Clinical Topics - Drugs and Devices

A nursing-driven approach towards reducing hypertension: a focus on evening dosing and circadian rhythm

A nursing-driven approach towards reducing hypertension: a focus on evening dosing and circadian rhythm

Tags: Antihypertensives blood blood pressure Chronotherapy hypertension hypertensive medication treatment

There are increasing data supporting evening administration as a means of achieving better BP control through re-establishing normal sleeping dipping patterns, thereby preventing the development of comorbidities. Additionally, this dosing change has been shown to prevent the morning surge, a precursor to negative cardiovascular (CV) events, including heart attack and stroke. When the costs are high both fiscally and medically, simple and cost-free interventions should be the first-line treatments.

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Sickle Cell Disease

Sickle Cell Disease

Tags: child children disease pain Sickle Cell Disease treatment

Sickle cell disease is a debilitating condition secondary to the severe pain patients with this condition suffer especially when they are in crisis. This article includes the management and treatment of sickle cell disease and the diagnosis.

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Case Study: A Systematic Approach to Early Recognition and Treatment of Sepsis

Case Study: A Systematic Approach to Early Recognition and Treatment of Sepsis

Tags: assessment Case Study emergency department guidelines mortality prevention risk factors sepsis standard of care treatment

The term sepsis is often misunderstood. The public and often healthcare workers are unaware of the severity and high mortality rates this infection process has upon the world. Sepsis has vague symptoms that make diagnosis difficult. Often, sepsis is diagnosed in the later stages, when more obvious yet severe symptoms occur. This case study discusses a female who presents to the emergency department with sepsis secondary to pneumonia. Over the course of three days, the patient’s health quickly deteriorates, demonstrating the rapid progression of sepsis. Clinical findings, such as vitals signs, lab abnormalities, and symptoms of sepsis are discussed. The term bundle of care is presented to educate the reader on the golden standard of care for treatment of sepsis. This case study intends to increase community awareness and education to health care providers as well as providing an evidenced-based treatment guideline. More education and raised awareness will help prevent a deadly yet treatable infectious process.

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Ethical Issues Raised When Parents Refuse Medical Treatment For their Ill Children

Ethical Issues Raised When Parents Refuse Medical Treatment For their Ill Children

Tags: child children ethical principles ethical principles in nursing ethical standards ethical values ethics nursing ethics parents treatment treatment options

Working as a nurse, I am seeing ethical issues raises when parents refuse medical treatment for their ill children. Health care providers need rapid access to legal remedies in order to help children whose parents neglect medical treatment for their young because of their religious beliefs and hopes that a miracle might heal the kids.  Despite those parents, who strongly stand by their point of view about spiritual treatment, doctors and state continue considering such point of view as futile, neglect, and abuse of the children. According to the doctors and courts, the medical treatment in ill children is more effective to cure disease in comparison to the spiritual means. As a society, we should make it a priority to protect children from parental neglect and abuse in case of withholding medical treatment, which in many cases leads to death.

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Mystery Diagnosis: Recognizing Serotonin Syndrome

Mystery Diagnosis: Recognizing Serotonin Syndrome

Tags: advanced practice hunter serotonin toxicity criteria recognition serotonin syndrome serotonin toxicity treatment

Serotonin syndrome (SS) is a rare condition that is believed to be induced by ingestion of serotonergic medications, leading to an increased serotonin level. Although many medications are thought to be responsible, some of the more common are antidepressants and opioids. There are no definitive tests to confirm SS, therefore diagnosis is based on clinical findings and can be somewhat difficult. A triad of symptoms, neuromuscular hyperactivity, altered mental status, and autonomic hyperactivity, are considered the hallmark signs, but are not present in all cases. Symptoms can vary from mild and almost undetectable to severe and life threatening. Three diagnostic systems are currently utilized to assist with diagnosis if SS is suspected: the Hunter, Sternbach, and Radomski criteria. A diagnosis of SS should prompt discontinuation of the suspected offending agent. Increased awareness of this issue is needed, including symptoms and risk factors, so that the advanced practice registered nurse (APRN) may promptly recognize and diagnosis this condition to avoid further complications. Completing a thorough history and physical, along with accurate medication reconciliation can assist the APRN in identifying high risk patients. While there is still so much about SS that remains unknown, current information and education on this issue will ensure the APRN is providing safe and high-quality care. Databases utilized were CINAHL, PubMed, and ScienceDirect. These databases provide access to numerous nursing, biomedical, and scientific journals and were useful in locating up-to-date, peer reviewed research on this subject.

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A Nursing Intervention to Enhance Wellness and Patient Adherence to Therapy for Headache - NEWPATH Study

A Nursing Intervention to Enhance Wellness and Patient Adherence to Therapy for Headache - NEWPATH Study

Tags: Chronic Disease Self-Management headache Migraine Nursing Initiative patient adherence study therapy treatment wellness

The objective of the study is to ascertain whether the implementation of a nurse-initiated phone call between initial and follow up Headache appointments has the potential to enhance wellness and treatment plan adherence by reducing common barriers experienced by patients with Headache.

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Cardiomyopathy: A Closer Look at the Disease

Cardiomyopathy: A Closer Look at the Disease

Tags: cardiac arrest cardiomyopathy disease heart disease treatment

Heart disease is a wide term used for a variety of diseases that affect the heart. Heart disease is the leading cause of death in the United States. Cardiomyopathy is one of the types of heart disease that affects about 50,000 Americans annually. There are four types of cardiomyopathy: dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular dysplasia (National Heart Lung and Blood Institute, 2007). This article will detail the different types of cardiomyopathy as well as the causes, treatment, sign and symptoms, diagnostic procedures and prevention. It will also cover ways to live with cardiomyopathy and end of life care.

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Rapid Response Team to the Rescue

Rapid Response Team to the Rescue

Tags: Ambulance cardiac Doctors EMS Follow-Ups patient patient safety Rapid Response rapid response team rapid response team benefits Rescue Rescue Team RRT RRT Nurse RRT Nursing Team treatment working together

Rapid response team (RRT) purpose is to initiate immediate measures before patient deteriorates further and to educate the staff on activating the staff the Rapid response team.

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Impact of Language Barriers on Patient Safety

Impact of Language Barriers on Patient Safety

Tags: communication language LEP linguistics medication errors patient education patient safety

This paper discusses how linguistic differences can contribute to patient adverse outcomes and the role of health care providers in mitigating the impact.

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New Innovation for Chronic Kidney Disease

New Innovation for Chronic Kidney Disease

Tags: chronic disease kidney Kidney Disease new treatments treatment options

This body of work looks at new and innovative treatments that are being researched and developed for the treatment of chronic kidney disease.

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Factors Influencing Nurse Medication Errors

Factors Influencing Nurse Medication Errors

Tags: medication medication errors nurse distractions

This article explores the medication errors and the phenomena of nurse distractions. Nurses are intimately involved in the medication administration process. Even though the parameters of selection, dosing, compounding, and dispensing medication remain under the purview of other allied health professionals, the nurse represents the last safety checkpoint between the medication and the patient and efforts should be directed toward removing obstacles which are negatively impacting this process. It has long been suspected that nursing distractions whether by patient, family, coworkers or others, are facilitating the occurrence of errors in the hospital setting. There are practices which are discussed which may ameliorate this threat to some extent if employed consistently and judiciously.

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Polypharmacy Mitigation:  A Lifetime of Education

Polypharmacy Mitigation: A Lifetime of Education

Tags: aging education medication mitigation polypharmacy prescriptions

An informational article on the issue of paolypharmacy and medication redundancy in todays healthcare and the use of education over the lifespan as a corrective measure.

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When Doing The Right Thing Leads to the Wrong Results

When Doing The Right Thing Leads to the Wrong Results

Tags: Case Study errors medication medication errors mental health prescriptions punishment termination due to medication error

Reprimanding nurses for medication errors contibutes to a culture of evasion and silence and does not address the reason behind the mistake.

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Tourette’s Syndrome: Implications for a Moving Disorder

Tourette’s Syndrome: Implications for a Moving Disorder

Tags: Psychiatry Tourettes Syndrome treatment

This article highlights the subjective, objective and recommended nursing treatment for Tourette's syndrome.

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Charles Bonnet Syndrome: What Nurses Need to Know

Charles Bonnet Syndrome: What Nurses Need to Know

Tags: Case Study Charles Bonnet Syndrome Guidance for Clinicians Hallucinations treatment Visual Hallucinations

Charles Bonnet Syndrome is frequently the appearance of visual hallucinations in psychologically intact people. Studies estimate the prevalence of these hallucinations of at least 10% of the elderly with vision impaired by, for example, macular degeneration or glaucoma. The syndrome is frequently undiagnosed or misdiagnosed. This case study shows how a patient's symptoms were misinterpreted causing unnecessary stress to the family.

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Therapeutic Hypothermia Management

Therapeutic Hypothermia Management

Tags: cardiac cerebral ischemia critical care hemorrhage Hypothermia perioperative recommendations Subarachnoid Hemorrhage Therapeutic Hypothermia therapy traumatic brain injury treatment

The leading cause of death in North America is heart disease, resulting in 611,105 deaths in the last year. Cardiac arrest accounts for more than 300,000 heart disease related deaths. Patients that receive early quality chest compressions and defibrillation present with increased survival rate, however, the degree of brain dysfunction varies. The advancement in cardiopulmonary resuscitation after cardiac arrest and the use of therapeutic hypothermia have minimized brain injury and improved neurologic outcome. In 2002, two studies demonstrated the use of therapeutic hypothermia after cardiac arrest proving to lower mortality rate and have neuroprotective effect. This led the American Heart Association and the International Liaison Committee on Resuscitation to recommend the implementation of therapeutic hypothermia after the return of spontaneous circulation post-cardiac arrest. Mild hypothermia is also utilized in traumatic brain injury to control cerebral edema and to decrease intracranial pressure (ICP), cerebral ischemia, and subarachnoid hemorrhage (SAH). However, clinical effectiveness for subarachnoid hemorrhage is still questionable. This paper will focus on the recommendations for therapeutic hypothermia after cardiac arrest as well as a briefly discuss its use for clinical trials in traumatic brain injury, cerebral ischemia, and SAH.

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 Prescriptive Authority for Nurse Practitioners

Prescriptive Authority for Nurse Practitioners

Tags: debate future of nursing Nurse Practitioners Prescriptive Authority

The physician shortage in primary care, plus the growth of nurse practitioners and increasing need for access to health care, creates a necessity for more autonomous nurse practitioners. However, current restrictions on nurse practitioners, particularly prescription regulations for controlled substances, limit what practitioners can do for patients. These restrictions also increase wait times for patients and have the potential to increase liability claims as physicians prescribe medications for patients they have not adequately evaluated. Nurse practitioners have proven to be a safe, quality, and cost saving approach to primary care. To meet the growing needs for patients, nurse practitioners must have the ability to prescribe controlled substances in all 50 states.

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Barriers to Patients Undergoing Methadone Maintenance Therapy

Barriers to Patients Undergoing Methadone Maintenance Therapy

Tags: addiction mental health methadone opiates therapy treatment treatment options

Methadone maintenance therapy is one method utilized to combat opioid addiction and is an effective treatment in the abstinence from opiates. The purpose of this article is to communicate comprehensive information to healthcare providers about methadone as a medication, and the treatment guidelines of maintenance programs in the hopes of diminishing the stigma attached to methadone maintenance therapy. Through a comprehensive literature review, information regarding mechanism of action, maintenance therapy program guidelines, different barriers to treatment, and how to overcome these barriers were collected and reviewed.

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The Birmingham VA Nursing Academy Partnership

The Birmingham VA Nursing Academy Partnership

Tags: education medical technology nursing academy nursing education nursing partnership nursing school partnership students veterans veterans affairs

This article describes a partnership and the importance of partnering with the Birmingham VA Medical Center and the University of Alabama at Birmingham School of Nursing as part of a pilot program in The United States to promote nursing careers in the VA hospital and to improve the quality of nursing education in the School of Nursing. Since it began, in 2009, this program, called the Veterans Affairs Nursing Academy Partnership, has consistently performed beyond expectations to increase the breadth of knowledge for a select group of baccalaureate nursing students. Further it has created a strong connection between the Birmingham VA Medical Center and the University of Alabama at Birmingham School of Nursing, a professional resource that benefits all students and faculty.

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Managing behavior in children with ASD

Managing behavior in children with ASD

Tags: ASD autism behavior behavioral child children medication mental health pediatric Psychiatry

Unfortunately, many of these children end up in the emergency department for these behaviors due to the lack of community mental health services. These crises visits often times result in unnecessary medications being prescribed for these problematic behaviors.

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Understanding and Treating Benzodiazepine Dependence; How you as a nurse can best assist the addicted patient

Understanding and Treating Benzodiazepine Dependence; How you as a nurse can best assist the addicted patient

Tags: addiction benzodiazepine emergency emergency room mental health treatment

This article provides information on the symptoms of benzodiazepine dependence, the neurophysiology behind the dependence and how the staff nurse can be part of the treatment involved.

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Going Against the Norm: Treating Cancer as a Metabolic Disease

Going Against the Norm: Treating Cancer as a Metabolic Disease

Tags: aging cancer cancer patients cancer risk metabolic metabolic disease oncology preventing cancer therapy treatment treatment options

The current treatment for someone diagnosed with cancer is no longer acceptable. The focus needs to shift away from our standard treatments which so often causes pain as well as physical and emotional suffering. Emerging research about the body’s cellular metabolism provides new hope for cancer prevention and treatment. A number of mechanisms present in the human body are known to inhibit cancer cell growth by providing the body with an alternative fuel source, one that cancer cells cannot metabolize. For instance, induced ketosis offers a physiological means of regulating glucose metabolism in cancer patients while suppressing tumor metabolism and progression while ketone production significantly produces anti-cancer effects by shifting the body’s fuel source from a glucose dependency to one that is ketone based. Even while there remains controversy over the occurrence of many types of cancer, recent research has unveiled promising results towards cancer prevention and treatment. Emerging evidence indicates cancer is primarily a metabolic disease. According to Dana-Farber Cancer Institute (2014) research is being done to look at the connection between body weight, sugar intake, insulin levels and their correlation to cancer. Understanding the cellular metabolism of cancer is necessary in order to find preventative and holistic treatment modalities and for this to occur, a paradoxical shift in our current perception of cancer treatment is necessary.

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Understanding behaviors in Autism Spectrum Disorder

Understanding behaviors in Autism Spectrum Disorder

Tags: autism autism spectrum disorder behavior behaviors child children medication mental health pediatric Psychiatry

With the rising incidence of Autism Spectrum Disorders, nurses need to be educated regarding comorbidities that can cause aberrant behaviors. Along with a thorough medical assesment, finding mental health services can be challenging for many families. Many PCP's and other non-mental health professionals take on medication management of behaviors due to the lack of appropriate mental health resources.

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Alternative Treatments: Doubting Thomas to Believer

Alternative Treatments: Doubting Thomas to Believer

Tags: alternatives treatment treatment center

My experience with reiki therapy and how it forever changed my practice.

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Poor sleep, hazardous breathing: An overview of obstructive sleep apnea

Poor sleep, hazardous breathing: An overview of obstructive sleep apnea

Tags: Hallucinations obstructive sleep apnea sleep apnea sleep-disordered breathing therapy treatment treatment options

Obstructive sleep apnea is a chronic disorder resulting from upper airway collapse during sleep. It is linked to a variety of health and safety risks but can often be effectively treated. This article provides an overview of the disorder, including an evidence-based approach to diagnosis and management.

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Literature Review: Safe Nurse Staffing

Literature Review: Safe Nurse Staffing

Tags: Competent Care float nurse float pool Floating floating nurse health ICU medication errors nurse Nurse and Burnout nursing ethics patient outcomes performance retention Staffing Issues stress Stress among Nurses work environment

The purpose of this literature review is to exam nurse staffing and staffing related issue and its impact on the healthcare world. Safe nurse staffing poses substantial issues at the clinical level including its tremendous impact on patient mortality, patient satisfaction, increased incidence of medical errors, and nurse dissatisfaction and burnout.

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Predicting exercise adherence in cancer patients and survivors: a systematic review and meta-analysis of motivational and behavioural factors

Predicting exercise adherence in cancer patients and survivors: a systematic review and meta-analysis of motivational and behavioural factors

Tags: adherence behavior cancer cancer patients exercise meta-analysis physical activity recruiting review treatment

Cancer patients are advised to participate in daily exercise. Whether they comply with the recommendations for physical activity or not remains unclear. The review identified that both the TPB and the TTM frameworks include aspects that predicts exercise adherence in cancer patients, and thus contributes to the understanding of motivational factors of change in exercise behaviour in cancer populations. However, the strengths of predictions were relatively weak. More research is needed to identify predictors of greater importance.

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The Management of Crohn's Disease in Adults and Young People

The Management of Crohn's Disease in Adults and Young People

Tags: adults best practice children Chron's clinical Crohn's disease disease treatment treatment options Young People

The guideline offers best practice advice on the care of adults, children and young people with Crohn's disease. These are the first evidence-based clinical and cost-effectiveness guidelines for Crohn's disease in the United Kingdom.

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Clinical Nursing: Keeping Your Skills In-Tune 

Clinical Nursing: Keeping Your Skills In-Tune 

Tags: advocate clinical clinical experience dermatitis health care medical technology student nurse

The primary duty of every nurse is the assessment of a patient’s physical and emotional well-being. This basic-skill learned in the very first nursing class is the one skill and primary duty the nurse will use every day with his and/or her patients.

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Conducting Nursing Research 

Conducting Nursing Research 

Tags: medical technology nursing research

Evidence-based research by nursing professionals has played a major role in the advances of medical technology.

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Distress and Depression Among Bone and Marrow Transplant Patients

Distress and Depression Among Bone and Marrow Transplant Patients

Tags: BMT cancer patients depression distress patient care stress therapy treatment

Bone and Marrow Transplant (BMT) is a five step treatment process: screening, collecting, conditioning, infusion, and engraftment. Bone and marrow transplant treatment is very aggressive that creates significant physical, social, psychological, and emotional stress. During the treatment process, many BMT recipients experience and display a wide array of psychosocial disorders including distress, anxiety, and depression. The way an individual experiences and copes with the distress, anxiety, and depression contributes to the physiological, psychological, and psychosocial outcomes of BMT treatment.

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How Personal Digital Assistants Can Increase the Quality of Nursing Care Provided in the Hospital Setting 

How Personal Digital Assistants Can Increase the Quality of Nursing Care Provided in the Hospital Setting 

Tags: digital assitants health care medication medication errors quality of nursing

Personal Digital Assistants (PDAs), tools that have the potential to help nurses increase the quality of care that they provide in the hospital setting.

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Lung Cancer: A Case Study 

Lung Cancer: A Case Study 

Tags: cancer death end of life therapy treatment

Lung cancer is the number one cause of cancer-related death in men and the second most common in women. Lung cancer is responsible for 1.3 million deaths worldwide annually.

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Making a Difference: Recognizing the Risk of Alcohol and Benzodiazepine Use by Older Women 

Making a Difference: Recognizing the Risk of Alcohol and Benzodiazepine Use by Older Women 

Tags: aging benzodiazepine elderly Hallucinations health care health care professionals medication older women risk of alcohol

Substance abuse in the elderly, specifically abuse of alcohol and benzodiazepines, is much higher than most people may think. According to a recent article published by CNN, of the 25.6 million women over the age of 59, seven percent abuse alcohol and eleven percent abuse psychoactive drugs such as benzodiazepines (CNN, 1998).

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Pharmaceutical Counseling 

Pharmaceutical Counseling 

Tags: counseling health medication medication errors nurse pharmaceutical

1.5 million Americans are sickened, injured or killed by medication errors each year; seniors most at risk due to the polypharmacy risk factor. Adding pharmaceutical counseling to patients on four or more medications decreases the risk of medication errors

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The Healing Impact of Palliative Care Gerontology

The Healing Impact of Palliative Care Gerontology

Tags: comfort end-of-life care euthanasia palliative philosophy treatment

Palliative care is a philosophy and treatment to give an improved quality of life to those near the end of life and those with life-limiting conditions.

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Risperdal and Autism

Risperdal and Autism

Tags: autism autism spectrum disorder child treatment

Autism is a developmental disorder in children and continues through adulthood. Currently, there is no known cause or cure for autism. The Food and Drug Administration (FDA) approved the use of Risperdal for the treatment of aggressive behavior in autistic patients ages 5-16 years old.

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End-Of-Life-Care: Are Nurses Educationally Prepared? 

End-Of-Life-Care: Are Nurses Educationally Prepared? 

Tags: care comfort death end of life end-of-life care health medical technology nurse physical health spiritual-psychosocial health

End Of Life Care study in the RN Journal. Are nurses prepared to offer quality end-of-life care to patients and families?

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