NursingLink

Best Nursing Team 2010

Wed, 11 Nov 2009 17:46:21 -0800

What is Dystonia?

Mon, 09 Nov 2009 14:56:00 -0800

Dystonia is a neurological disorder characterized by over-activity of a specific group of muscles and/or muscle. It is the over-activity of these specific muscles that causes involuntary movements and tremors, sustained muscle contractions, and abnormal postures.

How is Dystonia Misdiagnosed?

Dystonia is misdiagnosed 90% of the time by clinicians. The involuntary movements and spasms caused by dystonia sometimes are attributed to stress, stiff neck, dry eyes, tics, or psychogenic disorders. A significant clue to dystonia lies in the fact that dystonia often increases during activity, stress and anxiety; but diminishes during relaxation and sleep. The disorder is touched upon in medical school but not really emphasized.

How Often Does Dystonia Occur?

It is estimated that 550,000 people have some form of dystonia in North America alone. However, this value does not take into account that dystonia can coincide with other medical conditions such as Parkinson’s disease, Essential Tremor, Multiple Sclerosis, Cerebral Palsy, or Wilson’s disease, among others. The actual number of people identified with dystonia may be over a MILLION, but current funding has not adequately included research that determines the actual epidemiology of dystonia.

Who Can “Get” Dystonia?

Anyone can develop signs and symptoms of the disorder. No one is immune to this disorder.

Symptoms of Dystonia

Dystonia doesn’t just come along overnight. It develops gradually. On rare occasions, dystonia may come on suddenly, but such reactions are more likely related to the taking of antipsychotic drugs by the patient. Early symptoms may include some of the following:

* blinking
* sensitivity to light
* eye irritation
* subtle facial or jaw spasms
* difficulty chewing
* changes in pitch of speech
* mild jerky head movements
* stiff neck or neck discomfort
* cramping of hands during writing
* cramping of legs

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According to NINDS, the initial symptoms may be very mild and only noticeable after prolonged exertion, stress or fatigue. More debilitating symptoms may follow, becoming more widespread and painful. Progressive symptoms may include:

* heavy blinking to the extent of functional blindness
* twitching
* twisting, turning, and pulling of the head known as torticollis
* speech and swallowing difficulties
* pain in the hand referred to as writer’s cramp
* difficulty walking
* spasticity

Causes of Dystonia

The onset of dystonia can be brought on in two different ways. Primary dystonia is believed to come from the abnormal function deep within the brain in a region called the basal ganglia. The basal ganglia control movement. When something goes wrong in the basal ganglia, dystonia may arise. Genetic research, according to NINDS, has revealed a possible gene mutation that causes some forms of dystonia. The secondary forms of dystonia can arise because of a number of different issues including:

* birth injury
* trauma
* toxins
* stroke
* other disorders like Wilson’s disease
* medications

While some forms of dystonia are known to be genetic, the role of environmental factors contributing or causing the disorder is being investigated. Some people who inherit a specific gene may develop a severe form of dystonia while others may demonstrate a very mild form of the condition. However, the specific nature of how the environment affects dystonia is unknown. NINDS says that dystonia can occur at any age depending on the form of the disorder. Some forms show up in early childhood, others in adolescence and middle and late age.

Gene Information : Dystonia Clinic website at: http://www.massgeneral.org/neurology/movement_disorders/dystonia/index.html

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Forms of Dystonia

The sustained muscle contractions of people with dystonia can cause twisting, repetitive movements and even unusual postures. According to the National Institute of Neurological Disorders and Stroke (NINDS), muscles in the arms, legs, neck or the entire body can be affected. Classifying dystonia is related to the part of the body affected. NINDS lists five different classifications. They are:

* generalized dystonia; affecting most or all of the body
* focal dystonia; affecting a specific part of the body
* multifocal dystonia; affecting two or more unrelated body parts
* segmental dystonia; affecting two or more adjacent parts of the body
* hemidystonia; affecting the arm and leg on the same side of the body

Some of the more common focal dystonias have their own names. They include:

* Cervical dystonia, also called spasmodic torticollis, or torticollis, is the most common of the focal dystonias. In torticollis, the muscles in the neck that control the position of the head are affected, causing the head to twist and turn to one side, or backwards and forward.
* Blepharospasm, the second most common focal dystonia, is the involuntary, forcible closure of the eyelids. The first symptoms may be uncontrollable blinking. Only one eye may be affected initially, but eventually both eyes are usually involved. The spasms may leave the eyelids completely closed causing functional blindness even though the eyes and vision are normal.
* Cranial dystonia is a term used to describe dystonia that affects the muscles of the head, face and neck.
* Oromandibular dystonia affects the muscles of the jaw, lips and tongue.
* Writer’s cramp is a dystonia that affects the muscles of the hand and sometimes the forearm, and only occurs during handwriting. Similar focal dystonias have also been called typist’s cramp, pianist’s cramp, and musician’s cramp.

Useful Downloads

Demystifying Dystonia: Your complete guide to information about dystonia, diagnosis, current treatments, resource listings with contact info including telephone numbers and addresses, and much more. (Download: PDF)

Dystonia, New England Journal of Medicine: The following file may sound a bit complicated from a medical standpoint, but it clearly describes the most recent views about dystonia in today’s current medical literature.

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New Info Cause- New Theory about Dystonia (2007)

Early symptoms may include loss of precision muscle coordination (sometimes first manifested in declining penmanship, frequent small injuries to the hands, dropped items and a noticeable increase in dropped or chipped dishes), cramping pain with sustained use and trembling. Significant muscle pain and cramping may result from very minor exertions like holding a book and turning pages. It may become difficult to find a comfortable position for arms and legs with even the minor exertions associated with holding arms crossed causing significant pain similar to restless leg syndrome. Affected persons may notice trembling in the diaphragm while breathing, the need to place hands in pockets, under legs while sitting or under pillows while sleeping to keep them still and to reduce pain. Trembling in the jaw may be felt and heard while lying down and the constant movement to avoid pain may result in TMJ-like symptoms and the grinding and wearing down of teeth. The voice may crack frequently or become harsh triggering frequent throat clearing and swallowing can become difficult and accompanied by painful cramping.

Electrical sensors (EMG) inserted into affected muscle groups, while painful, can provide a definitive diagnosis by showing pulsating nerve signals being transmitted to the muscles even when they are at rest. The brain appears to signal portions of fibers within the affected muscle groups at a firing speed of about 10 Hz causing them to pulsate, tremble and contort. When called upon to perform an intentional activity, the muscles fatigue very quickly and some portions of the muscle groups do not respond (causing weakness) while other portions over-respond or become rigid (causing micro-tears under load). The symptoms worsen significantly with use, especially in the case of focal dystonia, and a “mirror effect” is often observed in other body parts: use of the right hand may cause pain and cramping in that hand as well as in the other hand and legs that were not being used. Stress, anxiety, lack of sleep, sustained use and cold temperatures can worsen symptoms.

H1N1 (Swine Flu) Quiz

Sat, 07 Nov 2009 20:54:15 -0800

Do You Love Your Health Insurance?

Thu, 05 Nov 2009 17:25:59 -0800

Do You Love Your Health Insurance?

Thu, 05 Nov 2009 17:23:02 -0800

New Light on the Plight of Winter Babies

Wed, 23 Sep 2009 17:11:09 -0700

Living with Fibromyalgia

National Fibromyalgia Association — Sat, 15 Aug 2009 09:01:44 -0700

www.fmaware.org

Fibromyalgia (pronounced fy-bro-my-AL-ja) is a complex chronic pain disorder that affects an estimated 10 million Americans. While it occurs most often in women, it strikes men and children, and all ethnic backgrounds. For those with severe symptoms, fibromyalgia (FM) can be extremely debilitating and interfere with basic daily activities.

Diagnosis:

The FM diagnostic criteria, established by the American College of Rheumatology (ACR) in 1990, includes a history of widespread pain in all four quadrants of the body for a minimum duration of three months, and pain in at least 11 of the 18 designated tender points when a specified amount of pressure is applied.

Since people with FM tend to look healthy and conventional tests are typically normal, a physician knowledgeable about the disorder is necessary to make a diagnosis.

Physicians should rule out other causes of the symptoms before making a diagnosis of fibromyalgia.

Symptoms:

Although chronic, widespread body pain is the primary symptom of fibromyalgia, a variety of other symptoms are common in FM patients. Symptoms include: moderate to severe fatigue, sleep disorders, problems with cognitive functioning, IBS, headaches and migraines, anxiety and depression, and environmental sensitivities.

Research has documented neuroendocrine physiological abnormalities that may contribute to the symptoms.

Causes:

Recent research has suggested a genetic component. The disorder is often seen in families, among siblings or mothers and their children.

Fibromyalgia often occurs following a physical trauma, such as an acute illness or injury, which may act as a “trigger” in the development of the disorder.

Increasing attention is being devoted to the central nervous system as the underlying mechanism of FM. Recent studies have suggested that FM patients have generalized disturbance in pain processing and an amplified response to stimuli that would not ordinarily be painful in healthy individuals.

Treatment:

Since there is no known cure for FM, treatment focuses on relieving symptoms and improving function.

A variety of prescription medications are often used to reduce pain levels and improve sleep. On June 21, 2007, the U.S. Food and Drug Administration approved Lyrica (pregabalin) as the first drug to treat fibromyalgia. Cymbalta (duloxetine HCl) was approved in June 2008; and Savella (milnacipran HCl) was approved in January 2009.

Alternative therapies, such as massage, myofasical release, acupuncture, chiropractic, herbal supplements and yoga, can be effective tools in managing FM symptoms.

Increasing rest, pacing activities, reducing stress, practicing relaxation and improving nutrition can help minimize symptoms and improve quality of life.

National Fibromyalgia Association (NFA) is a nonprofit [501 (c) (3)] organization

http://www.fmaware.org/ (714) 921-0150

The Art and Science of Infusion Nursing

Fri, 14 Aug 2009 07:26:17 -0700

Diseases That Could Affect Your Preteen or Teen

Wed, 29 Jul 2009 19:20:00 -0700

Running on Empty: Understanding Compassion Fatigue

Françoise Mathieu, M.Ed., CCC. Compassion Fatigue Specialist — Fri, 24 Jul 2009 07:20:42 -0700

This is an excerpt of an article which was originally published in Rehab & Community Care Medicine, Spring 2007 and is reprinted with permission.

To view the article in its entirety, go to www.compassionfatigue.ca and click on Resources and links.

For comprehensive coverage of this topic, we recommend The Compassion Fatigue Workbook which can be obtained by visiting www.cfsolutionsbookstore.com

“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet” (Remen, 1996)

What is compassion fatigue?

Our primary task as helping professionals is first and foremost to meet the physical and/or emotional needs of our clients and patients. This can be an immensely rewarding experience, and the daily contact with patients is what keeps many of us working in this field. It is a Calling, a highly specialized type of work that is unlike any other profession. However, this highly specialised rewarding profession can also look like this: Increasingly stressful work environments, heavy case loads and dwindling resources, cynicism and negativity from co-workers, low job satisfaction and, for some, the risk of being physically assaulted by patients.

Compassion Fatigue has been described as the “cost of caring" for others in emotional and physical pain. (Figley, 1982) It is characterized by deep physical and emotional exhaustion and a pronounced change in the helper’s ability to feel empathy for their patients, their loved ones and their co-workers. It is marked by increased cynicism at work, a loss of enjoyment of our career, and eventually can transform into depression, secondary traumatic stress and stress-related illnesses. The most insidious aspect of compassion fatigue is that it attacks the very core of what brought us into this work: our empathy and compassion for others.

Who does it affect?

Compassion fatigue is an occupational hazard, which means that almost everyone who cares about their patients/clients will eventually develop a certain amount of it, to varying degrees of severity. Statistics Canada recently published their first ever National Survey of the Work and Health of Nurses (2005) which found that “close to one-fifth of nurses reported that their mental health had made their workload difficult to handle during the previous month.” In the year before the survey, over 50% of nurses had taken time off work because of a physical illness, and 10% had been away for mental health reasons. Eight out of ten nurses accessed their EAP (employee assistance program) which is over twice as high as EAP use by the total employed population. In addition, nurses reported on the job violence and were found “more likely to experience on the job violence than all other professions.” (ONA, 2006) A study of Cancer Care Workers in Ontario carried out in 2000 also found high levels of burnout and stress among oncology workers and discovered that a significant number of them were considering leaving the field: 50% of physicians and 1/3 of other cancer care professionals had high levels of emotional exhaustion and low levels of personal accomplishment. (Grunfeld 2000) Similar findings have been found among other helping professionals such as child protection workers, law enforcement, counselors and prison guards. (Figley, 2006)

Signs and Symptoms of Compassion Fatigue

Each individual will have their own warning signs that indicate that they are moving into the danger zone of compassion fatigue. These will include some of the following:

Exhaustion

Reduced ability to feel sympathy and empathy

Anger and irritability

Increased use of alcohol and drugs

Dread of working with certain clients/patients

Diminished sense of enjoyment of career

Disruption to world view, Heightened anxiety or irrational fears

Intrusive imagery or dissociation

Hypersensitivity or Insensitivity to emotional material

Difficulty separating work life from personal life

Absenteeism – missing work, taking many sick days

Impaired ability to make decisions and care for clients/patients

Problems with intimacy and in personal relationships

Drs Figley and Stamm have developed a Compassion Fatigue self-test called the ProQuol that can be taken online to assess one’s own level of CF. It is considered the most effective screening tool to date: www.isu.edu/~bhstamm/tests.htm. You can also access a very easy self-scoring excel version of it by emailing me at: thingy@aweber.com. I affectionately renamed the ProQuol “thingy” as I found the original name rather unwieldy.

For more....visit www.compassionfatigue.ca and click on Resources. The full article is available free of charge and is entitled "Running on Empty"

The Author

Françoise Mathieu is a Certified Mental Health Counsellor and Compassion Fatigue Specialist. She works individually with clients in private practice and offers workshops and consultation to agencies on topics related to compassion fatigue, wellness and self care. She is the author of The Compassion Fatigue Workbook, which was published in 2009 and can be ordered by going to www.cfsolutionsbookstore.com

Contact information:

Françoise: whp@cogeco.ca

www.compasionfatigue.ca

© Workshops for the Helping Professions, 2007

V. Quality Management And Legal Issues

Demetrice Lee — Tue, 21 Jul 2009 12:46:31 -0700

Lawsuit Prevention Tips

Common Issues in Lawsuits Against Healthcare Providers

Documentation

Reporting of incidents

Failure to follow hospital procedures

Failure to ensure patient's safety

Improper treatment and performance

Failure to monitor and to report

Improper use of medical equiptment

Improper disposal of hazardous material, ex. needles, gowns, and gloves.

Prevention Tips

Be conscious of actions that could result in lawsuits, and follow healthacare facilities procedures for properly disposaling and collecting blood, and other biohazardardous waste. The other main prevention tip, is to treat patients the same way your want to be treated, use the golden rule of common courtesy, when doing patient care, and you will fine that the patient day, and your's will have a great meaning.

Drug Calculations

Fri, 12 Jun 2009 07:16:05 -0700

Watch Out for Nurse Jackie

Suzanne Gordon — Tue, 02 Jun 2009 15:29:03 -0700

At the end of this week, Showtime airs its new series Nurse Jackie with actor Eddie Falco, morphed from Carmela on the Sopranos to an ED nurse. I just went on line and watched the first episode on my computer. So here’s my first impression. A lot of nurses won’t like Nurse Jackie. She takes uppers to keep herself going and pain pills because she’s got a back injury. She was an alcoholic. She’s married and has two kids and is having an affair with the hospital pharmacist. She forges a young man’s signature on his license so it looks like he was a voluntary organ donor. This she does after a cocky young doc doesn’t listen to her when she tells him the biker — who got hit by a car — is going to have a brain bleed. The doc blows her off and the kid dies. So it won’t be for nothing, she makes him a donor. When a prostitute is brutally slashed by a John, the woman slices off the man’s ear. The hospital saves the guy’s ear. Turns out the guy worked at the Colombian embassy and has diplomatic immunity. The cops bring him into the hospital to have his ear sewn back on and Jackie has to take care of him. He shows no remorse, for his act. Quite the contrary. He insists that the girl liked being carved up like a turkey. “What do you like?” he asks Jackie. Jackie flushes his ear down the toilet and steals his money to give to the biker’s pregnant girl friend. I can hear some nurses wincing — screaming even — at every one of these scenes.

But if you’re tempted to scream out, or protest the show’s depiction of nursing. Remember two things. First, this is television. Television has to be entertaining. To be entertaining there has to be drama, conflict, humor. And Nurse Jackie has it all, not to mention really good actors, acting and writing. This show could be called Doctor Jackie — or Jack — because on doctor shows, MDs also pop pills (think of House), have affairs, curse etc. They have messy lives –each and every one of them. But they are still brilliant in the OR, ED, on the floors. Which leads me to the second point you need to think about. Jackie is smart. She is no nonsense. She cares like most of the expert, smart nurses I know — without a shred of sentimentality. This is no inane smiling nurse (at least not in this first episode). She’s gritty, wry, and has seen it all. That hasn’t left her callous. Not a bit. It has left her worn out, but not burnt out. And that’s the most important thing. Plus, at least this first episode depicts a lot of what is real about nursing today. Nurses work too many hours — and it’s not just mandatory — they volunteer for it . Jackie pops pain meds because she injured her backat work. Six to 11 percent of nurses leave their jobs because of back, neck and shoulder injuries. I reccomend that nurses watch this show carefully. That their bottom line should be is Jackie smart, expert, feisty. The question is –what does she have in her brain? From what I saw on my computer screen the answer is — a lot. If the pattern of this first episode carries through then I think nurses should support Jackie. They should suggest themes for the show. They should use Jackie as an opportunity to raise critical issues about nursing with their friends and neighbors. They should write op-eds and letters to the editor to discuss the show.

But give Jackie a chance. And remember, this is TV land, not sugar and spice land. Jackie gives you an opportunity to talk about what nurses do — really. It gives you a chance to contradict the hearts and flowers image so many nursing organizations promote on Nurses’ Week. It gives you a chance to wear your brains not your heart on your sleeves and talk about the kinds of things nurses know and how smart and feisty they really are. Go for it!

Trends in Smoking Before, During, and After Pregnancy --- Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 31 Sites, 2000--20

Mon, 01 Jun 2009 08:45:46 -0700

6 Daily Habits that May Make You Sick

Fri, 29 May 2009 18:48:20 -0700

Breastfeeding in the United States: Findings from the National Health and Nutrition Examination Survey, 1999-2006

Mon, 18 May 2009 12:37:01 -0700

Heliox and Epinephrine Boost Response in Bronchiolitis

Fri, 24 Apr 2009 13:15:18 -0700

Acetaminophen Overdosage: Oral versus Intravenous Acetylcysteine

Fri, 24 Apr 2009 00:38:00 -0700

This topic is an actual presentation from a national conference conducted by Contemporary Forums and includes the streaming, synchronized audio with visual materials. CE Credit is optional.

Contemporary Forums: Providing Quality, Accredited Continuing Education to Thousands of Healthcare Professionals For More Than 25 Years and Now Offering both Live Conferences and Online Conference Content Via the Online CE Library.

Chest and Neck Trauma: Beyond the Usual

Fri, 24 Apr 2009 00:36:00 -0700

This topic is an actual presentation from a national conference conducted by Contemporary Forums and includes the streaming, synchronized audio with visual materials. CE Credit is optional.

Pulling the Information Together: A Case Study - The Patient with Aortic Disease

Fri, 24 Apr 2009 00:36:00 -0700

This topic is an actual presentation from a national conference conducted by Contemporary Forums and includes the streaming, synchronized audio with visual materials. CE Credit is optional.