All posts by Barbie C

02Apr/17

Neurologic Diagnostics in Patients with Eclampsia

“pregnant” by il-young-ko

In 2013, Jindal, Gained, Hasija, & Vani published the results of their observational study titled “Comparison of neuroimaging by CT and MRI and correlation with neurological presentation in eclampsia” in the International Journal of Reproduction, Contraception, Obstetrics, and Gynecology. The researchers used Fisher’s exact and the chi square test to statistically analyze 25 antepartum/intrapartum patients with eclampsia. All of the patients experienced neurological symptoms including headache, blurred vision, loss of vision, altered level of consciousness, and/or coma. Neuroimaging with magnetic resonance imaging (MRI) provided diagnostic confirmation of cerebral cortex/subcortical edema and transient high T2 signal intensity along with generalized vasospasm. The researchers concluded that MRI correlated better to clinical findings than computed topography and is a preferred imaging modality for eclamptic patients.

Jindal, M., Gaikwad, H., Hasija, B., & Vani, K. (2013). Comparison of neuroimaging by CT and MRI and correlation with neurological presentation in eclampsia. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2(1), 83-87. doi:10.5455/2320-1770.ijrcog20130215

08Mar/17

Home Medications

In interviewing two older adults in my family I was pleasantly surprised by their knowledge of their home medications. I expected them to know at least the names and dosing schedule, but based on my experiences with patients I was unsure how informed they would be beyond that.
Not only did were they familiar with the names, doses, administration times and considerations of their medications and supplements, but they were aware of some of the risks as well. They each kept their pills in their own weekly pillbox, and were able to identify each one. They knew to what to avoid taking their pills with (e.g. coffee or antacids/milk) and possible interactions with alcohol. They were aware of adverse effects that required reporting (e.g. muscle pain with Statin use and stomach pain with NSAID use). For their age and in comparison to others in their age group, I would consider their mediation regimen to be relatively simple. They each had 2 or less prescribed medications and took vitamins and supplements that had been recommended or reconciled with their care provider. The only education I felt necessary to provide was to recommend they inquire about CoQ10 lipid based supplementation concurrent with Statin use since Statins inhibit heart protective CoQ10 synthesis thereby increasing risk for cardiovascular injury/disease.

01Mar/17

Investigating pulmonary embolism in obstetric patients: ventilation/perfusion scans vs. CT pulmonary angiography

The leading cause of non-obstetric maternal mortality is pulmonary embolism (PE), accounting for 10% of maternal deaths in developed countries (Easther, Langdana, Maharaj, Abels, Beasley, & Entwisle, 2016.) Pregnant women have historically been excluded from studies investigating evidenced based modalities for PE diagnosis. In their 2010-2012 cohort data analysis of 54 ante/postnatal Wellington Hospital (located in New Zealand) obstetric patient records, Easther et al. (2016) sought to determine the best practice for identifying PE via ventilation/perfusion (V/Q) imaging or computed topography pulmonary angiography (CTPA). This topic of research is vital to improving maternal healthcare as current practice standards do not take into account the unique physiology of ante/postnatal patients including, alterations in plasma volume, cardiac output, and body compartment fluid distribution. These changes negatively affect the accuracy of CTPA (Easther, et al., 2016.) Concerns about maternal and fetal exposure to radiation also contribute to the need for specific guidelines of CTPA use.

Although this was a small study, the researchers developed a clinical pathway for PE investigation. Following clinical suspicion of PE during pregnancy or postpartum, the clinical should take a full history, complete a physical examination, and assess for risk factors. If there is a likelihood of PE and concurrent clinical signs and symptoms a chest X-ray should be performed to rule out other pathologies (e.g. pneumonia). Once other pathologies are ruled out, V/Q scan using low dose perfusion contrast is indicated for 2nd and 3rd trimesters and during the postpartum period; CTPA is indicated in the first trimester, if massive PE is suspected, or if the chest x-ray was abnormal as this causes a V/Q scan to be indeterminate (Easther, et al., 2016.) The researchers took into account the improved accuracy of V/Q scan in pregnant women, the radiation exposure of both modalities to the fetus, mother, and breast tissue, and family history of breast cancer when developing this clinical pathway.

This study and its results present a guide for developing a best practice based on evidence to improve the recognition of life-threatening PE in ante/postnatal women. Further research into this topic is needed, with larger sample sizes in order for it to translate into practice.

Easther, S., Langdana, F., Maharaj, D., Abels, P., Beasley, R., & Entwisle, J. (2016). The diagnostic role of ventilation/perfusion scans versus computed tomography pulmonary angiography in obstetric patients investigated for pulmonary embolism at Wellington Hospital from 2010 to 2012. The New Zealand Medical Journal129(1433). Retrieved from https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2016/vol-129-no-1433-22-april-2016/6869

 

 

16Feb/17

Cardiac Episode Knowledge

After asking a few family members what they knew about “Cardiopulmonary Arrest” and “MI”, I received a variety of answers. Most appeared hesitant about defining either, and asked if I meant a heart attack. One person explained cardiopulmonary arrest as when you “stop breathing and your heart stops”. Myocardial infarction might as well have been another language. When questioned about what a heart attack was, answers included were variations of “when the heart stops” and one person identified that lack of oxygen makes the heart muscle die. When questioned about causes, all identified risk factors such as obesity, smoking, lack of exercise, and high fat diets. One person identified the hardening of the veins and plaque as a cause.

Everyone identified the result of CPR being blood continues to deliver oxygen to the brain and that it should be performed if someone has a heart attack/stops breathing. No one could identify the correct actions when performing CPR. Everyone also expressed they would feel incompetent if asked to do CPR by EMS dispatch and that they should learn CPR.

08Feb/17

Family Food Culture

Our family typically eats the same or similar meals every day of the week. Breakfast rotates between eggs, chicken sausage, turkey bacon, pork bacon, potatoes, yogurt, frozen fruit, and grains/whole grain cereals. Lunch is always a vegetable with either some sort of meat/cheese or peanut butter and jam sandwich…or dinner leftovers. Dinner is typically a lean meat, a large vegetable portion, and a grain or whole wheat pasta. Snacks rotate between a carb, a cheese, nuts, homemade fruit/veggie/yogurt smoothies, or whole fruit. We rarely have juice in the house, drink whole milk and coconut milk so our nutrition may appear heart healthy at first glance…but we have a dessert every night.

It seems as if we eat healthy, heart healthy even because of the low salt content, high vitamin content, inclusion of “good fats”, and our appropriate portioning as outlined by the American Heart Association (http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Nutrition-Basics_UCM_461228_Article.jsp#.WJtE-LHMw1g, 2017). However, the high added sugar consumption in our diet is extremely detrimental to health, heart and overall. It would not be difficult to follow fat and salt recommendations, although I question the published stance on fats/saturated fats. Eliminating added sugar would be difficult for us, despite the clear benefits.

On reflection, I believe the difficulty of changing our nutrition (whether it’s a patient with cardiac disease, or type 2 diabetes) is largely cultural. Even though we understand the rationale and effects of making nutritional changes, there seems to exist a programmed instinct to view food as a reward. For many it appears to be fat and sugar, although I know of several people with good nutritional intake who still view certain dishes or healthy food items as “treats”.  Investigating what other ways we can “reward” ourselves may provide insight into how to unlearn the ‘preferred food=reward’ mentality. It may be our perception of food that drives our nutritional choices, which could dictate that a more evolved (and involved) method of patient education is necessary to effect change.

14Oct/15

Open fractures (ouch!)

  • An open fracture is one in which damage also involves the skin and/or mucous membranes; also known as a compound fracture.
  • Risks of open fractures include osteomyelitis, tetanus, and gas gangrene.
  • Primary nursing objectives include: preventing infection of wound, tissue, and bone and to promote healing; administering prescribed IV antibiotics and tetanus toxoid if indicated.
  • Other nursing interventions include: wound irrigation; sterile dressing changes; elevation of extremity to minimize edema.
  • Accurate and frequent assessment of neurovascular status, vitals, and the wound is necessary to monitor for s/s of infection or other complications.

    http://nursingguides.org/wp-content/uploads/2015/01/Open_fractures_8a_540.jpg
    http://nursingguides.org/wp-content/uploads/2015/01/Open_fractures_8a_540.jpg