Saturday, October 18, 2014

Paradigm Bytes October 2014

PARADIGM BYTES

Newsletter for Paradigm 97

October 18, 2014

PARADIGM DEFINED:
1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated.

Our website...... http://paradigm97.blogspot.com/Please copy, paste, and bookmark it.

MISSION STATEMENT

We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.


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SNIPPET

                                Why America’s Nurses Are Burning Out by Sanjay Gupta, MD
Dr. Sanjay Gupta is a practicing neurosurgeon and associate chief of neurosurgery at Grady Memorial Hospital and an assistant professor at Emory University Hospital in Atlanta. He is a columnist for Time magazine, a contributor to CBS News, and a chief medical correspondent at CNN.
Three out of four nurses cited the effects of stress and overwork as a top health concern in a 2011 survey by the American Nurses Association. The ANA attributed problems of fatigue and burnout to “a chronic nursing shortage.” A 2012 report in the American Journal of Medical Quality projected a shortage of registered nurses to spread across the country by 2030.
Work schedules and insufficient staffing are among the factors driving many nurses to leave the profession. American nurses often put in 12-hour shifts over the course of a three-day week. Research found nurses who worked shifts longer than eight to nine hours were two-and-a-half times more likely to experience burnout.

“Our results show that nurses are underestimating their own recovery time from long, intense clinical engagement, and that consolidating challenging work into three days may not be a sustainable strategy to attain the work-life balance they seek,” says study author Linda Aiken, PhD, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. ...
http://www.everydayhealth.com/news/why-americas-nurses-are-burning-out/
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A nurse wrote in to a list serve asking our member: Wendie for advice. She wrote:
"I'd like some input on an interesting situation I've encountered in two patients and also with my mother (all elderly).

In all 3 cases, dementia was present. Two of the three had a history of severe COPD.

Here's what happened: Every morning, these three individuals would awaken soaked in urine. They would require bathing from head to toe as well as linen change. In all three cases, the intake of fluid during the day was quite minimal (maybe 3 glasses of liquid) - certainly not enough to account for the
volume of urine that was being released at night.

One of the individuals is my current patient. I placed an indwelling catheter in her and the next morning her husband reported 1000 ml in the bag and she was soaked head to toe as well.

Seems like somewhere I have heard that if someone stops breathing at night, momentarily, urine is produced. I don't remember exactly what the mechanism is but I believe it has something to do with
the inhibition of ADH (anti-diuretic hormone). That in the case of undiagnosed sleep apnea, for example, if someone is getting up frequently to urinate in the night, it may be because
this person has sleep apnea and does not know it. He or she thinks she has a bladder or prostate problem but really has sleep apnea.

I'd appreciate any and all information about my case studies as well as inventive solutions. Thanks!
Wendie answered as follows: (I just love her inservices)
One classic cause for bigtime night diuresis is steroids. Are these old birds on any prednisone (or anything else
that promotes Na+/H2O retention) for their COPD/arthritis/other reason? The mechanism is that you retain a lot
of sodium and water with prednisone, which esp in old people with weaker hearts (including right heart failure
such as you see in COPD) tends to go extracellular in dependent areas all day long, due to increased venous pressure in those dependent veins, which makes for peripheral edema. Remember that you can have up to 10L
of extra fluid on board before edema is noticeable. This is one reason why they have fat feet when they go to bed, esp if they aren't that active during the day (as old ladies with COPD and/or dementia tend to be inactive/restrained, too).

So then you take one old bird with a lot of extra fluid on board and lie her down for the night. Venous pressure in legs goes down to next to nothing, increased intravenous venous volume makes for suppressing ADH production in lungs, better LV loading makes more BP, kidneys see more pressure and lower osmolarity and less AHD, and bingo! Lots of peeing. I'll bet that night-time urine has a specific gravity of close to 1.0001. You could check the one with the Foley for different SG during the day time and overnight, another clue.

You could do the quick and dirty check for CVP over the course of the day, including positional when they lie down at night (remember how to do that without an intravascular monitor? Hah! There IS some use for old knowledge!) Jugular venous distention is the way to do it. Most old ladies gave transparent enough skin that it's really easy to see the jugular unless they are really, really fat (another risk factor for immobility and not seeing edema). You should see the level fluctuate with respiration efforts.

The other classic cause for nocturnal diuresis is, of course, CHF, for more or less the same reason-- fluid retention in dependent areas during the day, then migration of this fluid into the vascular space when the legs are no longer dependent.

These are the folks for whom an afternoon nap with a hit of vitamin L (Lasix) (good dose in mg is age + BUN,
even if it is a joke in House of God) is a good idea. Also compression stockings, as much active leg movement as possible, to keep those dependent veins undistended and the lymphatics chugging along. Maybe a coupla hours in the late afternoon/dinner with compression booties would get the diuresis started before bedtime.
(Wendie added:  also, contact their physician)
 
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FROM A MEMBER

This was sent in by Laregis (Laura)...Thank you !
Dear Laura:
With the identification of the second case of Ebola virus in the U.S., which now also involves a healthcare worker, it is imperative that we all remain highly aware of early identification strategies, care practices, and the issues surrounding this virus. Promptly identifying those at risk for Ebola exposure and maintaining diligence in infection control policies are mandatory to provide a safe environment for our patients, ourselves, and the community at large.
Please familiarize yourself with the information provided on the Centers for Disease Control and Prevention (CDC) website:
The importance of us all consistently practicing safe care is vital. Thank you for your diligence.
Sharon Longton, BSN, RN, CNN, CCTC
ANNA President




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INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days
 


New capsule has potential to replace some injections Researchers at MIT and Massachusetts General Hospital have developed a drug capsule coated with tiny needles that can inject drugs directly into the lining of the stomach after the capsule is swallowed. In animal studies, the capsule delivered insulin more efficiently than injection under the skin, and there were no harmful side effects. Read more and watch a video. Access the study abstract.

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Breaking News on California Walnuts and Alzheimer's disease:

  • The new study states that eating walnuts regularly may have a beneficial effect in reducing the risk, delaying the onset, slowing the progression of, or preventing Alzheimer's disease [1]
  • Walnuts are nutrient-dense and provide not only antioxidants like flavonoids, ellagic acid, melatonin, gamma tocopherol and selenium, but also ALA, the plant-based omega-3 fatty acid [1]
  • That high content of ALA may be a contributing factor in improving behavior in an animal model of Alzheimer's disease; while most nuts contain monounsaturated fats, only walnuts consist primarily of polyunsaturated fat, of which ALA is 2.5 g [1]
Interested in learning more about walnuts and Alzheimer’s disease? Visit the California Walnuts Health Research page.
For more information, including recipes, please visit the California Walnut Commission at walnuts.org.

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Study links exercise to a lower risk of heart failure

Adults who got more than 60 minutes of moderate exercise or 30 minutes of vigorous activity daily reduced their risk of heart failure by 46%, according to a study that included almost 40,000 adults of all ages. The study was published in the journal Circulation: Heart Failure. HealthDay News(9/2)
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Motor vehicle safety for children:
10 minutes:
Length of time it can take for the inside temperature of a vehicle to heat up to 20 degrees hotter than the outside temperature
73%:
Percent of time child restraints are misused
13:
Children should ride in the back seat until they are at least 13 years old.
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Sierra Leone records 130 new Ebola cases during three-day lockdown
FREETOWN (Reuters) - Sierra Leone recorded 130 new cases of the Ebola virus during a three-day lockdown
and it is waiting for test results on a further 39 suspected cases, Stephen Gaojia, head of the Ebola Emergency Operations Centre, said on Monday.

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UK opens first clinic for child victims of female genital mutilation
LONDON (Thomson Reuters Foundation) - Britain's first specialist clinic for child victims of female genital mutilation (FGM) opened in London on Monday as part of a push to eradicate the illegal ritual in the country.

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Almost Everyone Needs a Flu Shot: CDC
Vaccine is safe, effective for those 6 months and older, experts say.
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Respiratory failure from a myasthenic crisis Laura Mcilvoy, PhD, RN, CCRN, CNRN
(Spo


"Nina R", age 36, is admitted to the medical unit with pyelonephritis. She states she has had a fever above 102° F, back pain, vomiting, and painful urination for the last 24 hours. Her urinalysis reveals bacteria. Admitting vital signs are blood pressure (BP) 140/82 mm Hg, heart rate (HR) 124 beats/minute, respiratory rate (RR) 28 breaths/minute, and arterial oxygen saturation ( 2) 94% on room air. In the emergency department, she received ciprofloxacin 400 mg I.V. You note that Ms. Robbins was diagnosed with myasthenia gravis 8 months ago and takes pyridostigmine 60 mg P.O. every 6 hours to improve muscle strength. But because of her nausea and vomiting, she has missed the last two doses ...
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Virtual Backtable 3.0 Could Be Breakthrough In OR Efficiency
Operating rooms continue to look for new ways to improve efficiency and trim costs.
Innovations in software have allowed ORs to accomplish this goal and the Virtual Backtable 3.0, (VBT) from S2 Interactive, Inc., could be the next information technology innovation that meets both objectives. VBT provides instant analytics with dashboard metrics and analysis of surgical instrument usage specific to doctors and procedures.
VBT was created by S2 Interactive CEO Larry Foster, a registered nurse who used his own experience in the OR to design a cost-efficient solution for a better, safer environment for the surgeon, technician and patient.
According to Foster, VBT allows hospitals to reach significant efficiencies associated with cleaning, sterilization and assembly of surgical trays, within 4-6 weeks of utilizing the software. Often, according to OR executives, only 30 percent of a surgical tray is used. Streamlined trays reduces wear and tear on unused instruments, and with a full surgical tray costing about $10,000, savings can be impressive. ...
https://mail.aol.com/38771-416/aol-6/en-us/suite.aspx



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Health literacy is essential to gain the most benefit from health care:
5th:
One out of fivadults in the U.S. read at the 5th grade level or below.
10th:
Average reaading-level grade of most healthcare materiesl
50%:
Estimated percentage of Hispanics with literacy problems
66%:
Percentage of adults in the U.S. age 60 or older who have inadequate or marginal literacy skills.


Documentation: You’ve got a lot to lose Leah Curtin, RN, ScD(h), FAAN
According to the Centers for Medicare & Medicaid Services, fraud is “the intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person.” Misstatements or omissions found by auditors are not necessarily fraud. In fact, they’re usually errors. Errors aren’t deliberate; fraud is. Fraud requires the intent to mislead. ...
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Problems with Privacy Leah Curtin, RN, ScD(h), FAAN
frequent misunderstandings about what the rules allow have been causing frustration, uncertainty, and anxiety in physician offices, clinics, hospitals, and even pharmacies across the country. Confusion (actual or intentional) over the rules has triggered a fresh round of acrimony over the issue of medical privacy, patient’s rights, and now even the Affordable Care Act (ACA)! ...
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Current topics in Safe patient handling and mobility

Lies we have been told about Sex ( I wasn't able to copy any text as a lead in)
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INQRI Study Shows Nursing Improvements Could Boost Outcomes for 7 Out of 10 Critically Ill Black Babies
Identifying the reasons for racial health disparities and ways to address them is a significant, complex challenge in health care. A new INQRI-funded study led by Eileen T. Lake, PhD, RN, FAAN and Jeannette A. Rogowski, PhD, provides insight into the issue of very low birth weight (VLBW) infants, who are disproportionately black, and finds that it’s not just their race that’s a factor in their health outcomes, it’s the quality of care at the hospitals where they’re born. The study was published in the journal Health Services Research.

The research team examined data on 8,252 VLBW infants in 98 Vermont Oxford Network member neonatal intensive care units (NICUs) throughout the country and the results of a survey of 5,773 NICU nurses. They found that nurse understaffing and practice environments were worse at hospitals with higher concentrations of black patients, contributing to adverse outcomes for VLBW infants born in those facilities. ...

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The U.S. Food and Drug Administration today approved Movantik (naloxegol), an oral treatment for opioid-induced constipation in adults with chronic non-cancer pain.
Opioids are a class of drugs that are used to treat and manage pain. A common side effect associated with the use of these drugs are that they reduce the gastrointestinal tract’s motility, making bowel movements difficult and causing patients to strain, have hard or lumpy stools or experience a sensation of incomplete evacuation. Movantik belongs to a class of drugs called peripherally acting opioid receptor antagonists, which are used to decrease the constipating effects of opioids.
“Supportive care products such as Movantik can lessen the constipating side effects of opioids,” said Julie Beitz, M.D., director of the Office of Drug Evaluation III in the FDA’s Center for Drug Evaluation and Research.
Movantik’s safety and effectiveness were established in two clinical trials of 1,352 participants who had taken opioids for at least four weeks for non-cancer related pain and had opioid-induced constipation. Participants were randomly assigned to receive 12.5 mg or 25 mg of Movantik or placebo (sugar pill) once daily for 12 weeks. The trials were designed to measure the change in the number of bowel movements per week from the start of the study.
Results of the first trial showed that 44 percent of participants receiving 25 mg of Movantik and 41 percent of participants receiving 12.5 mg of Movantik experienced an increase in bowel movements per week, compared to 29 percent of participants receiving placebo. The second trial showed similar results.
Common side effects of Movantik include abdominal pain, diarrhea, headache and the experience of excessive gas in the stomach or intestinal area (flatulence).
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Respiratory failure from a myasthenic crisis Laura Mcilvoy, PhD, RN, CCRN, CNRN
"Nina R", age 36, is admitted to the medical unit with pyelonephritis. She states she has had a fever above 102° F, back pain, vomiting, and painful urination for the last 24 hours. Her urinalysis reveals bacteria. Admitting vital signs are blood pressure (BP) 140/82 mm Hg, heart rate (HR) 124 beats/minute, respiratory rate (RR) 28 breaths/minute, and arterial oxygen saturation (Spo2) 94% on room air. In the emergency department, she received ciprofloxacin 400 mg I.V. You note that Ms. Robbins was diagnosed with myasthenia gravis 8 months ago and takes pyridostigmine 60 mg P.O. every 6 hours to improve muscle strength. But because of her nausea and vomiting, she has missed the last two doses ...
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CHICAGO --- The first blood test to diagnose major depression in adults has been developed by Northwestern Medicine® scientists, a breakthrough approach that provides the first objective, scientific diagnosis for depression. The test identifies depression by measuring the levels of nine RNA blood markers. RNA molecules are the messengers that interpret the DNA genetic code and carry out its instructions.
The blood test also predicts who will benefit from cognitive behavioral therapy based on the behavior of some of the markers. This will provide the opportunity for more effective, individualized therapy for people with depression.
In addition, the test showed the biological effects of cognitive behavioral therapy, the first measurable, blood-based evidence of the therapy’s success. The levels of markers changed in patients who had the therapy for 18 weeks and were no longer depressed.
“This clearly indicates that you can have a blood-based laboratory test for depression, providing a scientific diagnosis in the same way someone is diagnosed with high blood pressure or high cholesterol,” said Eva Redei, who developed the test and is a professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. “This test brings mental health diagnosis into the 21st century and offers the first personalized medicine approach to people suffering from depression.”
Blood test to diagnose depression Test identifies nine blood markers tied to depression; predicts who will benefit from therapy -
Researchers have developed a blood test to diagnose major depression in adults and to measure the effects of cognitive-based therapy. and access the study in Translational Psychiatry.
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Anyone who has ever been to a baseball game has undoubtedly heard the familiar lyrics, "Take me out to the ball game, take me out with the crowd..." However, I bet you never knew that this classic tune was created in 1908 when entertainer/songwriter Jack Norworth scribbled some lyrics on scrap paper during a train ride to Manhattan, New York.

Norworth later gave the lyrics to Albert Von Tilzer who composed the music, and the song went on to be published by the New York Music Company. "Take Me Out to the Ball Game" was a hit before the year was over! It took Norworth a total of 15 minutes to write a song that has been sung during the seventh inning stretch at nearly every baseball game in the country.
"You can learn little from victory. You can learn everything from defeat."

Christopher "Christy" Mathewson: (1880-1925), Major League Baseball player, pitcher for the New York Giants and Cincinnati Reds, one of the first five players elected to the Hall of Fame


                                                 RANDOM TIDBITS


The inventor of baseball is also credited with firing the first Union shot of Civil war.

The baseball tradition of spring training came about because in 1885 the Chicago White Stockings went to Hot Springs in Arkansas to prepare for the new season.

In July 1934, Babe Ruth paid a fan $20 dollars for the return of the baseball he hit for his 700th career home run.

In an effort to sell more licensed apparel, minor-league baseball teams were changing their names so often that the sport's governing body now limits franchises to team name changes every three years.

The first perfect nine innings baseball game was achieved by John Lee Richmond on June 12, 1880.

Baseball ended one of its oldest traditions in 1997 when inter league play begin for the first time. This means that teams from the American league can play National league teams during the regular season. The first inter league game was played on June 12, 1997.

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(1) Quiz Time
In patients with hemophilia, which of the following is among the first signs or symptoms of a joint bleed?
a. Redness of the joint area
b. Pain in the joint
c. Bruising of the skin around the joint
d. Edema of the joint
See answer at end of Newsletter.

Ebola cases could reach between 550,000 and 1.4 million by late January: CDC
(Reuters) - Between 550,000 and 1.4 million people in West Africa could be infected with the Ebola virus by January 20, 2015, according to a report issued on Tuesday by the U.S. Centers for Disease Control and Prevention (CDC).

The top range of the estimate, 1.4 million, assumes that the number of cases, 5,864 according to the count kept by the World Health Organization, is significantly underreported, and that it is likely that 2.5 times as many cases, or about 15,000, have in fact occurred.

CDC emphasized that the projections, based on an epidemiological model that takes into account how many people each Ebola patient eventually infects as well as other factors, are based on data from late August. They, therefore, do not account for the recently announced U.S. government Ebola relief effort, which includes sending 3,000 members of the armed forces to the stricken region and training 500 healthcare workers per week. ...
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USPSTF recommends wider STD screening for women
The U.S. Preventive Services Task Force is recommending that all sexually active women age 24 years and younger undergo screening for chlamydia and gonorrhea. The recommendations, published in Annals of Internal Medicine, also apply to older women who have previously tested negative but have developed new risk factors for these infections, as well as pregnant women who tested positive for chlamydia or gonorrhea in the first trimester and have been treated for three months. ...
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Current Topics in Safe Patient Handling and Mobility
A supplement to the September issue of American Nurse Today
To avoid injuring their patients and themselves, healthcare providers must get in the habit of using safe patient handling and mobility (SPHM) technology. In this supplement, national experts share their perspectives and best practices on topics ranging from dealing with bariatric patients, managing slings, and assessing a patient’s mobility to transforming the culture, building the business case for an SPHM, and developing a successful SPHM program. ...






This supplement was funded by an unrestricted educational grant from Hill-Rom. Content of this supplement was developed independently of the sponsor and all articles have undergone peer review according to American Nurse Today standards.

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The Role Telomeres play in our lives....A new study/ discovery

The tiny "caps" that keep our chromosomes from fusing together are also providing clues that could eventually lead to the achievement of one our nation's most important public health goals: extending good health well into old age.
To help understand the role telomeres play within the human body, it's useful to review some basic biology. All of the tissues within the human body are made up of individual cells. These cells contain chromosomes within their nuclei. Chromosomes are the packages that hold most of our DNA - the genetic instructions that tell the cell what to do.

To help understand the role telomeres play within the human body, it's useful to review some basic biology. All of the tissues within the human body are made up of individual cells. These cells contain chromosomes within their nuclei. Chromosomes are the packages that hold most of our DNA - the genetic instructions that tell the cell what to do.

Telomeres are repeating DNA sequences at the ends of the chromosomes. They do not contain any genetic instructions; they simply repeat a sequence of DNA over and over. When we are young, the telomeres are very long - they may contain as many as 20,000 base pairs of DNA. ...


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(2) Quiz Time:

The growth in the number of jobs for registered nurses from 2010 to 2020 is expected to be faster than average.
False

Answer at end of newsletter.
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Many Nurses Unprepared to Meet Dying Patients

Most nurses in their work care for patients who are dying. A study of more than 200 students has shown that many nurses in training feel unprepared and anxious when faced with the prospect of meeting patients during end-of-life care. Scientists from the Sahlgrenska Academy have interviewed 222 nursing students at the University of Gothenburg, the University of Skövde and the Ersta Sköndal University College. The interviews dealt with their thoughts about caring for dying patients, their ideas about how to support and meet the patient in dialogue, and their own feelings when faced with dying patients. ...
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Sure, sharks are fearsome killers, but then there are only 4 or 5 fatal shark attacks per year, while it is estimated that texting while driving kills 6,000 annually in the U.S. alone.

But what about less obvious dangers, like deadly plants?

RANDOM FACTS:


Giant Pitcher Plant

Discovered more than 5000 feet above sea level on Mount Victoria in the Philippines, the giant, carnivorous pitcher plant secretes a nectar-like substance to lure unsuspecting prey into a pool of enzymes and acid.Castor Bean Plant

Castor-bean plants can be purchased at just about any garden center, despite containing the deadly poison ricin.Western Water Hemlock

Deemed the most "violently toxic plant that grows in North America" by the USDA, the water hemlock contains the toxin cicutoxin, which wreaks havoc on the central nervous system, causing grand mal seizures--which include loss of consciousness and violent muscle contractions--and eventually death, if ingested.
White snakeroot

Every part of this perennial plant contains tremetol, an unsaturated alcohol that can cause muscle tremors in livestock before killing them.

Monkshood

The vibrant purple plant, commonly found in backyard gardens, is loaded with the poisonous alkaloid aconite, which tends to cause asphyxiation.

Common Bladderwort

This aquatic meat eater relies on several submerged bladders to capture prey such as tadpoles and small crustaceans. An unsuspecting passerby will brush against an external bristle-trigger, causing the bladders to spring open and capture it. Once inside, the victim dies of suffocation or starvation and then decays into a liquid that is sucked up by cells on the walls of the bladder.

Venus flytrap
With the ability to clamp shut in a half-second, the Venus flytrap's reaction time seems fit for the animal kingdom. Insects need to touch two of the flytrap's hairs consecutively in order for the plant to react, but the precise mechanism that shuts the trap remains unclear.

Angel Trumpet

The droopy, gorgeous angel trumpet, native to regions of South America, packs a powerful punch of toxins, containing atropine, hyoscyamine, and scopolamine.

Oleander

This extremely common evergreen shrub is one of the most poisonous plants in the world. The leaves, flowers and fruit contain cardiac glycosides, which have therapeutic applications but are likely to send someone into cardiac arrest should he eat part of the plant.

Mala Mujer

Mala mujer, which translates to "bad woman," can be found in parts of the southwest and Mexico and is covered with nasty thorns, which could be turned into makeshift barbwire if needed. The real danger, however, comes from the caustic, milky sap that can leak from the plant. The sap, a common feature among many plants in the Euphorbia genus, can cause painful skin irritations and unsightly discoloration.
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HUMOR SECTION

 

After a tiring day, a commuter settled down in his seat and closed his eyes.
As the train rolled out of the station, the young woman sitting next to him pulled
out her cell phone and started talking in a loud voice:
"Hi sweetheart.It's Sue. I'm on the train".
"Yes, I know it's the six thirty and not the four thirty, but I had a long meeting".
"No, honey, not with that Kevin from the accounting office. It was with the boss".
"No sweetheart, you're the only one in my life".
"Yes, I'm sure, cross my heart!"
Fifteen minutes later, she was still talking loudly.
When the man sitting next to her had enough, he leaned over and said into the phone,
"Sue, hang up the phone and come back to bed."
Sue doesn't use her cell phone in public any longer.
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Montana State Trooper ( a rerun of my fav joke)
 
In most ot the United States there is a policy of checking on any stalled vehicle on the highway when temperatures drop to single digits or below. About 3 A.M. one very cold morning, Montana State Trooper Allan Nixon #658 responded to a call that there was a car off the shoulder of the road outside Great Falls, Montana.
He located the car, stuck in deep snow and with the engine still running. Pulling in behind the car with his emergency lights on, the trooper walked to the driver's door to find an older man passed out behind the wheel with a nearly empty vodka bottle on the seat
beside him. The driver cam awake when the trooper tapped on the window. Seeing the rotating lights in his rearview window, and the state trooper standing next to his car, the man panicked. He jerked the gearshift into "drive" and hit the gas.



The car's speedometer was showing 20-30-40 and then 50 MPH, but it was still stuck in the snow, wheels spinning. Trooper Nixon, having a sense of humor, began running in place next to the speeding (but stationary) car. The driver was totally freaked, thinking the trooper was actually keeping up with him. This goes on for about 30 seconds, then the trooper yelled. "PULL OVER!"
The man nodded, turned his wheel and stopped the engine. Needless to say, the driver from North Dakota was arrested, and is probably still shaking his head over the state trooper in Montana who could run 50 miles per hour.

Who says troopers don't have a sense of humor?




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CEU SITES---(CME and CNE)

Those that are-----Free and Otherwise..........Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member.
Please follow me on Twitter as Dr Robert Hess.
Pay Only $34.99 for a full year of CONTACT HOURS
www.nurse.com for CNE offerings.



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WEBSITES/ LINKS

Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com.


This is an excellent nursing site, check it out:http://nursingpub.com/

Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell) Founder, Forum for Shared Governance
info@sharedgovernance.orgwww.sharedgovernance.org

Decubqueen's website: www.accuruler.com.
 
If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood



 Metric conversion calculators and tables for metric conversions:


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MEDICAL RECALLS

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Dobutamine Injection (250mg/20mL)/Hospira: Recall - Visible Particulates
ISSUE: Hospira, Inc. issued a nationwide recall to the user level for one lot of Dobutamine Injection, USP, 250 mg, 20 mL, Single-dose fliptop vial, (NDC 0409-2344-02), Lot 27-352-DK. (NDC and lot number can be found on the right-hand side of the primary label). This lot was distributed nationwide to distributors/wholesalers, hospitals and clinics from August 2013 through September 2013.
Risk factors associated with particulate and/or a glass defect include the potential for particulate to be injected, a breach of sterility/contamination of the vial contents, leakage of contents, and/or a delay in therapy. In general, injected particulate matter may result acutely in local inflammation, phlebitis, and/or low level allergic response through mechanical disruption of tissue or immune response to the particulate. If contaminated solution is used on a patient, this may potentially cause bacteremia, sepsis, septic shock and endocarditis, and death may result. Leakage may result in drug wastage, spillage onto equipment, flooring and personnel. If a defective vial is not detected until the point of care, there may be a delay in therapy. ...

Read the MedWatch safety alert, including a link to the press release, at:
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Eszopiclone Containing Sleep Aids: Drug Safety Communication - Can Cause Next-Day Impairment
ISSUE: FDA has notified health professionals and their medical care organizations of a new warning that the insomnia drug Lunesta (eszopiclone) can cause next-day impairment of driving and other activities that require alertness. FDA recommends a decreased starting dose of Lunesta to 1 mg at bedtime. Women and men are equally susceptible to impairment from Lunesta, so the recommended starting dose of 1 mg is the same for both. FDA approved changes to the Lunesta prescribing information and the patient Medication Guide to include these new recommendations

Read the MedWatch safety alert, including a link to the press release, at:

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The-frightening-truth-to-unsafe-injection Practices
Patients that receive an injection don’t expect to leave the hospital or clinic with a newly acquired infection, like hepatitis, yet that’s been happening with alarming frequency and the culprit may surprise you. The Statistics The CDC has identified the misuse of multi-use drug vials as the cause of at least 19 widespread infection outbreaks since 2007. These outbreaks involved both viral and bacterial pathogens, and they occurred both in hospitals and in outpatient settings like pain clinics, chemotherapy centers, etc. Going back even farther, to 2001, the CDC reports that over 150,000 patients had to be notified that they may have been exposed to a blood borne pathogen after receiving an injection or infusion from a potentially ...
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Three Infections You Should Worry About More Than Ebola

Our nation has been struck with Ebola fever— not literally, of course, but rather a rising tide of fear that the virus will sweep across the United States. In fact, since the first case cropped up in Texas, tracking Ebola has become something of an American obsession— and not a healthy one
So what should we be worried about? It’s tough to predict since it is the unpredictability of certain bacteria and viruses that often makes them so alarming, Schooley said. But there are some existing viruses and bacteria that pose an ongoing threat— and that you’re much more likely to catch than Ebola. ...
Influenza
The flu doesn’t have an exotic, tropical-sounding name— and we are able to vaccinate against it with some degree of efficacy. Yet it is still a major killer in the United States. ...
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from the members

This ad is from Decubqueen (Gerry)..........AccuRuler Accurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.

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DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views.
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THOUGHT FOR THE DAY


“How wonderful it is that nobody need wait a single moment
before starting to improve the world” -

Anne Frank

Correct answer: b. Pain is among the first symptoms of a joint or soft-tissue bleed. The patient may complain of pain in a localized area but lack outward signs of bleeding.




Hope to hear from you..... Frankie


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