Nursing histories for better patient care

The article about patients not recalling their medications brought back many memories from when I was working in the hospital. When patients are admitted, nurses do a nursing history that is quite similar to the medical history, but with a different goal. Although the patients have already been asked many questions, our questions were geared towards helping us understand our patients to be able to give good patient care. The more we learned about our patients, the better we could care for them.

One question that would get a lot of confused answers would be “what medications are you on?” So many patients, especially the older ones, would say, “the white one for diabetes, the blue one for high blood pressure…” Trying to track down which medication and which dosage wasn’t always easy. Challenging would be a good word. :-)

Other questions we asked were sometimes met with suspicion. We would ask what the bowel and sleeping habits were normally. I remember some families members getting really upset over these questions. The stress of their loved one being ill, the stress of the admission and all that went into it, and now they were being asked questions that seemed useless to them. I would explain knowing what is usual at home helps us a lot in the hospital. For example, if we have admitted someone who only has a bowel movement every three days, we’re not going to start pushing laxatives after 24 hours. If a patient usually stays up until 2 a.m., we’re not going to worry if they’re still awake at midnight.

Even questions such as if someone lived alone, if there were stairs in the home, and about living arrangements. These are all important issues. Nurses need to know what people are like at home in order to judge if they are having problems in the hospital. Equally important, nurses need to know what type of living situation the patient is going to be discharged to.

Most of us are aware that by the time we are doing the nursing assessment and nursing history, the patients have been poked and prodded more than they thought was humanly possible, and they have been asked questions until they can’t think straight any more. But, it’s also important to remember that nurses have a different take on patient care and the answers patients give nurses are for different goals than the answers patients give doctors.

News for Today:

Infants' cough and cold meds pulled from shelves
MS that Runs in Families Appears More Severe than Non-Familial MS
A little tipple might topple food-borne microbes
Statins cut risk of heart attack, but lifestyle changes still needed: scientist
Patients can't recall their medications to tell doctors
Anticlotting drug found to be safe in sickle cell patients
Prostate cancer increases hip fracture risk by eight times in 50 to 65 year-olds
COPD rates, higher than expected in China, will continue to grow
Statins reduce loss of function, keeping old lungs young - even in smokers
Even occasional use of spray cleaners may cause asthma in adults

Head Injuries

The incidence of head injuries is dropping in Canada. In a report issued by the Canadian Institute for Health Information, the rate of children and youth with traumatic head injury admitted to hospital dropped by 53% from 1994 to 2004 and deaths dropped by 34%. However, while the numbers dropped, the severity of the injuries increased by 46%. Among seniors, there was a slight increase (4%) of head injuries, but it should be kept in mind that the population of seniors rose by 17% in the same period.

According to the Brain Injury Association of America, 1.5 million people per year in the United States experience a traumatic brain injury. This compares to an annual rate of 176,300 people affected by breast cancer and 43,681 affected by HIV/AIDS. The report states that 50,000 people per year die from traumatic brain injuries and 80,000 live with the long-term effects of such an injury.

Those numbers are high and we have to keep in mind that head and traumatic brain injuries don't affect just the recorded number of injured, but family and friends, as well.

The lower rate of children with head injuries is likely because of the increased awareness of what causes head injuries and the injury prevention programs, from bicycle helmets to stricter rules about participating in sports following a concussion. But, there is still a lot that needs to be done.

Another issue is sometimes a bang on the head that doesn’t seem to be too bad really may be serious. This type of injury isn’t always obvious right away and the effects can catch people by surprise.

If you or someone you know has had some sort of head injury, there are some signs and symptoms you can watch for. If you see any of these or suspect that there is a problem, don’t hesitate and get medical help as soon as possible.

From FamilyDoctor.org:

Get help if you notice the following symptoms:
· Any symptom that is getting worse, such as headaches, nausea or sleepiness
· Nausea that doesn't go away
· Changes in behavior, such as irritability or confusion
· Dilated pupils (pupils that are bigger than normal) or pupils of different sizes
· Trouble walking or speaking
· Drainage of bloody or clear fluids from ears or nose
· Vomiting
· Seizures
· Weakness or numbness in the arms or legs


News for Today:

Statins cut risk of heart attack in men with elevated cholesterol: study
Stored blood lacks oxygen-making ability: study
Elderly don't know stroke signs: study
HER-2 status could predict chemo success
Severe heart defect likely caused by genetic factors
Health Canada to advise against cough, cold remedies for infants
Head injury may increase the risk of ALS

WHO's guide on palliative care

Palliative care is for any terminal illness, but often seems to focus on cancer. This is likely because this is the disease with which most of us are familiar. The important thing to take away from the discussion about palliative care is that it almost always is also applicable to other terminal illnesses. While certain symptoms or physical issues may be different, there are more similarities than differences when it comes to end-of-life care.

This month, the World Health Organization (WHO) has published a new guide on palliative care for those who are dying of cancer in the developing nations. You can find a copy of this guide at the WHO website. On page 2, you will find the Key Messages:

“Palliative care is an urgent humanitarian need worldwide
for people with cancer and other chronic fatal diseases.
Palliative care is particularly needed in places where a
high proportion of patients present in advanced stages
and there is little chance of cure.

Ideally, palliative care services should be provided from
the time of diagnosis of life-threatening illness, adapting
to the increasing needs of cancer patients and their
families as the disease progresses into the terminal
phase. They should also provide support to families in
their bereavement.

Effective palliative care services are integrated into the
existing health system at all levels of care, especially
community and home-based care. They involve the
public and the private sector and are adapted to the
specifi c cultural, social and economic setting.

In order to respond to the cancer priority needs in a
community and make the best use of scarce resources,
palliative care services should be strategically linked to
cancer prevention, early detection and treatment services
for both adults and children.”

The guide is very interesting reading and I encourage anyone who is interested in the institution of palliative care in the developing world to read it. The authors review the social context of palliative care plan, gaps in services, assessment of the feasibility of services, priorities, planning, and organization.

It's that time of year again: vaccination time, that is

It’s time for that old annual influenza vaccination debate. There's an article in today's news picks about the pneumoccal vaccine: Patients with pneumonia who received pneumococcal vaccine have lower rate of death, ICU admission. The pneumococcal vaccine isn't the same as the influenza vaccine but the two come up at the same time of year.

The benefits of the flu vaccine are plenty. The vaccine reduces the chances of you getting the flu (Note, that I didn’t say “eliminates”); if you do get the flu, it’s likely that it will be a less virulent illness; it reduces the spread of the flu; it helps save money in the workplace by reducing absenteeism, and it reduces the cost of health care as it limits the number of people seeking medical care from the flu.

So, what to do? Opponents of the flu vaccine say that we need to fight viruses on our own, that they don’t need it because they never get sick, and when they do get sick, they don’t get that sick. The funny thing is that every person who has told me that they never get “that sick” when they get the flu – when they get the *real* flu, they’re so sick, they tell me that they never want to live through that again. To be fair though, that is only in my own experience.

We get the flu shot here in our home. I’m asthmatic, as are two of my three kids. I also am very susceptible to anything that attacks the lungs. Colds go directly to my lungs and cause great discomfort for weeks. I’m not taking a chance with the flu. If a cold can knock me off my feet, I’m afraid of what influenza can do. I had pleurisy once – never want to experience that again.

While the initial goal was to vaccinate the people who would get sickest should they get the flu (the elderly and immunocompromised), the latest push is to vaccinate those who aren't so susceptible. It seems that the vaccine isn’t as effective in the elderly but if the people around the elderly are vaccinated, they can’t pass it on to them. Makes sense to me.

But, it is a personal decision. If you don’t want to get vaccinated, that’s your choice. But, please don’t fight against those of us who do. I’ve been told I’m a sheep for following the crowd. I’ve been told that I’m weakening my family members’ immune system by getting every vaccinated – I’ve been told a lot of things. The thing is, this is my choice just as those who don’t want a vaccination are making their choice. Neither is right or wrong, but both are the best decisions for us, with the information and the knowledge that we have.

Today's News:

One-year follow-up of a therapeutic lifestyle intervention targeting cardiovascular disease risk
Effect of perindopril on physical function in elderly people with functional impairment: a randomized controlled trial
Phone counselling leads to lower cardiovascular risk: study
Relatives of patients with Parkinson's disease risk developing dementia, cognitive impairment
Patients with pneumonia who received pneumococcal vaccine have lower rate of death, ICU admission
Swiss study suggests surgery may offer best chance of long-term prostate cancer survival
Bad relationships hurt the heart literally: study

Appendectomy and tonsillectomy, very common in the past

When I was a child, it seemed as if everyone was having at least one of the surgeries, if not both. Both, the appendix and the tonsils were seen as superfluous, not necessary, so if they were causing problems, just “take ‘em out.” Now, however, we're learning that the appendix may not be so useless after all: Scientists figure out what the appendix is doing.

Of course, we don’t really always know what is going on in the body and what different parts of the body are for. Tonsils, for example, are now known to be the first defence against infection. According to EHealth.MD, in early childhood, the tonsils and adenoids help make antibodies against infection. Of course, if they become infected on a regular basis, they should be removed if the doctors feel that this is the best course of action.

With an appendix, if infection or inflammation occurs, removal is more urgent. If someone has appendicitis and it is left untreated, it can be fatal.

The symptoms of appendicitis include:
- Pain in the abdomen, starting in the middle and then moving to the right
- Nausea and vomiting
- Constipation or diarrhea
- Fever

If the appendix becomes so inflamed (swollen), it can burst, causing an infection in the abdomen, called peritonitis. This is life-threatening.

When someone is diagnosed with appendicitis, surgery is generally the treatment. Historically done by an incision a few inches long, it can now be done with a laparoscope in most uncomplicated cases, leaving just a small scar after healing.

If the surgeons suspect that the appendix may burst, or if it has already, the traditional larger incision is usually needed.

Recovery after an appendectomy, without bursting, is usually straight forward. The most important issue is dealing with the after-surgery pain and making sure that the bowels begin to move properly. If the appendix did burst, then antibiotics are usually ordered to be sure that an infection doesn’t set in.

I think my husband and I are very unusual for our generation. Both of us have our appendix, our tonsils, and our wisdom teeth!

News for Today:

New Diabetes Tool Available On American Diabetes Association Web Site
Aclasta Receives European Approval As First Once Yearly Treatment For Postmenopausal Osteoporosis
Differences observed between black and white women in use of breast cancer therapy
Limiting refined carbohydrates may stall AMD progression
New Prescription Allergy Treatment XYZAL® (levocetirizine Dihydrochloride) Now Available For Fall Allergy Season In The USA
Nutrition labels lead to calcium confusion, underconsumption: study
Scientists figure out what the appendix is doing
Paramedics can provide an effective alternative to standard ambulance service in the community
No strong evidence linking amateur boxing with long-term brain injury
Warm weather prolongs West Nile threat

Happy Thanksgiving to my fellow Canadians

I had an amusing exchange with an American collegue. I mentioned that I was preparing Thanksgiving dinner and she was shocked, thinking that she had missed something somehow. :-)

Nope, we just celebrate our Thanksgiving a bit earlier, to say thanks for our harvest, our bounty, our food.

So, to those of you celebrating this weekend, I hope you have a healthy, happy and peaceful Thanksgiving. For those of you in the US who have to wait a whole month, let me tell you how delicious my turkey was. {grin}