Latest Comments by NRSKarenRN

NRSKarenRN, BSN, RN Moderator 147,817 Views

Joined Oct 10, '00. NRSKarenRN is a PI Compliance Specialist, prior Central Intake Mgr Home Care Agency. She has '35+' year(s) of experience and specializes in 'Home Care, VentsTelemetry, Home infusion'. Posts: 27,404 (22% Liked) Likes: 13,606

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  • 5

    Thanks for being a patient advocate, your actions were appropriate to acheive adequate pain control. I've cared for hundreds of patients with Sickle Cell Disease.... they are admitted often for pain management and hydration, many with vaso-occlusive disease causing cell and bone death, which many nurses don't understand. Following article informative of this disease.

    Sickle patients best managed by Hematologist. Having a pain management + care plan for handling acute crisis as part of patients medical record is best practice these days.

    American Academy Family Physicians.
    Approach to the vaso-occlusive crisis in adults with sickle cell disease

    ...the vaso-occlusive crisis, or sickle cell crisis, is initiated and sustained by interactions among sickle cells, endothelial cells and plasma constituents.1 vaso-occlusion is responsible for a wide variety of clinical complications of sickle cell disease, including pain syndromes, stroke, leg ulcers, spontaneous abortion and renal insufficiency.

    a vaso-occlusive crisis is initiated and sustained by the interaction among sickle cells, endothelial cells and plasma constituents. clinical complications include pain syndromes, stroke, leg ulcers, spontaneous abortion and renal insufficiency.

    acute pain in patients with sickle cell disease is caused by ischemic tissue injury resulting from the occlusion of microvascular beds by sickled erythrocytes during an acute crisis. chronic pain occurs because of the destruction of bones, joints and visceral organs as a result of recurrent crises. the effect of unpredictable recurrences of acute crises on chronic pain creates a unique pain syndrome.2,3

    acute bone pain from microvascular occlusion is a common reason for emergency department visits and hospitalizations in patients with sickle cell disease.4 obstruction of blood flow results in regional hypoxemia and acidosis, creating a recurrent pattern of further sickling, tissue injury and pain. the severe pain is believed to be caused by increased intramedullary pressure, especially within the juxta-articular areas of long bones, secondary to an acute inflammatory response to vascular necrosis of the bone marrow by sickled eythrocytes.5 the pain may also occur because of involvement of the periosteum or periarticular soft tissue of the joints.

    the approach to pain control must include measures to treat acute pain crises, prevent future vaso-occlusive crises and manage the long-term sequelae of chronic pain that can result from multiple recurrent bony infarction....

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    Christy1019 and AJJKRN like this.

    German nurse charged with 97 more murders

    By Sheena McKenzie and Stephanie Halasz, CNN

    Updated 5:10 PM ET, Tue January 23, 2018

    (CNN)A German nurse who allegedly killed his victims out of boredom has been charged with 97 murders, potentially making him one of the country's deadliest serial killers.

    The nurse, Niels Hoegel, was already serving a life sentence for six convictions for homicide and attempted homicide. He was charged with another 97 murders Monday, prosecutors said in a press release.

    He is accused of giving victims various non-prescribed drugs in an attempt to show off his resuscitation skills to colleagues and fight off boredom.

  • 14

    US needs to expand Program of All-Inclusive Care for the Elderly to ALL states:
    Program of All-Inclusive Care for the Elderly |

    The Programs of All-Inclusive Care for the Elderly (PACE) provides comprehensive medical and social services to certain frail, community-dwelling elderly individuals, most of whom are dually eligible for Medicare and Medicaid benefits . An interdisciplinary team of health professionals provides PACE participants with For most participants, the comprehensive service package enables them to remain in the community rather than receive care in a nursing home. Financing for the program is capped, which allows providers to deliver all services participants need rather than only those reimbursable under Medicare and Medicaid fee-for-service plans. PACE is a program under Medicare, and states can elect to provide PACE services to Medicaid beneficiaries as an optional Medicaid benefit. The PACE program becomes the sole source of Medicaid and Medicare benefits for PACE participants.
    In PA/NJ/DE program is called LIFE (Living Independence for the Elderly)

    LIFE is an option that allows older Pennsylvanians to live independently while receiving services and supports that meet the health and personal needs of the individual.

    Living Independence for the Elderly (LIFE) is a managed care program that provides a comprehensive, all-inclusive package of medical and supportive services to help keep a person living in own home/apt. PA has 35 programs throughout the state. Our health system is largest provider of LIFE care throughout the US. Through this program, my father was able to live at home for 2 1/2 yrs until no longer safe to be alone at night due dementia.

    Services provided in own home or at Adult Daycare Center include:

    Medical Services

    • Primary care and physician specialist services
    • Nursing care
    • Prescribed medications
    • Physical, occupational and speech therapies
    • Dental care
    • Vision care
    • Hearing care
    • Foot care
    • Medical equipment
    • Personal emergency response systems
    • Mental health services
    • Hospital services
    • Nursing home care (if it becomes necessary)

    Support Services

    • Light housekeeping, laundry, cooking and help with bathing and dressing
    • Meal planning and nutrition
    • Spiritual counseling
    • Personal care assistance
    • Medication management meds provided without copay.

    Transportation is provided to daycare centers and to medical appointments.

    There are income levels under Medicare/Medicaid programs with private pay option available.

    Find a PACE Program in Your Neighborhood | National PACE .

  • 0

    Public Health Response to Severe Influenza

    1/16/18 at 1PM
    CDC Grand Rounds Live Web stream

    The topic for CDC's Public Health Grand Rounds on January 16 will now focus on influenza. With the spike in flu cases around the country, this Grand Rounds will provide key and timely information for public health professionals on how to reduce the spread of seasonal flu in communities and adjust to spot shortages in antiviral drugs because of high influenza activity in some areas.

    To date, this influenza season is notable for the sheer volume of flu that most of the United States is seeing at the same time which can stress health systems. The vast majority of this activity has been caused by influenza A H3N2, associated with severe illness in young children and people 65 years and older.

    Join us for this session of Grand Rounds to learn what steps can be taken to reduce the spread of flu in communities and adjust to spot shortages in antiviral drugs in some places experiencing high influenza activity.

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    CNN posted 1/15/17: CDC postpones session on nuclear disaster response; instead having ground rounds on the severe Flu Epidemic

    CDC postpones session on nuclear disaster response

    CDC: Public Health Response to Severe Influenza

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    tnbutterfly likes this.

    I took the opportunity to attend the premiere of the film May 8th, 2014 in Silver Springs MD, bringing my friend Elaine. What an inspiring night that was, re-igniting out nursing passions.
    Meeting Carolyn and getting my copy "The American Nurse" book (given to me by my staff) signed by her and the nurses featured in the film was a highlight of 2014.

    Carolyn's ability to capture nursing's essence in such a wide variety of nursing settings is truly amazing and unsurpassed in nursing's history.


    Previous threads:

    Documenting our nursing stories: The American Nurse Project- now film

    Film:The American Nurse Healing America May7th premiere ="Bedside Nursing Rock Stars

    For anyone feeling unappreciated, questioning why they chose nursing profession or facing burnout, visit the The American Nurse Project website to see interviews, view the books photo collections and learn more about the nurses behind the amazing photographs.

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    poppycat, rn1965, traumaRUs, and 3 others like this.

    Do not contact your employer. American Association of Nurse Attorneys may be able to assist you in seeking council.

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    Mothers side of the story:

    Mother calls hospital "callous and heartless" for leaving her daughter in the cold

    ....According to Cheryl, Rebecca was diagnosed with mental illness - bipolar schizoaffective disorder - when she was 16 years old, and also has Asperger's syndrome, a form of autism. Rebecca lived in a residential youth program called Pathways from the time she turned 18 until Christmas Eve, when she was discharged for not taking her medication.

    "She has to be on meds, otherwise she has psychosis," Cheryl said. "She will have, uh, a manic episode."

    Cheryl says she has been trying to get legal guardianship of her adult daughter to gain control of her medication, housing and Social Security. But because of HIPAA patient privacy laws, she says doctors will not speak with her.

    "This is a byproduct of what the mental health system is," she said. "I cannot get any help for my daughter."...

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    Lack of compassion for troubled patient...University of Maryland Medical Center investigation underway. Karen

    From CNN
    Patient left at cold bus stop at night, wearing only a hospital gown

    A viral video of a recently discharged patient left at a bus stop at night in Baltimore has inspired widespread outrage and prompted an investigation at the hospital where she was treated.The video is distressing to watch -- both for its content and for the questions it raises about the events leading up to it.
    A young woman, wearing only a hospital gown and socks, is left standing by a bus stop Tuesday night or early Wednesday as four men in uniforms, possibly security guards, walk away. The man who filmed it, Imamu Baraka, follows them as they leave the stop with an empty wheelchair.
    "Wait, so you all are just going to leave this lady out here with no clothes on?" he says. "That is not okay."
    One of the men replies it was "due to the circumstances of what happened."
    The young woman barely speaks and seems dazed, occasionally crying out. Baraka urges her to sit at the bus stop, where two plastic bags full of the woman's belongings lie on the ground next to a pair of shoes. As she approaches the cold bench, the thin gown exposes her bare skin.

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    AJJKRN likes this.

    USA Today
    Jan. 6, 2018

    Millennials flock to nursing, staving off shortage

    INDIANAPOLIS - Millennials are saving the nursing profession.

    Facing a potential shortage due to Baby Boomers retiring, nursing has welcomed an unexpected surge of Millennials entering the field.

    Those Millennials are nearly twice as likely to be nurses as their grandparents' generation, the Baby Boomers, a recent Health Affairs study found. This trend has averted a potential workforce crisis and has implications for the future of nursing, said David Auerbach, one of the authors of the study.

    "Definitely the composition of the workforce is shifting. In just a few years there will be more Millennials than Baby Boomers in the nursing workforce," he said.

    Health Affairs Oct. 2917

    Millennials Almost Twice As Likely To Be Registered Nurses As Baby Boomers Were

    David I. Auerbach, Peter I. Buerhaus, Douglas O. Staiger

    Baby-boomer registered nurses (RNs), the largest segment of the RN workforce from 1981 to 2012, are now retiring. This would have led to nurse shortages but for the surprising embrace of the profession by millennials-who are entering the nurse workforce at nearly double the rate of the boomers. Still, the boomers' retirement will reduce growth in the size of the RN workforce to 1.3 percent per year for the period 2015–30.

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    My brother has anaphylaxisis from IV Vanco in ED (had Vanco multiple times in past 2 yrs for cellulitis) -coded, hyperthermia protocal started in ED. No one expected him to make it out of hospital... needed trach, was home 2 months later after SNF + another hospital stay. Lived 2 1/2 more yrs able to meet 2 granddaughters.

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    Davey Do likes this.

    Check out the wonderful advice in AN's LTC: Directors / Assistants forum

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    Orion81RN, brownbook, and AJJKRN like this.

    Internet search:

    Osteomyelitis secondary to an osteoenteric fistula.

    Pubic Bone Osteomyelitis and Pubosymphyseal Urinary Fistula