AHCA/NCAL Gero Nurse Prep – Page 47 – News, updates, tips and more

Gero Nurse Prep Faculty Advocates for Pressure Ulcer Awareness

Pressure ulcers – commonly called bedsores — are a big problem in the United States. More than 2.5 million U.S. residents develop pressure ulcers every year, with about 60,000 people dying each year from pressure ulcer complications.

Today is International Stop Pressure Ulcer Day, a day dedicated to bringing awareness to the causes and ways to prevent pressure ulcers.

Joyce Black, Ph.D - GeroNursePrep faculty

“This is not just a problem for patients and their families, but also health facilities,” said Joyce Black, Ph.D., associate professor in UNMC’s College of Nursing, who is recognized as a national expert in pressure ulcers. “The government won’t reimburse for Medicare and Medicaid expenses if patients get pressure sores.”

Pressure ulcers can develop in as little as three hours as a result of sitting or lying too long in the same position, she said. Those who are bedridden are most at risk, including those in hospitals and long term care facilities like nursing homes. It can happen in the home as well.

“Ulcers develop quickly depending on how hard the surface is that you’re on and how much fat padding a person has,” Dr. Black said. “Thin, frail individuals develop them more quickly.”

She said pressure ulcers  develop  due  to  pressure  on  the  soft  tissues when patients don’t move or continuously slide down in a chair. The blood in the area stops and the tissue dies. Most problems with ulcers occur on the buttocks, tailbone and the heel of the foot.

Tips on prevention and treatment
Dr. Black has these tips for preventing and treating minor pressure ulcers.

Sit or lay in different position, walk if you can.
Stay off the sore spot until the pain or red or purple color goes away.
Put a pillow under the calf of the leg to keep the heel off of the bed.
Don’t rub the skin. It may tear.
Keep skin clean. The healthier you can keep skin the less chance of skin breakdown.
Make sure diapers get changed.
Turn individuals every three hours if they are on a good mattress. Every two hours if mattress is thin, frayed or worn.
Cover wound with dressing or apply topical antibiotic to keep wound clean.
Ask what the facility is doing to reduce or prevent bed sores and if you can help.
Ask how they are turning your loved one to get them off their back (individual should be turned on their sides-family members can help).
Ask what kind of mattress the patient is sleeping on. An old spring mattress with an inch padding is not adequate. Family may be well advised to go to a bedding store and get two inches of memory foam so there is more padding on the bed.
Make sure the patient is eating a well-balanced meal (not junk food).

Drugs and its consequences

The 1.4 million people who live in nursing homes are among the most vulnerable, powerless individuals in American society. They are old (mean age 79.2), they are physically frail (60% are unable to do 4 or more of the most basic daily activities), and most of them are cognitively impaired, many of them severely (39%). Nursing homes have come a long way since the bad old days when residents were tied up, neglected, and abused, and one of the stratagems for improving care has been the “care planning meeting.” A plan of care must be developed by the facility staff for all new admissions to nursing homes that are Medicare or Medicaid certified, addressing physical, emotional, and medical needs. These plans are reviewed on a quarterly basis—more often if there is a major change in status, such as a hospitalization. And one of the innovations of the last decade is to invite family members to participate in care planning meetings. This gives families information about their loved one and an opportunity to make suggestions and raise concerns. But one issue that neither staff nor families routinely raise and that the many websites that advise families about how to negotiate the unfamiliar nursing home terrain is medications. And that, specially in light of recent revelations, is an essential question.

The recent revelation is that Johnson & Johnson, the world’s largest drug company, just settled a variety of civil and criminal complaints about its sales of the psychiatric drug Risperidone (Risperdal) for $2.2 billion (yes, that’s billion) J&J “accepted accountability” for misbranding Risperdal as useful for treating elderly patients with dementia, for marketing Risperdal for the elderly, and for paying kickbacks to both physicians and to Omnicare, the largest pharmacy supplying nursing homes, for using the drug.

Read more here..

Reference:
Murriel Gillick, “Getting Off Drugs”, http://blog.drmurielgillick.com/2013/11/getting-off-drugs.html

Perspectives On Aging

Showing We Care

Since the 1990s, physicians and patients have been fighting over futility. The doctors look at a patient who is dying and say that further tests and treatment cannot possibly work and shouldn’t be done. The patients, or more commonly their families, look at those same patients and say that they want “everything done” to try to prolong life.

As often happens in the US, the futility battle ended up in the court room. In the case of Helga Wanglie, an 86-year-old woman in a vegetative state after hip surgery, the doctors went to court over whether the patient’s husband had the right to insist that she remain on a ventilator. The court, as also often happens, didn’t address the issue of whether the ventilator was or was not appropriate treatment for Mrs. Wanglie; it simply ruled that her husband, as her surrogate, had the right to make the decision. After that case, many physicians concluded that the fight over futility was itself futile. For the last 15 years, physicians have tried to focus on determining a patient’s goals of care and then suggesting what treatments are most consistent with those goals. When they still cannot agree with family members about the right course of action, they resort to mediation, sometimes provided by a hospital ethics committee. But simmering below the surface, conflicts over perceived futility rage bubble vigorously.

A short article in the New England Journal of Medicine, “The Debt of Life—Thai Lessons on a Process-Oriented Ethical Logic,” offers a refreshing way of looking at futility. Based on his experiences doing ethnographic field work in Thailand while a graduate student in Anthropology, physician Scott Stonington shines a new light on the typical ICU dilemma. The physicians, he reports, are loathe to perform various possible tests and treatments because they think in terms of outcomes. They argue that their interventions won’t work in the sense that they won’t overcome the existing medical problems and that they are burdensome to the patient and, parenthetically, expensive. The patient’s family, he observes, think in terms of the process of care. He comments on one Thai family who said that their father had given them “flesh, blood, and breath” so they had a “debt of life” to pay. The ICU, they reasoned, allowed them to repay their debt: it gave their father flesh (tube feedings for nutrition), blood (intravenous medications and dialysis to cleanse the blood), and breath (a ventilator for breathing). The family was not so much interested in the outcome of treatment as in the treatment itself. In this scenario, the conflict was ultimately resolved when the family came to the conclusion that they had paid their debt and further aggressive care could be discontinued.

Resource: http://cnx.org/content/m42973/latest/Figure_13_04_01.jpg

I made a very similar argument in my essay, “The Standard of Caring: Why Do We Still Use Feeding Tubes in Patients with Advanced Dementia?” I noted that it had been over 10 years since a series of studies in the medical literature reported that feeding tubes (a tube inserted into the stomach to provide nutrition) did not prolong life in patients with advanced dementia who had eating difficulties. These patients are nearing the end of their lives and no matter what procedures they have, their prognosis remains pretty much the same. Not only don’t the tubes prolong life, but they don’t accomplish a variety of other goals that doctors had hoped they might: preventing pressure ulcers (skin breakdown that is often related to malnutrition) or preventing pneumonia (caused by food going into the lungs instead of the stomach). As a result of these studies, the rate of tube feeding people with advanced dementia has declined, but it is still far from zero. I suggest that the reason some families want a feeding tube is to show that they care. It’s not that they expect to improve some quantifiable outcome—living longer or avoiding pneumonia. It’s that they want to have a way to demonstrate caring. For the same reason, we keep people with advanced dementia clean and dressed. We don’t require a study that shows that they will be less likely to develop an infection if they are kept clean. We don’t demand proof that they will live longer if they are clothed. We assume that being clean and clothed contribute to well-being because they are among the only ways we as caregivers have of showing respect for the human being who happens to have dementia. Tube feeding, from this perspective, is a means of proving that we care.

Resource:
Murriel Gillick, “Showing we care”, http://blog.drmurielgillick.com/2013/11/showing-we-care.html

ANCC Board Certification Nursing Conference

Submit by November 10, 2013

Stand out among your board-certified nurse peers by presenting your clinical expertise, best practices, or research at the ANCC Board Certification Nursing Conference™ next March!

Abstract proposals for live posters and concurrent podium sessions may now be submitted online. You must be a certified nurse to submit.

The deadline for abstract submissions is 11:59 p.m. on November 10, 2013.

Abstracts will be considered based on how well they fulfill the goal and learning objectives of the conference. The goal of the ANCC Board Certification Nursing Conference is for APRN and specialty nurses to improve their clinical practice while pursuing professional development for continuing education credit and certification renewal.

More Info can be found here- http://edirectreach.com/CLIENTS/ANCC/30-certcon/

AHCA/NCAL Gero Nurse Prep Demo Site

New Feature! Check out the latest at Gero Nurse Prep! We have prepared a demo site to help you decide if Gero Nurse Prep is right for you. The demo contains a sampling of choice topics, and was constructed with the look and feel of the full course.

Access the demo, and find out more information about the full course at www.geronurseprep.org

Statin Use Associated With Cataract Development

The risk for developing cataracts, a leading cause of impaired vision and blindness, is higher among individuals using statins as compared with nonusers, according to the results of a recent propensity score–matched cohort study.

Previous studies on the link between this popular class of drugs used to lower cholesterol levels and cataracts have yielded mixed results.

For their analysis, Jessica Leuschen, MD, Wilford Hall Ambulatory Surgery Center and San Antonio Military Medical Center, San Antonio, Texas, and colleagues reviewed data from 2003 to 2010 from the medical records of patients enrolled in a military healthcare system.

Patients were split into two groups based on prescription refills during fiscal year 2005: statin users and nonusers. Statin users were defined as those who had taken statins for at least 90 days, and nonusers were individuals who had never used a statin throughout the course of the study.

Continue reading here: Statin Use Associated With Cataract Development – Consultant360.com

Reference:

Leuschen J, Mortensen EM, Frei CR, Mansi EA, Panday V, Mansi I. Association of statin use with cataracts: a propensity score-matched analysis. JAMA Ophthalmol. 2013 Sep 19. doi: 10.1001/jamaophthalmol.2013.4575. [Epub ahead of print]

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Gero Nurse Prep Success Pointers

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Important Findings in C difficile Infection

The Role of Infection Control

Standard teaching is that Clostridium difficile infection (CDI) is a hospital-acquired infection that reflects a failure of infection control, but it may be more closely related to antibiotic control. A recent report from the Centers for Disease Control and Prevention (CDC), based on an analysis of 10,342 cases of CDI in 111 hospitals and 310 nursing homes, showed that 75% of the patients were already colonized with C difficile at the time of admission.^[1] Nearly all (94%) of these cases were “healthcare-associated,” meaning that acquisition occurred during an outpatient visit, a nursing home stay, the current hospitalization, or a previous hospitalization. Only 25% of patients actually acquired the pathogen in the same hospital where clinical expression of CDI occurred.

Clinical relevance. The CDC study suggests that infection control personnel and physicians need to be aware of this association, because this may require changes in infection control practice. The implication is that to prevent CDI, clinicians need to find ways to identify patients who are already colonized to protect them from obvious risks, and also to consider them to be potential sources of infection to others. This could substantially change infection control practice for prevention of CDI.

5 Important Developments in C difficile Management.

Fidaxomicin- Fidaxomicin is the second drug approved by the US Food and Drug Administration (FDA) for the treatment of CDI. The first was oral vancomycin, which was approved in 1978 on the basis of a 16-patient randomized controlled trial.^[2] The fidaxomicin trials included approximately 1200 patients randomly assigned to receive fidaxomicin vs oral vancomycin.^[3,4] Results showed similar initial response rates (88% vs 86%), but a significantly reduced rate of relapse in fidaxomicin recipients (15% vs 25%).^[3] A subsequent trial showed that fidaxomicin was also superior to vancomycin in prevention of a second relapse in patients who had already experienced a relapse of CDI (36% vs 20%).^[5] The presumed mechanism for reduced rates of relapse is a less pronounced alteration of the colonic microbiome with fidaxomicin,^[6] which is presumed to be the ultimate control of C difficiletoxin production.

Clinical relevance. It appears that fidaxomicin is a good drug for CDI because it is FDA-approved; similar to oral vancomycin with respect to cure rates; and clearly superior in terms of “global cure” rates, which include initial responses without relapses. Nevertheless, the cost of fidaxomicin (which reflects the high cost of FDA trials) is intimidating.

Increased Iron in Brain Associated With Alzheimer’s Disease

A recent UCLA study has shown that individuals with Alzheimer’s disease (AD) have increased ferritin iron levels in the hippocampus, but not the thalamus, and this iron accumulation occurs in conjunction with hippocampus damage.

These findings, along with prior observations, suggest that “increased brain iron may be contributing to the process that leads to AD,” said senior study author George Bartzokis, MD, Department of Psychiatry and Biobehavioral Sciences, The David Geffen School of Medicine at UCLA, Laboratory of Neuroimaging, Department of Neurology, Division of Brain Mapping, UCLA, and Department of Psychiatry, Greater Los Angeles VA Healthcare System, West Los Angeles, CA.

Increased-Iron-in-Brain-Associated-With-Alzheimer’s-Disease

The study noted that iron accumulates in gray matter regions of the brain as one ages, which may contribute to the risk of developing AD and other age-related diseases. Although previous magnetic resonance imaging (MRI) studies have demonstrated increased iron deposits in basal ganglia regions, the hippocampus (a region of the brain associated with memory and one of the first regions of the brain to suffer damage in persons with AD) and the thalamus (a region that is generally not affected until the later stages of AD) have rarely been examined.