Many employers offer wellness programs to contain their health-care costs—and perhaps also improve morale and productivity.

There is evidence that the programs lower health-care spending and reduce absenteeism. But participation rates tend to be low, limiting the benefits to companies and employees. In one survey, a majority of companies reported that 20% or less of employees took advantage of a health coach or weight-management program.

What do you think? Register your vote and leave us your comments. We may use them in print in a coming special report.

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Vote: Do You Want to Know What’s in Your Genes?

Are you better off knowing or not knowing?

For healthy people, is there a compelling reason to know if your genes make you susceptible to a specific disease or condition? Or are there some things you’re better off not knowing? As the cost of sequencing a person’s genome plunges, these are no longer hypothetical questions.

National Human Genome Research Institute

Some scientists and doctors see sequencing as another preventive diagnostic test. But others argue that the results are still too imprecise. How useful is it to know you have an increased risk of cancer when it could be twice the norm or 100 times? And some fear the strains put on the health-care system by millions of otherwise healthy people who, as a result of sequencing, demand further tests and procedures that ultimately could prove unnecessary or harmful.

What do you think? Register your vote and leave us your comments. We may use them in print in a coming special report.

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