| TRANSCEND |
Northeast
Georgia
Chapter
American
Association of Critical Care Nurses
Volume 2, Number 5
Autumn 2007 Editor: Dave
Esson daensg@hotmailcom
_______________________________________
_______________________________________
_______________________ _______ ___
Chapter Officers for this year UPCOMING EVENTS
Chapter officers for the upcoming year: Chapter
Meetings: Glenda Nottingham - President
7:30 - 9:30 pm Northeast Georgia Susan Fraser
- President-Elect Monday, October
8, 2007 Diane Haywood - Treasurer
Speaker - Paul Nelson, Laurelwood:
Dave Esson - Secretary
How to Deal with Aggressive Behavior in
Patients and Families
Free Educational Credits Home Sweet Georgia Gainesville
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Sponsored by Abilify
AACN has announced that they will now make all
of their CERP credits, through print journals and For
the most
up-to-date info, go to your
online articles, free to all members on an unlimited
Northeast Georgia chapter website:
basis Spread the word
wwwaacnorg, click Chapters, then
Northeast Georgia Chapter
Submissions to TRANSCEND Welcome
Please submit material for review to:
Non-Chapter Events:
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October 27, 2007 Durham, NC Integrating
Multiple Guidelines for CVD Risk Reduction
October 2007
Preventive Cardiovascular Nurses Association
Healthy Lung Month
Web-Based Smoking Cessation Support
November 2-4, 2007 Augusta, GA
American Lung Association
20th Annual Southern Region Burn Conference
800-423-4992 or
vickib@smaorg
November 2007
American Diabetes Month
November 5, 2007 Louisville, KY
American Diabetes Association
To Breath or not to Breath: Evidence Based
http://wwwdiabetesorg/homejsp
Ventilator Management and Weaning 2007
Sharon Ruhl 502-897-8832 sruhl@bhsicom
Pulmonary Hypertension Awareness Month
Pulmonary Hypertension Association
February 2-6, 2008
Honolulu, HI
http://wwwphassociationorg
37th Critical Care Congress
For further info: registration@sccmorg
March 28 - 31, 2008 Nashville, TN
American Association of Neuroscience
Nurses AANN
http://wwwaannorg/meeting/indexhtm
N E W S
from Hypertension: Journal of the American Heart Association
Research to Sink Your Teeth Into:
Dark Chocolate Reduces Blood Pressure, Improves Insulin
Resistance
If you have high blood pressure, a daily bar-sized serving of flavonol-rich
dark chocolate might lower your blood pressure and improve insulin
resistance, researchers report in Hypertension: Journal of the American
Heart Association Flavonoids are natural antioxidants found in many foods
from plants This study suggests that cocoa flavonoids appear to have
benefits on vascular function and glucose sensitivity
Although earlier studies have suggested that flavonoid-rich foods fruits,
vegetables, tea, red wine and chocolate, might offer
cardiovascular
benefits, this is one of the first clinical trials to look specifically at
dark chocolates effect on lowering blood pressure among hypertensive
people
For one week before starting the study, participants avoided all chocolate
and other flavonoid-rich foods During the next 15 days, half ate a daily
35-ounce bar of flavonoid-rich dark chocolate, while the other half ate
the same amount of white chocolate no flavonoids After another week of
avoiding flavonoid-rich foods, each subject crossed over and ate the
other chocolate None of the participants was taking antihypertensive
medicines, none had diabetes or other disease, nor did they smoke
The researchers found a 12 mm Hg decrease in systolic BP and a 9 mm Hg
decrease in diastolic BP in the dark chocolate group after 15 days Blood
pressure did not decrease in the white chocolate group
The researchers also found that the dark chocolate group also experienced a
significant reduction in several measures of insulin resistance compared to
the white chocolate group LDL cholesterol levels dropped by about 10
percent in the dark chocolate group, but stayed the same in the white
chocolate group
These results can generate
improved dietary recommendations that will help
people regulate these risk factors Its important to note that most
Americans eat milk chocolate, which is low in flavonoids, whereas dark
chocolate contains a high level of flavonoids Flavonoid-rich foods should
be part of an overall healthy diet, and that some dark chocolate could be
part of that effort, as well as fruits, vegetables, and whole grains
from the National Heart, Lung, and Blood Institute
Framingham: Higher Incidence of Metabolic Syndrome Among Adults Consuming
Soft Drinks
Middle-aged adults who drink more than one soft drink daily, either diet or
regular, have a 40 or more greater chance of either having, or developing,
metabolic syndrome, a cluster of conditions that increase the risk for
heart disease
A person is considered to have metabolic syndrome if he or she has three or
more of the following five risk factors: waist circumference ?35 inches
women or 40 inches men, fasting blood glucose ? 100 mg/dL,
triglycerides ? 150 mg/dL; blood pressure ? 135/85 mmHg, and HDL
cholesterol 40mg/dL men or 50 mg/dL women
These Framingham results, Soft Drink Consumption and Risk of Developing
Cardio-Metabolic Risk Factors
and the Metabolic Syndrome in Middle Aged
Adults in the Community, were published online in Circulation July 23,
2007
Other studies have shown that the extra calories and sugar in soft drinks
contribute to weight gain, and thus heart disease risk This study extends
the link to all soft drinks and metabolic syndrome Although the increased
risk of metabolic syndrome would be expected to be associated with high-
calorie, high-sugar regular soft drinks, the similar risk found among those
drinking diet sodas is more difficult to understand Dietary patterns were
noted to be similar among drinkers of both regular and diet soft drinks;
they also eat foods that are higher in calories and fat, and get less
physical activity
As reported in Diabetes Care, August 31, 2007: Tight insulin
control lowers resting heart rate
A high resting heart rate RHR is a risk factor for cardiovascular disease
in the general population and studies have reported a higher RHR in
individuals with type 1 diabetes
As part of the Diabetes Control and Complications Trial DCCT, 1,441 type
1 diabetic patients had their RHR measured every 2 years, for up to 8
years In a follow-up study to the DCCT
– the Epidemiology of Diabetes
Intervention and Complications EDIC study — RHR was measured annually
for 10 years Data analysis of both studies showed an association between
faster RHR and higher blood glucose levels
Type 1 diabetics who controlled their blood glucose within the normal range
had a lower heart rate than those with less than optimal blood glucose
control This effect occurred within 2 years after the start of the
intensive insulin treatment and persisted for at least 10 years after the
end of the treatment
Diabetic? Exercise-only Improves Sugar Control No Sweat
A US study has found that diabetics who attended classes to increase
exercise had more improvement than people who focused on medication and
diet modification The researchers considered data from over 10,000
subjects in 103 research reports
In studies that focused on exercise only, blood glucose improved twice as
much as it did in studies that focused on exercise, diet and medication
adherence
It also did not matter how overweight patients are or how poor their
current blood glucose was at the start of the studies, the improvements
from exercise were equal across the board, according to the study
published
in Diabetologia
It could mean that it is easier for people to focus on one thing at a time,
It is easy for people to get overwhelmed when asked to make too many
changes
Quick Micro Test Speeds VAP Therapy
as reported in Clinical Infectious Diseases, February 2007
Researchers in Madrid report that using a direct E-Test AB Biodisk method
produces faster results and improved outcomes compared to standard
procedures for guiding antimicrobial use in patients with ventilator-
associated pneumonia VAP The E-test involves direct placement of test
strips with six key antimicrobial agents on lower respiratory tract
secretion samples According to the researchers, the E-test obtains an
early microbiological diagnosis, making it possible to provide that
information in less than 24 hours
In addition to helping guide antimicrobial treatment, cost of antibiotics
was also decreased The E-Test group cost 666 euros versus 984 euros in the
control group There were no significant differences, however, in mortality
per episode, in the ICU or at hospital discharge
from National Heart, Lung, and Blood Institute Longer Treatment
Benefits Sleep Apnea Patients
Adults
with obstructive sleep apnea benefit significantly from longer
nightly use of continuous positive airway pressure CPAP, according to a
new study supported by the National Heart, Lung, and Blood Institute
NHLBI of the National Institutes of Health This is the first study to
identify the actual length of nightly CPAP use that is needed to gain
maximum benefit for daytime alertness and functioning
Canadian and US researchers studied 149 adults with sleep apnea to
determine how long they routinely used CPAP each night They were also
evaluated for daytime symptoms, like excessive daytime sleepiness, as well
as daytime functioning before treatment and after three months of CPAP
therapy The researchers found that most patients should use CPAP for at
least 75 hours each night in order to realize the greatest possible
benefits of therapy
Relationship Between Hours of CPAP Use and Achieving Normal Levels of
Sleepiness and Daily Functioning, is published in the June 2007 issue of
SLEEP
It is estimated that over 12 million adult Americans have sleep apnea, a
common disorder where the upper airway is intermittently narrowed during
sleep, causing breathing to be difficult or even completely
blocked The
CPAP mask is worn while the patient sleeps; it works by blowing just enough
air into the nose to keep the patients throat open
Because they often find it awkward, many patients do not use CPAP
consistently or for long enough periods while sleeping In the current
study, for example, patients used CPAP an average of about 5 hours a night
The researchers found that although daytime sleepiness could be improved
after 4 hours to 6 hours a night, depending on the measurement used,
functional status or quality-of-life improvements were maximized after 75
hours of use each night Although individual patient response to CPAP
therapy can vary, these latest findings provide a gauge to help clinicians
determine whether a patients use is optimal
Beware of Popcorn???
Microwave popcorn is a popular snack, but some questions have been raised
about the about whether this treat could be dangerous to something other
than your waistline
A chemical, diacetyl, that helps create microwave popcorns butter flavor
has been linked to serious health issues for workers who make the snack
Some of the workers have developed a potentially lethal lung disease,
bronchiolitis obliterans, also
called popcorn lung
Experts believe that diacetyl, when heated in a factory setting, produces a
toxic and potentially lethal gas Workers who mix the chemical as a liquid
or powder breathe in small amounts of this chemical
Flavoring manufacturers have paid more than 100 million as a result of
suits brought by workers affected by popcorn lung California is
considering a bill banning its use
Now the food is coming under scrutiny from those who want to be sure that
eating it at home is not a hazard The Food and Drug Administration has
never studied the effects of diacetyl For now, the focus of concern is
workplace exposure
from New England Journal of Medicine, March 2007: Vancomycin may trigger
low platelet count
The antibiotic vancomycin is often used in intensive care units as the drug
of choice to treat antibiotic-resistant staph infections Researchers at
the Medical College of Wisconsin in Milwaukee and the BloodCenter of
Wisconsins Blood Research Institute have linked vanco to thrombocytopenia
If accompanied by uncontrollable bleeding, thrombocytopenia can be fatal
Patients suspected of having thrombocytopenia can be tested for an antibody
to see if it is related to
medications For this study, the researchers
obtained clinical information on 29 patients who tested positive for
vancomycin-dependent platelet antibodies These patients were seen at major
US hospitals
A close correlation was found between exposure to vancomycin, development
of a vancomycin-dependent antibody, and the onset of severe
thrombocytopenia accompanied by serious bleeding in most cases Three of
the 29 cases described ended fatally, with serious bleeding as a possible
contributing factor
It is not widely recognized that vancomycin can cause thrombocytopenia For
that reason, it was continued in 15 of the 29 patients while other possible
causes for the low platelet count were investigated None of these patients
showed an increase platelet count until the vanco was D/Ced and an
alternative antibiotic started The vancomycin was stopped early in the
other 14 patients because it was suspected as a cause of the
thrombocytopenia These patients platelet counts rose to normal shortly
thereafter
In a separate study, the researchers found that 25 patients given
vancomycin who did not develop thrombocytopenia did not develop antibodies
Clinicians administering vanco should be alert to
the possibility that it
may cause severe immune thrombocytopenia A hematology consultant should be
considered if a patient develops a low platelet count while being treated
with the drug If theres a question, the physician should substitute
another antibiotic for vancomycin for a few days to see if the platelet
count improves
from the Society for Cardiovascular Angiography and Interventions:
Abdominal Artery Stenting Offers Safer, Simpler Treatment of Intestinal
Angina
A study reported at the 30th Annual Scientific Sessions of the Society for
Cardiovascular Angiography and Interventions SCAI, May 9-12, 2007, in
Orlando, FL, angioplasty and stenting of clogged abdominal arteries
successfully restored blood flow to the intestines and relieved painful
symptoms in more than 90 percent of patients, without major complications
Using the same catheter techniques used for coronary arteries,
interventional cardiologists are successfully treating chronic mesenteric
ischemia intestinal angina This can often be done as an outpatient
procedure, as is often the case with cardiac catheterizations
The tricky part in chronic mesenteric ischemia is obtaining an accurate
diagnosis Nausea,
vomiting, or pain after eating are common symptoms, but
are often mistaken for gallbladder disease or gastroenteritis Eventually
they may fear eating and lose large amounts of weight Surgery for this
condition results in death in up to 15 percent of patients, partly because
its a complex four to eight hour surgery By the time diagnosis is
finally made, patients are often debilitated In about one-third of
patients, the diseased artery suddenly becomes completely blocked, gangrene
develops in the bowel, and infection spreads throughout the body Over half
of such patients die, even with surgery
Abdominal artery stenting typically involves passing a catheter from the
femoral artery up through the abdominal aorta and into the arteries
supplying blood to the intestines In some cases, the catheter was
introduced into the brachial artery in the arm and passed downward through
the aorta A balloon was inflated to expand a large bare metal stent, which
was left in place to prop open the artery at the site of the blockage
Angioplasty and stenting were successful in 96 of the studys patients,
without major complications More than 90 reported relief of abdominal
pain, and a similar percentage
reported gaining weight Nineteen percent
later developed renarrowing of the stented artery Of these, 92 had repeat
procedures to reopen the artery, including laser treatment At 1 year, 91
of patients were alive and free of symptoms Two- and 3-year symptom-free
survival rates were 88 and 82, respectively
PUZZLE PAGE
CRYPTOGRAM
Can you solve this cryptic message? The solution, of course, is available
on the website for the Northeast Georgia AACN Chapter For your
convenience, a grid is provided below that may help you Youll notice
that one letter has been given to you as a freebie
B R A D E S D E Y A K U P H U E S P U R N P O O F N E S Y
B R U G
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E O D P L Y K E U G R K L D E Y A - Y I N Y J U B V R K T
O Y A
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R U A U V H Y, A E S Y B R K Y A R S J V E M Y B R U G
P L Y
_ _ _ _ _ _ _, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ A _ _
C H U E K O Z R F U G Y L V P J Y A
B Y V Y L E E D R
K U G Y
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_ _ _ _ _ _ _
X R V A U J O P N Y - P C R L P R O M P K C H V Y K D Y P V
P C C Z
_ _ _ _ _ _ _ A _ _ - A _ _ _ A _ _ _ A _ _ _ _ _ _
_ _ A _ _ _ _ _
A B C D E F G H I J
K L M
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N O P Q R S T U V W
X Y Z
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T H E F U N N I E S
The Coincidental Nurses from REALNURSEnet
Tina Dye went to nursing school in Creston Iowa - and thats fine But we
heard she was looking at working
in mental health - with suicidal people
Eliza Katherine Gallagher works in Emergency Her friends call her Kate,
but when she initials a chart, shes EKG
Darcy Tuttle regularly signs charts with her initials - DDT
If your name was
Diana, and you worked in the ER would you let people
call you Di?
Isobel Risk, who teaches the HIV module in Scotland, signs off as I Risk
An Emergency Department in Birmingham boasts a Nurse Payne
Nurse Hacker scrubs regularly in a London Operating Department
Sister DeAth walks the corridors of a hospice in Victoria
Does Annie Beaver still work in LD in New York?
Dr Hui pronounced Wee is a urologist whose wife, a nurse, works as his
office manager
Her name is Pi pronounced Pee Nurse Cox works for a different team
Mrs Ake, a retired RN, was a specialist nurse in rheumatology
Kathy Foley was the head of the Catheter Insertion Team back in the olden
times when there was such a thing
Chris Feely always favoured complementary therapies - especially
therapeutic massage, while Nurse Fang was
more at home with Cosmetic Surgery
Ed worked with a nurse, who was a nun, whose last name was Fuchs He did
not know how to pronounce her
name - so he asked her And regretted it
Mary Slaughter could never get a post on the Surgical Unit, and Nurse Cutts
was never the First Pick Midwife
Sister Smallbones ran an orthopaedic ward in Stevenage
RN Melina works in Endoscopy Unit or is that
not for real? and Nurse
Nurse - shes in a Float Pool
——-Youve met the Coincidental Nurses - but have you heard about the
Coincidental Doctors?
In Lynchburg, VA there are two dentists named Dr Pinch and Dr Hurt In
Roanoke, VA there is a gynecologist named Dr Clapp
You think these really are coincidences?
There is a Neurologist in St Louis named Dr Richard Head, and Dr Weiner
has selected a career in Urology Meanwhile, Blytheville AR has a
Dr Yao, who is an orthopedic surgeon
There is an orthopedic specialist in Southwestern Iowa named Dr Bonebreak
There is an orthopaedic surgeon working at St Jamess Hospital in Leeds who
rejoices in the name of Mr Limb - and a Urologist in Bedford Mr
Waterfall
How bout the doctor who worked in palliative care Dr Gonna
Orthopedic surgeon Dr Richard Bohn works in Kansas City, while Dr Ginger
Breedlove, in Planned Parenthood But Dr Hartsuck, a
cardiologist, works in another city
Alice Springs Hospital has a Doctor Butcher who calls him self just that
But a German surgeon in Jacksonville, Dr Butcher, prefers to
be pronounced boo - ker?
YOU MIGHT BE AN ER NURSE
IF
Your idea of a good time is a full arrest at shift change
You believe a good tape job will fix
anything You
have the bladder capacity of five people
You can identify the positive teeth to
tattoo ratio
You find humor in other peoples stupidity
You want lab to order a dumb-ST
profile
You believe in aerial spraying of Prozac
You believe the waiting room should
be equipped with a valium fountain
Discussing dismemberment over a gourmet meal seems perfectly normal to
you You disbelieve 90 of what you
are told and 75 of what you see
You have your weekends off planned for a year in advance
You believe that shallow gene pool
should be a diagnosis
You have discovered a new condition that you call hypo-xanax-emia
You believe that the
government should require a permit to reproduce
You plan your dinner break while lavaging an overdose
patient
You believe
that unspeakable evils will befall you if the phrase wow, its really
quiet is uttered You refer to Friday as NH Dump
Day and you dont mean New Hampshire
You say to yourself great veins when looking at
complete strangers You have
ever referred to someones death as a transfer to the eternal care unit
or as a celestial transfer You have ever answered a
lost condom phone call
Youve ever had a patient look you straight in the eye and say I
have no idea how that got in there Youve ever
had a patient say, But, Im not pregnant; I cant be pregnant; how can
I be having a baby? You refer to someone
in severe respiratory distress as a smurf
Your idea of a good time is dueling shock rooms
You have ever had to
leave a patients room before you begin to laugh uncontrollably
You have ever referred to the ER Doc or triage
nurse as a S@T magnet You
think that caffeine should be available in IV form
Your most common assessment question is
what changed, —tonight, to make this an emergency after six hours,
days, weeks, months, years?
Youve
witnessed the charge nurse muttering down the hallway whos in charge of
this mess anyway? You have been exposed to so
many x-rays that you consider radiation a form of birth control
You believe your patient is demonically possessed
You
know the phone number to the local Detox Center by heart
You have ever had a patient control his
seizures when offered some food
You carry your own set of keys to the leathers
Your idea of gambling is not a football
pool, its an ETOH level pool
You play poker by betting ectopics on EKG strips
Your idea of fine
dining is anywhere you can sit down to eat
You have a special shrine in your home to the inventor of
Haldol You have
recurring
nightmares about being knocked to the floor and run over by a
portable x-ray machine Your nursing
shoes have been seized and quarantined by either the CDC, OSHA, the EPA, or
the Nuclear Regulatory Commission
Your immune system is so well
developed that it has been known to attack squirrels in the backyard
Youre able to tell the difference between a medical order
and the ground around a poultry farm You
have every referred to subcutaneous air as Rice Krispies
Youve ever had to contend with
someone who thinks constipation for 4 hours is a medical emergency
Youve ever entered a patients chief complaint as Im drunk
You refer to motorcyclists as organ donors
Youve ever had a patient with a nose-ring tell you Im afraid of
shots
Youve ever referred to a body bag as a To Go bag
You think OD instead of BBQ when asked to get
the Charcoal
Youve identified the ULTIMATE Cruel Practical Joke: Get someone drunk,
then take them to the ER and announce that theyve overdosed on
some kind of pills just prior to
arrival
Youve ever heard the radio report from the ambulance and put the morgue
bag on the cart before the patient arrives
You have four categories of patientsurgent, emergent, non-emergent,
and SIO sleeping it off
You dont have to ask frequent flyers any medical history because you
can fill it out from memory
You can keep a straight face as the patient responds Just two beers
| TRANSCEND |
Northeast
Georgia
Chapter
American Association of Critical Care Nurses
PO Box 907761 Gainesville Ga 30501
CHAPTER OFFICERS please contact us with questions or comments
President Glenda Nottingham GlendaNottingham@nghscom
President-Elect Susan Fraser Susanfraser@nghscom
Treasurer Diane Haywood Dianehaywood@nghscom
Secretary Dave Esson daensg@hotmailcom
Membership Chair Malissa Hill mpolarbears1234@aolcom
Photography Dianne Haywood Dianehaywood@nghscom
Website Manager Dave Esson daensg@hotmailcom
Source:usmc-mccs.org
