Strictly Clinical

‘Tis the season…to immunize

For many nurses, August is a whirlwind of back-to-school activity. And it’s not just the crunch of shopping for school…

2009 H1N1 Flu – Situation Update

Each week CDC analyzes information about influenza disease activity in the United States and publishes findings of key flu indicators…

A little humor please

Laughter is a way of dealing with life’s stressors. Learning how to use humor to enrich our personal and professional…

A new oral anticoagulant hits the market

Pradaxa gives clinicians a new tool for preventing strokes and
blood clots in patients with atrial fibrillation. Learn how it works,
who’s eligible to receive it, and how to administer it.

A quantum life

Quantum theory explains how you create your life through what you choose to think, then intend and, ultimately, do.

A troubled life, a difficult death

Editor’s note: National Homelessness Awareness Week is November 10-18. Like many of our homeless patients, “Sarah” was a bundle of…

A woman’s worst enemy

Most women woefully underestimate their risk for heart disease. Although breast cancer gets more publicity, heart disease and stroke kill nearly 12 times as many American women. This article details gender-based differences in diagnosis, treatment, and prevention and discusses strategies to raise awareness of women’s cardiovascular risks.

abdominal aortic aneurysm

Abdominal aortic aneurysm

Recognize potential danger for a positive outcome. Takeaways:  Abdominal aortic aneurysm is a serious condition that requires prompt identification and…
absolute neutrophil count (anc)

Absolute Neutrophil Count

For a patient with cancer, the absolute neutrophil count (ANC) is a crucial lab value. Are you familiar with the two methods for calculating it?

Act fast against anaphylaxis

Anaphylaxis can kill within minutes unless the victim receives immediate treatment. Calling a rapid response team to the scene can avert disaster.

Acts of kindness

Many of us have lasting memories of a few special patients. For me, Joe is one of those patients. The…
Acute cardiac tamponade

Acute cardiac tamponade

Martin Pace, a 65-year-old man, is admitted with an inferior wall ST-segment elevation myocardial infarction and receives a permanent pacemaker…

Acute cardiogenic pulmonary edema

Quick action prevents respiratory failure. Takeaways:  Acute cardiogenic pulmonary edema occurs with reduced cardiac muscle efficiency. Decreased pump function results…

Acute flaccid myelitis

Nursing implications and public health Takeaways:  Acute flaccid myelitis (AFM) is a perplexing condition which, to date, has no concrete…
Acute hypopituitarism, healthcare, registered nurse, nursing, nursing journal

Acute hypopituitarism

Your recognition of troubling signs and symptoms results in prompt diagnosis and treatment. Takeaways: Hypopituitarism is the deficient secretion of…

Adult intussusception

Quick action ensures prompt diagnosis and treatment. Takeaways: Metformin-associated induced lactic acidosis (MALA) is a life-threatening condition that requires prompt,…

Advances in blood transfusion

Ongoing research, development, and vigilance initiatives are designed to make blood components safer and more easily available.

Adventures in virtual meetings

Tired of unproductive staff meetings held at inconvenient times? Had it  up to here with being interrupted when trying to express your opinion? Maybe it’s time to explore alternatives to the traditional in-person meeting. One hospital unit did just that, and their online meeting forum helped them create new protocols in record time.

Airway pressure release ventilation: A boost for spontaneous breathing

Many clinicians are using this mechanical ventilation mode to help reduce lung damage, pneumonia, and other complications of ventilation. Find out how it works, when it’s indicated, how it preserves spontaneous breathing, and why it reduces sedation requirements.

Amniotic fluid embolus

Amniotic fluid embolus

A team’s quick actions ensure a positive outcome.   Takeaways: After a patient is admitted with gestational hypertension, she experiences an…

An invitation to error

What happens when you’re short staffed and there isn’t anyone to help?

ANA comments on ACOs

In the political realm, there is intense debate on how to cut costs in the Medicare program without sacrificing services…

ANA Immunize resource

Click to visit www.anaimmunize.org, the American Nurses Association’s online immunization resource.

ANA urges nurses to volunteer before disaster strikes

In the aftermath of the Haiti earthquake on Jan. 12, many nurses felt the urgent need to jump on a plane and hit the ground in Haiti to help treat and comfort the survivors, but were not sure how to go about it.

Anaphylasxis_schoolnurse

Anaphylaxis in the school setting

Quick action results in positive outcome.  Takeaways: School mealtimes are important for socialization and nutrition, but food allergies can be…

Anatomy lesson 101

ANA’s National Center for Nursing Quality promotes nursing quality and patient safety while helping nurses advocate for themselves.

AnimalAssistants

Animal assistants in healthcare

An animal may provide just the benefit patients need. Prepandemic, I had the pleasure of traveling to the National Institutes…

Antibiotic stewardship

Every nurse has a responsibility to prevent antibiotic resistance. Takeaways: Nurses have a key role to play in preventing infections…
Aphasia

Aphasia: When speaking is hard

Imagine you are talking, and then suddenly you can’t. Your ability to communicate has paused. Over time, or in an…

Are 12-hour shifts safe?

Is working 12 consecutive hours in a fast-paced, high stress, physically and mentally demanding environment a good idea? Click here…

Are you an ABG ace?

Can you interpret arterial blood gas (ABG) values with confidence? To find out, test yourself with the case studies in this article.

Are you prepared for malaria?

Global traveling brings about 1,000 cases of malaria to this country each year. Don’t be caught off guard if you encounter it in your practice.

Astute assessment prevents paralysis

What seems like a simple pulled muscle to a shipping clerk turns out to be cauda equina syndrome, a potentially paralyzing injury that warrants immediate surgery.

Attitude: The power of human energy

Our thoughts, feelings, and disposition influence other people, not just because people see and read our facial expressions or body language, but because thoughts themselves are energy.

AWHONN releases new staffing guidelines

The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) recently announced that it has published new perinatal nurse staffing…

Be a myth-buster: Stop the misconceptions about fibromyalgia

Fibromyalgia produces many symptoms but no signs, so some clinicians dismiss it as a wastebasket diagnosis. But the pain is very real, and patients with fibromyalgia need you to understand their pain – and try to relieve it.

Be a myth-buster: Stop the misconceptions about fibromyalgia

Fibromyalgia produces many symptoms but no signs, so some clinicians dismiss it as a wastebasket diagnosis. But the pain is very real, and patients with fibromyalgia need you to understand their pain – and try to relieve it.

Being with Dying

Your most powerful message has nothing to do with words.

gift patient gratitude thanks acceptance

Beyond a box of chocolates

Often, patients and families express their gratitude for a special nurse’s outstanding care with spoken thanks or heartfelt commendations written…

Beyond customer service

Many nurses don’t like to hear their patients called “customers” or be told to provide “customer service.” This expert explains how to lose the lingo and adapt the principles of customer service to patient care.

Blood-borne pathogen exposure injuries

Healthcare workers are exposed to blood-borne pathogens through contaminated needlesticks, sharps injuries, and mucous membrane exposures to infectious blood or…
bradykinin induced angioedema

Bradykinin-induced angioedema

Quick treatment results in a good outcome. Takeaways: Angiotensin-converting enzyme inhibitors can increase the release of bradykinin, which can increase…

Breath at the belly

Mindfulness training can help nurses, patients, and loved ones cope with loss, grief, and suffering.

Brought to you by NDNQI: Data that do good

Thanks to the National Database of Nursing Quality Indicators, hospitals and nurses are capturing and converting into data what nurses actually do and how their actions affect patient care.

Calculating and interpreting the odds ratio

Researchers use the odds ratio to analyze which of two groups of individuals
is more likely to have an adverse outcome. Find out how to calculate the
odds ratio and interpret its significance

Calculating I.V. drip rates with confidence

Do you sometimes have trouble remembering the equation you learned for calculating I.V. drip rates? This article presents a simplified equation that can make calculations quicker and easier – whether the medication order is written for mcg/kg/minute, mcg/minute, or mg/minute.

Calculating I.V. drip rates with confidence

Do you sometimes have trouble remembering the equation you learned for calculating I.V. drip rates? This article presents a simplified equation that can make calculations quicker and easier – whether the medication order is written for mcg/kg/minute, mcg/minute, or mg/minute.

Calming a thyroid storm

Saving a patient’s life may rest on recognizing which findings are red herrings and which hold the key to the crisis.

Care during crisis

ANA brings nurses, experts together to shape practice policy during disasters

Care, not chaos

A new document created by ANA and other groups delineates emergency care principles for psychiatric patients.

Carrots and sticks

The Stick—penalties for excess readmissions Is your hospital on the list? Starting this month, over 2,200 hospitals are forfeiting up…

Cartoonist with a cause

The cartoons of Theresa Garnero, APRN, BC-ADM, MSN, CED, help patients cope with diabetes.

Case study: Coerced consent

“Coercion is commonly said to invalidate consent, and that is always true if the source of the coercion is the physician.

Case Study: How much is enough?

Three-year-old Christy* has been in the hospital’s pediatric intensive care unit (PICU) since birth, when she was diagnosed with McCune-Albright…
cauda equina

Catching cauda equina in time

Michael Smith, age 45, is admitted for lumbar laminectomy revision and fusion surgery. Despite his operative blood loss of an…

Catching on to C. difficle

Typically caused by antibiotic therapy, Clostridium difficile is now common in hospitals. Learn how to help stop the spread of this potentially fatal infection.

Cerebral Vasospasm

Cerebral vasospasm

Prompt recognition of subtle signs saves patient’s life. Key Points: Patients who experience an aneurysmal subarachnoid hemorrhage (aSAH) require frequent…

Challenging nursing’s sacred cows

Do you routinely instill normal saline solution into endotracheal tubes before suctioning? Use only the Glasgow Coma Scale for neurologic assessment? Evidence on these and other sacred cows of nursing practice might surprise you.

Chemical soup

ANA and state associations work to protect nurses and the environment from chemicals.

Clinical trials 101

Don’t miss the second in a four-part series on clinical trials written by nurses from the National Cancer Institute at the National Institutes of Health, which covers phases of clinical trials, informed consent, ethics, and more.

Closing in on the cause of agitation

When an elderly patient becomes confused and agitated, a careful history of recent procedures and medications points clinicians in the right direction.

Color awareness: A must for patient assessment

Color “blindness” may help minimize social and economic disparities, but can impede accurate patient assessment. The author explains why nurses should practice color awareness and tells how to adapt skin inspection for dark-skinned patients.

Coloring outside the lines

The Institute of Medicine’s Future of Nursing Initiative needs to create solutions that propel nursing and health care into the future.

Cornucopia

Food-and Americas’ overconsumption of it-have become public health issues. We need therapy for what one expert calls our “national eating disorder.”

covid 19 diagnostic testing

COVID-19 diagnostic testing

Nurse knowledge can improve test administration, ensure efficacy, and increase result accuracy Takeaways: • Three COVID-19 diagnostic testing methods are…

Creating a smooth move for patients and staff

When Missouri Baptist Medical Center had to relocate nearly 200 patients in a single day, staff and leaders knew collaboration and planning would be key. Here’s how they did it.

Cystocerebral syndrome

Rapid recognition leads to a quick reversal. Takeaways: Assess the full medical history of patients on admission, including bowel and…

Dealing with the dangers of dog bites

Dog bites can cause serious or even fatal injuries. Find out how to assess and intervene when your patient has been bitten.

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Dear Members of Congress

In an open letter to Congress, Dr. Cipriano urges legislators to leverage nurses’ knowledge, skills, and abilities to help bring order to a chaotic healthcare system.

Déjà vu all over again

Some people simply can’t learn from the past—even the fairly recent and painful past.

Delegating without doubts

With this decision tree as your guide, you’ll delegate tasks to assistive personnel with confidence.

dementia quiet thief nurse forgetful

Dementia: The quiet thief

The nurse’s note read, “not orientated to place and time due to dementia.” Several hours of general anesthesia for a…
denture-care-promotes-good-health

Denture care promotes good health

Advocate careful cleaning and storage.  Takeaways: Microbial plaque that accumulates on dentures may be harmful to oral mucosa and overall…

Derailing potentially deadly dehydration

When a dehydrated patient falls into a stupor and her vital signs head south, a rapid response team can help unit nurses stabilize her quickly – and avoid the semmingly inevitable.

Detecting cardiac injury with telemetry

With multi-lead telemetry monitoring, a nurse detects dangerous changes in her patient’s heart rhythm, permitting quick action before an acute MI does permanent damage.

Detecting dysphagia

It’s 8:00 am and time for your 83-year-old patient, Virginia Johnson*, to take her oral medication. She was admitted with…
Detecting, managing, and preventing pulmonary embolism

Detecting, managing, and preventing pulmonary embolism

Pulmonary embolism (PE) kills about 25% of those it strikes. This article explains how deep vein thrombosis (DVT) sets the stage for PE and describes how to assess, manage, and prevent both DVT and PE.

Detecting, managing, and preventing pulmonary embolism

Detecting, managing, and preventing pulmonary embolism

Pulmonary embolism (PE) kills about 25% of those it strikes. This article explains how deep vein thrombosis (DVT) sets the stage for PE and describes how to assess, manage, and prevent both DVT and PE.

Differences among physicians, risk managers in admitting errors

Differences in attitudes among physicians and risk managers about revealing medical errors to patients may diminish the effectiveness of such disclosures, according to a new study published in the March 2010 issue of The Joint Commission Journal on Quality and Patient Safety.

Dispelling pain myths

Read up on the latest evidence-based best practices in pain management.

Do you know which vaccines are recommended for special populations?

Pregnant and postpartum women, immunocompromised
children, and persons at high risk for flu-related complications have special immunization needs. Part of ANA’s Bringing
Immunity to Every Community campaign, this handout
explains how to help ensure that these vulnerable populations are protected.

Dodging a trach tragedy

When a patient’s O2 Sat falls and subcutaneous neck edema arises, adroit troubleshooting identifies the cause.

Does your workplace culture need CPR?

If you suspect your workplace culture is “ill,” assessment is a crucial first step. Using an established assessment tool can help ensure more thorough data collection.

Doing the most good

The Patient Protection and Affordable Care Act of 2010 provides many benefits.

Drugs and Devices Today

2/11/10 Recall of AEDs On February 3, Cardiac Science Corporation issued a recall for about 12,200 automated external defibrillators because…

Drugs Today – August 2008

Web Exclusive! An update of drug news, including alerts, approvals, and removals, at www.AmericanNurseToday.com/journal.

Drugs Today – November 2008

Web Exclusive! An update of drug news, including alerts, approvals, and removals at www.AmericanNurseToday.com/journal.

Drugs Today – Sept/Oct 2009

FDA warns against certain OTC nasal sprays Over-the-counter Zicam intranasal cold medications may cause long-term or permanent loss of the…

During an emergency: Be safe!

Thousands of accidental chemical spills and leaks take place in this country each year. Providing nurses with adequate first-receiver training can help ensure that we can care for contaminated patients without endangering ourselves.

Easing the way for the electronic health record

Pressure is building to develop a national electronic health record – and the nursing profession is playing a pivotal role in developing the standards needed to support it.

Emergency!

Our new crossword puzzle test your knowledge of medical emergencies.

Ending the cycle

Nurses nationwide work to eliminate partner violence.

Ensuring quality and saving time

The National Database of Nursing Quality Indicators&#174 tracks the care nurses provide, helping to improve nursing practice, patient outcomes, and the work environment.

health safety environment musculoskeletal disorder nurse

Environment, health and safety

ANA has been very concerned with and involved in the issue of ergonomic hazards as a health and safety concern…

Environment, health, & safety

With the growing reuse of single-use medical devices, ANA supports improvements in end-of-use product management and research on ethical and safety issues related to these devices.

Environment, health, & safety

Is widespread triclosan use leading to microbial resistance? ANA urges nurses to take a cautionary approach toward using triclosan-containing products at home.

Environment, health, & safey

Help reduce the toll of seasonal influenza by receiving, administering, teaching about, or encouraging seasonal influenza vaccination.

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esophageal

Esophageal varices

Quick action prevents a negative outcome.     Takeaways: Cirrhosis of the liver causes scaring, shrinking, and hardening. Complications of cirrhosis include…
faculty shortfall nurse

Faculty shortfall

Helen O’Shea, PhD, RN, hasn’t retired completely from her role as a nurse educator, and that is very fortunate, for…

Family initiated rapid response team

Rapid response isn’t just for staff. More hospitals are allowing, even encouraging, patients and their families to make the call for help.

FES

Fat embolism syndrome

Early identification prevents negative outcomes.    Takeaways: Fat embolism syndrome is a rare complication that can occur after traumatic orthopedic injuries.…
Fine-tuning your feeding-tube insertion skills - American Nurse

Fine-tuning your feeding-tube insertion skills

Even if you’re accustomed to inserting feeding tubes, the procedure can cause complications. The authors provide safety guidelines to help you make feeding-tube insertion safer.

Food in the fight against cancer: The evidence on cancer-related anorexia

Among the many treatments and supportive interventions for cancer, nurses and patients must not overlook a foundation of health—good nutrition. A proper diet during cancer treatment and beyond is essential for patients to feel better, have the strength needed to fight the disease, and maintain wellness.