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Thunderwolf

Thunderwolf

Charge Nurse
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  1. Thunderwolf

    New face of addiction in America

    I find it interesting that the prescription overdose trend also tends to show some parallels to JCAHO's goal in improving a patients alleviation of pain. I would really like to see some studies that may demonstrate or not a correlation between the two...JCAHO and rising prescription drug overdoses. I wouldn't be surprised that a correlation exists, proving some iatrogenesis.
  2. Thunderwolf

    Med Ed.... any ideas?

    Kids are very visual, interactive and hands on. Whatever info you present should incorporate these modalities. Peace
  3. Thunderwolf

    Confused about detox

    Think of heroin withdrawal symptoms like the worst flu symptoms...muscle/abd cramping, joint aches, anxiety, some dehydration as a result of nausea/vomiting, diaphoresis, lacrimation, rhinorhea, diarrhea...very unpleasant, but not at all fatal. They feel like dying, but it is nothing like alcohol or benzo withdrawal, which can be fatal. Pretty much, heroin/opiate withdrawal only requires supportive care till it runs its course. Some meds can be helpful. Bentyl for abd cramping, Neurontin at a fairly moderate to high dosing schedule for anxiety and aches (only if kidney functioning is adequate though...check the BUN/Creatinine levels), Motrin for joint aches, Trazodone or Seroquel as a sleeper, Benadryl or Vistaril for itch/pruritis, Haldol or another antipsychotic for psychotic symptoms, Zofran or Tigan for nausea....please notice, no PRN meds with an addictive quality (ie Benzos)...this is very very important with this population. If they shoot up, be mindful that Hep C may be present, which can jack up those liver enzymes. Also, if shooting up, most fatalities from IV heroin occur from endocarditis from using dirty needles. If there is this concern, an echocardiogram may be warranted to rule it out. These folks are also well known to be very theatrical in their presentation of symptoms. Be mindful of this. Manipulation and lying are their names of the game. It comes with the turf in this drug category of dependence, much worse than in alcohol. Observing them/behaviors/reported symptoms when they are not aware of being observed by you is best, if possible (ie TV monitor). You will often observe huge inconsistencies in what they report and in what you observe. Also, have strict guidelines that your patients are only medicated by their assigned nurse...do not permit staff splitting or going behind your back to another nurse for medication of symptoms. The games, the games...watch for it. Now is not the time to be working on depression issues with you...while going thru active withdrawal. That is for the CD/MH Counselor. That is for outpatient or followup after detox. Many have used heroin/opiates as a means to numb out...physically, spiritually, and emotionally. Numb is what most heroin addicts call "feeling normal"...and they actively seek it by any means. Normal to them is numb. When they actually are off the drug after detox, they will begin experiencing feelings once again...that is good, very good...but they may not want to...much easier in their minds to be numb and soulless. Outpatient counseling after detox will then be helpful as they begin experiencing feelings previously denied or numbed. As a detox nurse, it is your role to help them from the physical aspect...the physical withdrawal. Counseling comes after you or in conjunction with you if your facility has CD counselors on site. But, you are not the one to be really delving into their issues or business. If you do, it tends to reflect more about yourself than the patient in front of you. As a nurse, it is best to be objective in your approach, assessment, and intervention. If you have issues with codependency yourself, this makes this all the more important. If not, you may allow yourself to become totally ineffective as a nurse. Side and last note, nurses are to be very mindful of their professional boundaries with this population....that means...no giving out your personal info like your cell or home phone number, your address, giving money, going out together after detox on a personal level, and god forbid, dating your ex patient. If you cross these boundaries, it says much more about yourself than the patient....you have issues. Your patients are not your friends, your buddies, or to be your potential future mate. If a nurse treads these sort of waters, that nurse needs counseling. As you can tell, I am very passionate about this topic. I saw alot when I worked in detox...excellent experiences. I learned greatly from the literature, from this population while in the field, and from the nurses themselves. Some of the nurses were excellent role models, very learned and experienced. Some, well, going back to the boundary topic, really needed some professional help. Hope this answered many of your questions (asked and unasked). Peace to yah. Good luck in your clinicals.
  4. Thunderwolf

    New face of addiction in America

    addiction in america has a new face: prescription drugs. last year, prescription drugs replaced heroin and cocaine as the leading cause of deadly overdoses. and celebrities are showing us that mixing prescription pills -- the pills you may have in your home right now -- could be just as deadly as shooting up heroin or snorting cocaine. according to [color=#004276]statistics from the office of national drug control policy, there are some 20,000 drug-related deaths a year in the united states. even more shocking than the deaths of all of our mothers, fathers, brothers, sisters and children is that drugs prescribed by a doctor -- not bought off the streets -- were the leading cause of fatal overdoses. http://www.cnn.com/2009/health/09/14/velez.mitchell.pill.addiction/index.html
  5. Thunderwolf

    Who HATES the term MURSE?

    More professional....I agree.
  6. Thunderwolf

    New psych RN as charge nurse?

    Ditto
  7. Thunderwolf

    The Medicine Wheel in Recovery

    Interesting, you are correct. That was the link then...but since from then to now, it links elsewhere to that other site. How odd. Any way, the info on the original post remains informative and relevant. Thanks for the update.
  8. Thunderwolf

    Drums: Heartbeat of Mother Earth

    Dummers welcome dancers for Feast Day at Ohkay Owingeh Pueblo, New Mexico, 2008. Photo by Julien McRoberts. The drum is a powerful instrument. Indigenous people throughout Turtle Island refer to it as the heartbeat of Mother Earth. It is used in many spiritual and sacred ceremonial practices. Some say the beat of the drum has the power to change natural elements, including the weather. It is believed to have the power to heal sickness, and some believe it has the power to send messages both to the animal world and to the spirit world. The drum is broadly considered to be the first musical instrument used by humans. Historians and music ethnologists alike point out that the drum has been utilized by virtually every culture known to mankind for a multitude of purposes. In ancient times, the earliest drums were used for religious rituals, social dances, sporting events, feasts, special ceremonies, in preparation for hunting, and as a prelude to war. However, it is virtually a universally held belief that the original purpose of the drum was to communicate, many times over long distances as a warning or signal. In the Americas, the drum has a history that dates back to pre-Columbian times. Remnants of wooden cylinder drums and small pottery drums found in Central Mexico, Costa Rica, Peru, the Guatemala highlands and other parts of Mesoamerica have been dated back to A.D. 700; older examples most likely existed but succumbed to the elements. From the Inuit people of the Arctic region, the salmon and whaling cultures of the Pacific Northwest, and the Northern and Southern Plains tribes, to the Eastern Woodlands, the Rio Grande Valley and elsewhere, Indigenous people of North America continue to use drums for dances, ceremonies, games and sacred practices. Power Over Illness and Weather The drumbeat evokes many powerful forms of energy and is an aid in helping to focus one’s attention and to see clear intentions. Certain types of beats are said to carry special healing powers into the human body. A sick person’s psychological and physiological states are believed to be altered by the rhythmic drumbeats and accompanying song, and the illness becomes more attuned to other medicinal remedies. Stories about drummers being able to influence weather conditions, such as inducing or dissuading thunder, rain and other elements through the vibrations sent into the atmosphere, are common among Indigenous people. In the springtime, the Menominee of Wisconsin celebrate the return of the sturgeon to Keshena Falls, the fish’s original spawning waters, and summon the sturgeon’s return home with the beat of the drum. Black Elk, an Oglala Sioux holy man made famous by John Neihardt’s book Black Elk Speaks, offers this perspective: “Since the drum is often the only instrument used in our sacred rites, I should perhaps tell you here why it is especially sacred and important to us. It is because the round form of the drum represents the whole universe, and its steady strong beat is the pulse, the heart, throbbing at the center of the universe. It is the voice of Wakan Tanka (Great Spirit), and this sound stirs us and helps us to understand the mystery and power of all things.” Thomas Evans is a citizen of the Pawnee Tribe who works in the curatorial lab with the National Museum of the American Indian’s artifact collections. Although he cannot say so definitively, he believes the oldest drum in the museum’s collection may be an old Delaware drum that was originally collected prior to 1850. He points out that there are other Eastern drums in the collection that are made of whiskey/nail kegs that were also collected at about the same time. Evans believes research shows that many of the Missouri River tribes, as well as Eastern tribes, traditionally used gourd rattles and rawhide bundles for their ceremonial practices and singing, rather than drums, until perhaps the 1880s when the hiduska (powwow) was introduced. In his upcoming book Moving History: The Evolution of the Powwow, Dennis Zotigh, a citizen of the Kiowa Tribe who also works for NMAI in Washington D.C., describes how, in pre-reservation days, Plains singers would unroll a big rawhide, sit on the ground and use ceremonial sticks to drum out a cadence. “With the introduction of the military base drum around the turn of the 19th century, most Plains tribes adopted it, replacing their rolled-out hides. In some cases, it was modified to fit tribal constraints. Rawhides were stretched and tied over the drum to create drumheads. The base is made from a hollowed-out tree trunk or by bending wood panels into a circle or eight-sided frame,” Zotigh writes. http://www.nativepeoples.com/article/articles/326/1/Drums%3A-Heartbeat-of-Mother-Earth
  9. The Indian Health Service (IHS) Public Health Professions (PHP) are responsible for addressing the health needs of over 1.8 million American Indians and Alaska Natives in a network of 48 hospitals, more than 230 clinics, and a system of Tribal and Urban programs. As part of the US Department of Health and Human Services, our mission is to raise the physical, mental, social and spiritual health of this diverse population to the highest level. Learn more about the Opportunity, Adventure, and Purpose offered by IHS Public Health Professions. Learn more about the men and women, and services of IHS Public Health Professions. More about Disciplines Starting your career? Looking for new challenges? IHS has openings for full-time and part-time positions, as well as residency and externship opportunities. More about Positions Commissioned Corps, Civil Service or Direct Tribal Hire - match your professional and personal priorities to the right career path. More about Career Paths & Benefits Information you need to know to apply for an IHS Loan Repayment Program Award. More about Loan Repayment IHS hospitals and clinics are located in 35 states throughout the US - find an IHS Service Area. More about IHS Service Areas IHS has temporary duty (TDY) opportunities available for volunteers interested in serving. More about Volunteers IHS hospitals and clinics are located in 35 states throughout the US - find an IHS Service Area. More about Events Find the IHS recruiter for your profession. More about Contact Us Go to the site: http://www.ihs.gov/JobsCareerDevelop/careers/
  10. A Collaborative Approach to Specialty Patient Care in Cardiology University Medical Center, Indian Health Services, University of Arizona The Native American Cardiology Program was established by Dr. James Galloway in 1994, in recognition of the changing health problems and needs of Native Americans in the Southwest. Prior to the 1960s, coronary artery disease was relatively uncommon among Native Americans. Over the past decades, changes in diet, economics, and lifestyle have resulted in marked increases in the rates of obesity, diabetes, high blood pressure and kidney failure, all of which increase rates of coronary disease, heart attacks, and cardiac deaths. Rates of diabetes and the metabolic syndrome are twice as high among Native Americans compared to the general US population. The most common cause of death for people with diabetes is cardiovascular disease. Unfortunately, these changes in risk factors have resulted in Native American death rates from heart disease that surpass those of the general U.S. population. Cardiovascular disease is the number one cause of death for Native Americans in the Southwest and around the nation. Rheumatic heart disease is another unique problem that affects Native Americans much more commonly than the general US population. High rates of rheumatic fever have resulted in a significant amount of valvular heart disease that has become rare among other populations in the country. The valve disease associated with this childhood illness may present 20 to 40 years after the episode of rheumatic fever and only half of the patients with rheumatic disease remember ever having had rheumatic fever. As a consequence, high rates of mitral stenosis, often accompanied by other valve disorders are seen that require surgical intervention. Diagnosis and management of these difficult cases are worked closely with cardiac surgeons at University Medical Center when surgical intervention is required. This collaborative group understands the unique living conditions and economic limitations that many of their patients face and incorporate these factors into their decisions regarding valve surgery and anticoagulation needs. The circumstances and history of each patient are considered individually in making recommendations regarding surgical or percutaneous interventions. 24/7 Provider Consultation and Patient Transfers: All Health Care Providers who care for Native Peoples 1-800-777-7552 http://www.ihs.gov/Cardiology/
  11. Injuries are the leading cause of death for American Indians and Alaska Natives from ages 1-44 years, and the third leading cause of death overall. Unintentional injury mortality rates for Indian people are approximately three times higher than the combined all-U.S. races rate (IHS, Trends in Indian Health 2000-2001). However, this disparity varies by IHS regional Area and by cause of injury (CDC, Atlas of Injury Mortality Among American Indian and Alaska Native Children and Youth, 2005). The IHS has established a widely-recognized injury prevention program that works with tribes and other partners to reduce the disproportionate impact of injuries on Indian people. http://www.ihs.gov/MedicalPrograms/InjuryPrevention/
  12. Kimberly Teehee is senior policy adviser for Native American affairs at the White House Domestic Policy Council. This is what Kimberly Teehee has written regarding the myths. ___________________________________________ I wanted to record this and write this post to debunk the myth that the Indian Health Service (IHS) is a government health plan gone wrong. It is truly unfortunate that recent press stories seek to scare Americans about health insurance reform by highlighting the IHS system. First, the IHS system is not an insurance plan. And comparing the two is like comparing apples to oranges. IHS provides comprehensive health care services to approximately 1.9 million American Indians and Alaska Natives living on or near reservations in 35 states. Some of these health services include doctor visits and check-ups, dental and vision care, diabetes prevention and treatment, mental health and substance abuse treatment, and home health care. IHS also helps construct hospitals and clinics and provides safe drinking water and sanitation facilities to American Indians and Alaska Natives. Health insurance, by contrast, provides individuals a guarantee to a defined set of benefits for a price. While the IHS accepts insurance payments for care it provides, it is not an insurance plan. Second, national health reform will not dismantle IHS. American Indians and Alaska Natives will continue to have access to their Indian health service facilities. And third, while Indian health has been historically underfunded, several tribes have developed innovative and award-winning approaches to provide health care to their communities. These sites serve as successful models for other rural and public health programs. President Obama supports IHS which is why he proposed a 13 percent increase in the FY 2010 budget, and invested $590 million in the American Recovery and Reinvestment Act of 2009. http://www.reznetnews.org/blogs/tribalog/clearing-myths-health-insurance-reform-and-ihs-38200
  13. Thunderwolf

    Swine Flu at Fort Belknap Reservation

    Health officials on the Fort Belknap Indian Reservation are stressing prevention after eight residents were diagnosed with swine flu. Officials have no idea how widespread the infection is because after the eight cases were confirmed, laboratory testing by the Indian Health Service, Centers for Disease Control and Prevention and the state of Montana is no longer being done. http://www.reznetnews.org/article/swine-flu-fort-belknap-reservation-38000
  14. Alone. This is how Notah Begay III describes his journey as a youth with golf aspirations to a Division I athlete and now a professional golfer. Begay, a Navajo, Isleta and San Felipe Pueblo, is one of the few Native professional athletes in the world. The 36-year-old is a Stanford graduate and the lone full-blooded Native golfer on the PGA Tour, where he is a four-time winner. "I always felt alone," he said in a media conference call Monday. "Through my entire career because I was the only Indian on the whole golf course. What really kept me together was knowing that Native American people were always supportive of me, always behind me. That's what kept me going and it keeps me going to this day." Today Begay is doing his part to help Native youth on and off the golf course. Four years ago, he created the Notah Begay III Foundation to provide health and wellness education to Native youngsters in form of golf and soccer. This year Begay has the help of his Stanford roommate and friend, Tiger Woods. http://www.reznetnews.org/article/tiger-woods-joins-notah-begay-help-native-youth-38110
  15. Deputy Attorney General David Ogden: "We're really at kind of a crisis point." On just a single day this year on the Red Lake reservation in northern Minnesota, police and investigators received emergency calls about a suicide, a murder, three stabbings, two shootings and multiple incidents of domestic violence. Federal statistics have shown American Indians are the victims of violent crime at more than twice the national rate, with incidence of homicide and domestic violence much higher than the national average. The Obama administration announced Thursday a new effort to try and combat some of this crime on reservations, where shortages of law enforcement personnel and federal dollars have led to lawless environments. The top three Justice Department officials — Attorney General Eric Holder, Deputy Attorney General David Ogden and Associate Attorney General Thomas Perrelli — will travel to states with high Indian populations over the next two months to talk to tribal members and crime experts about what can be done. 'Suffering in People's Lives That Is Just Unacceptable' "It translates into suffering in people's lives that just is unacceptable in this country," Ogden said in an interview with The Associated Press. "We're really at kind of a crisis point." The problems are not new. In the 1990s, Holder, Ogden and Perrelli all worked on Indian crime for then-Attorney General Janet Reno in the Clinton administration. Many of the same issues still exist, including limited resources, a lack of coordination among agencies and little focus on the issue. "We have to look at whether we're doing enough and I think it's clear we're not," Ogden said. "I think we can devote more law enforcement agents, I think we can help in the training of law enforcement agents, we can have more prosecutors and I think we can provide more support to tribal institutions." Increased federal dollars will probably also be part of the equation, Ogden said. Gang Activity Part of the Problem Reports of violence on reservations — especially the poorest and most remote — are constant. Red Lake has certainly known its share of crimes. In 2005, a 16-year-old there killed seven people at his school and two people on the reservation. Gang activity has risen in tribes across the country as drug traffickers have taken advantage of gaps in law enforcement. Still, little is known about what exactly is happening on reservations or how the incidents are handled. Data has been sparse for decades and crime surveys rarely separate out tribal statistics. Ogden says better data collection is one of the department's priorities. One of the main problems in reducing crime has been a lack of officers; often a handful of patrol cars will police a reservation the size of a small state. http://www.reznetnews.org/article/justice-boost-fight-against-tribal-crime-38250
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