HOME MANAGEMENT OF SICKLE CELL ANEMIA
C. Adams, W.
Ahmad, J. Brown, R. Jackson, & A. Ringgold
Department of Nursing
Sickle cell anemia is an autosomal recessive inherited disorder of the blood that causes red blood cells (RBCs) to be abnormally shaped. Instead of cells having a round, doughnut shape, they have a long “sickle” shape. These sickle cells build up and accumulate causing decreased perfusion and oxygenation to body tissues, which can lead to complications such as hypoxia, severe pain crisis, and infection.
The purpose of this project is to educate patients about the management of their disease at home, decreasing the frequency of hospitalization. Proper management of sickle cell, by the patient, can increase the accuracy of data collection during a nurse’s assessment.
Key aspects addressed include prevention, pharmacological treatment, and non-pharmacological techniques.
COMPLICATIONS AND CONTRIBUTING FACTORS OF EATING DISORDERS IN
ADOLESCENTS
S. Black, K. Mayhan, J. Sullivan, & J. Weathers
Department of Nursing
Background: Sociological influences present an unattainable perfected body image. When presented with this ideal, adolescents often attempt to attain “perfection” through the use of anorexia nervosa, bulimia, and other behavior modifications related to eating disorders. Statistics have shown that currently, “0.48% of females age 15 to 19 years are affected by anorexia nervosa, whereas bulimia nervosa occurs in 1 to 5% of middle to older adolescents (Panagiotopoulos, McCrindle, Hick, & Katzman, p. 1100).”
Purpose: The purpose of this research is to educate the reader about the sociological influences, physiological consequences, psychological complications, and nursing implications needed for the treatment of adolescents with eating disorders.
Synthesis: A review of literature has revealed many sociological influences predispose adolescents to eating disorders such as media and peer group influences. The physiological complications of eating disorders are mostly cardiac related. The psychological are body dissatisfaction, low self-esteem, and obsessive-compulsive trends manifested as calorie counting and vigorous exercise routines. The role of the nurse is to educate adolescents about eating disorders.
Discussion/ Recommendation: Based on the literature, prevention is the best method for preventative measures in adolescents with eating disorders. As a patient advocate, the nurse’s role in prevention and treatment is to educate the adolescent population on dietary and nutritional concerns and address psychological and sociological concerns which contribute to eating disorders.
CHILDHOOD OBESITY
B. Johnson, H. Saddler, B. Talley, & D.Thornton
Department of Nursing
During the last two decades the prevalence of overweight children has increased by 50%. Pediatric obesity has reached epidemic proportions and is considered a major chronic and complex child health problem. Despite the fact that childhood obesity has been linked with numerous medical problems it continues to remain under-treated and under-diagnosed (Schumann, Nichols, & Livingston, 2002). If the childhood obesity trend remains unopposed, it is inevitable that obesity will continue into adulthood causing a severe depletion of the financial resources for the healthcare condition (Laing, 2002). The purpose of this research study is to discuss the specific nursing roles related to childhood obesity.
INVESTIGATING THE LACK OF KNOWLEDGE OF BIRTH DEFECTS
RELATED
TO FOLIC ACID
H. Hohrine, M. K. Gray, and K. Clement
Department of Nursing
Approximately 50 percent of neural tube defects, such as spina bifida and anencephaly, can be prevented by the used of periconceptional folic acid. It is estimated that neural tube defects occur in 4,000 pregnancies in the U.S. each year. According to Anding, Robinson, and Laanen (2003), reasons that many women do not achieve a sufficient intake of folic acid include lack of knowledge of the relation between folic acid and neural tube defects, inconvenience of taking folic acid supplements, and misconception that supplements are not needed if one consumes a proper diet. The recommended intake is 400 mcg/day before becoming pregnant and 600 mcg/day during the early weeks (Anding et al., 2003). Hilton (2001) conducted a study of 42 female college students, ages 18-24, that were enrolled in a private college in North Carolina. The purpose was to investigate the awareness of the importance folic acid as well as the intake of women in this age range. A survey was given to three different groups of women with information explaining the study. The survey gathered information including demographic data, knowledge of folic acid, and a dietary assessment. Only 33.3 percent reported taking daily multivitamins, and only 61.9 percent were able to identify that folic acid aids in preventing spina bifida. Greater than 80 percent were not planning pregnancies within the next three years. The study concluded that females in this age range frequently have an insufficient intake of folic acid. Because many of these women are not planning pregnancies in the future, unplanned pregnancies may take place which may be affected in a negative way by a lack of a sufficient intake of folic acid. Rosenberg, Gelow, and Sandoval conducted a study of 1867 women to determine the link between pregnancy intention and intake of periconceptional folic acid. A stratified random sample survey was conducted by the Oregon Pregnancy Risk Assessment Monitoring System (PRAMS), in which women were asked about folic acid intake before becoming pregnant as well as their feelings about becoming pregnant. Results yielded that 33.2 percent of women had taken periconceptional folic acid and 39.9 percent of females had unplanned pregnancies. The study concluded that women with intentional pregnancies were more likely to have been taking folic acid than women whose pregnancies were unintentional. Therefore, the importance of folic acid should be emphasized in public health education, both for individuals who are or are not planning a pregnancy in the near future.
PATIENT EDUCATION REGARDING NUTRITIONAL MANAGEMENT
OF DIABETICS
S. Cunningham, A. Kelley, K. Kordsmeier, & C. Smith
Department of Nursing
Three studies reviewed and analyzed the nutritional management advice given to patients with diabetes by health-care professionals. Dyson (2002) examined the role of nutritional management in the diabetic patient as well as the lack of patient education consistency among health-care professionals including nurses, physicians, and dieticians. More specifically, effective specialist diabetes dietitians are responsible for balancing the need to achieve the nutritional recommendations with each specific requirement of each individual patient. However, they are not solely responsible and require assistance of nurses, physicians, and other health-care professionals to be involved with diabetic nutrition. All must be consistently involved providing care as well as patient education. The diabetes specialist dietitian does this through the training of health care professionals. Savoca and Miller (2001) focused on challenges to dietary adherence in relation to food selection and eating pattern among diabetic patients. Interviews were conducted with members of a convenience sample of 45 men and women who were diagnosed with type two diabetes for at least one year. This study concluded that participants’ knowledge about diabetic nutritional management highly influenced their specific eating patterns. Daly, Warshaw, Pastors, Franz, and Arnold (2003) centered a study around the role of the nurse practitioner in providing medical nutrition therapy to diabetic patients. They concluded that their responsibilities consists of six main concepts: (1) refer patient to a registered dietitian specifically trained in medical nutrition therapy of diabetic patient, (2) provide specific referral data, (3) collaborate with the patient to obtain adequate goals, (4) provide and reinforce correct basic nutrition specific to each patient, (5) adjust medications if needed, and (6) patient education on nutrition self-management.
IMPORTANCE OF EDUCATION IN THE MANAGEMENT OF TYPE I DIABETES
MELLITUS IN PEDIATRIC PATIENTS
R. Cupps, P. McCullough & A. Moore
Department of Nursing
The importance of education in the management of Type I diabetes mellitus in pediatric patients was reviewed in five studies. Llahana, Poulton, and Coates (2001) studied the methods of teaching that were effective in 66 pediatric patients along with who was important in the diabetic teaching, such as the clinical nurse specialist, volunteer organizations, and the parents. Another study was done that found the cost of effective diabetic education to the parents and patients was more cost effective for health maintenance organizations than inadequate education, which subsequently led to hospitalization or emergency department visits related to diabetic ketoacidosis from improper management of diabetes mellitus (Beck, Logan, Hamm, Sproat, Musser, Everhart, McDermott, and Copeland, 2004). In 1997 a study was conducted by Leydne, Caravalho, and Saylor (2000) where 56 children with diabetes and their parents or primary caregivers visited a Diabetes Team clinic that included a dietitian, social worker, and a nurse case manager every three months. At these visits education was provided taking into consideration the educational and psychosocial needs of the patient and family, family system/dynamics, developmental stage of the child, and the cognitive maturity of the child, along with adjustments of insulin dosages, and education of problem solving strategies related to diabetes for the parents. This intervention led to greater self-management, better quality of life, and self-efficacy of the child and family. Additionally, Marshall, Flemming, Gillibrand, and Carter (2002) found that adequate education of the parents or caregivers of the child with diabetes is crucial to the effective management of the disease. Moreover, Dixon (2003) emphasizes the importance of appropriate patient education so that the child and family may lead a normal lifestyle even though they are daily dealing with a chronic disease. Dixon also identified micro or internal issues and macro or external issues that influence the normalization, education, and quality of life of the family dealing with diabetes mellitus.
OBESITY IN CHILDREN AND RELATED HEALTH PROBLEMS
C. Brocker, C. Carlat, M. Colbert & M. Shirey
Department of Nursing
The correlation between obesity in children and numerous health problems has been identified in several studies. Ruxton (2004) studied 200 children in an effort to explore whether there was a link between health problems and obesity. The Ruxton (2004) study utilized a questionnaire administered to the parents of obese children. The study questionnaire was sent to the parents of 156 obese children under the age of 10 years. The questionnaire covered questions ranging from health practices to health problems. The authors discovered that a link exists between short-term health problems such as snoring, hypertension, asthma, and obesity. They also discovered a connection between long-term health problems such as cardiovascular disease (CVD), breast cancer, colon cancer, type II diabetes, and obesity. Another connection, psychosocial in nature, determined that obese children are many times considered to be “lacking in academic success, unpopular, and unhealthy” (Ruxton, 2004, p. 49). A study by Lau, Lee, Ransdell, Yu, & Sung (2004) related not only physical problems but psychological problems as well. Children who were obese reported being lonely, afraid, and having low self-esteem (Lau et al., 2004).
Play and Pets: The Physical and Emotional Impact of Child-Life
and Pet Therapy on Hospitalized Children
A. Baldridge, S. D’Andrea & A. Winston
Department of Nursing
The “human-animal” bond has been recognized as an important part of therapeutic regimes for centuries. Pet facilitated therapy has been found to promote social interactions and behaviors, increase emotional comfort, decrease loneliness and anxiety, and provide a source of self-esteem and independence. The following research question was addressed in this study: a) How do patients rate their mood before and after a single session of pet therapy, b) how do parents or caregivers perceive a child’s mood prior to and following pet therapy, c) what percentage of time are positive, negative, and neutral emotions displayed during therapy, and d) how does pet therapy affect physiological indicators of stress, that is heart rate and salivary cortisol? Prior to the pet therapy session the child and parent or caregiver were asked to report the child’s mood rating and pain rating. The child’s heart rate and blood pressure were checked before the pet therapy began. A seven-item mood rating scale was completed by the participants. The items were taken from the Reynolds Child depression Scale and included questions about whether the children felt happy, lonely, sad, worried, bored, like crying and like playing with other kids. A four-item mood rating was completed by the parents or caregiver who was with the child before or after therapy. The parents or caregivers were asked to rate their perception of the child’s mood by rating each item ( happy, lonely, sad and relaxed) on a 5-point scale. During the therapy the child was video taped. The videotapes were evaluated by a coding scheme to assess the percentage of time the child displayed different types of affect (positive, negative, or neutral), time on task, touching, and the number of times the child initiated activities. Saliva samples revealed that the children and parents or caregivers viewed pet therapy as a positive experience. Heart rates, parents rating of the child’s mood, and display of positive affect were enhanced in pet therapy group. Overall, pet therapy likely provides an additional supportive activity for hospitalized children.
POSSIBLE VIRAL ETIOLOGY OF HUMAN BREAST CANCER
J.D. Smith & B. Smith
Department of Nursing
The possible viral etiology of breast cancer was reviewed in six articles. It is known that the beta-type retrovirus mouse mammary tumor virus(MMTV) causes mammary cancer in mice ("The Inherited", 2004). Wang et al. (1995) found through polymerase chain reaction a viral gene sequence that is 95% homologous to MMTV in 38% of human breast cancers and only two percent of normal breast tissues. Pogo et al. (2001) identified a whole replication competent proviral structure in two breast carcinomas that is 95% homologous to MMTV and appears to be exogenous. Exogenous means not inherited or acquired. Stewart et al. (2000) found a worldwide close correlation between human incidences of breast cancer and the geographic range of Mus domesticus, or the common house mouse. A retrovirus that is greater than 95% homologous to MMTV, known as HMTV, appeared in cancer and normal blood cells of 90% of human individuals with breast cancer (Gary, 2001). It can be inferred from this study that those individuals who have HMTV have a 90% of developing breast cancer. Another virus, the Epstein-Barr virus, may also play a role in the development of breast cancer (Bonnett et al., 1999). A viral etiology of breast cancer may indicate change in the current method of education on the prevention of breast cancer. Furthermore a blood test screening may indicate whether an individual has the HMTV sequences so that earlier aggressive monitoring can be initiated.
MANAGING DYSPHASIA IN PATIENTS WITH STROKE
L. Douglas, C. Hanle & B. York
Department of Nursing
Patients who experience a stroke often develop dysphasia, or difficulty swallowing, which is one of the leading causes of eating difficulties. These patients are at greater risks for complications such as aspiration pneumonia and malnutrition as well as negative feelings and social isolation. Westergren et. al. (2001) performed a study using three groups, one of which could not complete a meal, one who completed a meal with major difficulties, and those who completed a meal with only minor difficulties. The study found that the first two groups or those who completed a meal and those who only had minor difficulties were at risk for respiratory infections and malnutrition, while those who completed meals with minor difficulties had less complications which led to shorter hospital stays. In a former study, also performed by Westergren (1999), it was found that nursing assessment and care must be performed both upon admission and throughout the hospital stay in order to prevent complications. Nurses play a critical role in assessing and recognizing patients with problems swallowing. Stroke patients with neurological dysfunction more often have dysphagia along with a decreased level of consciousness, dysarthria, and dependency in activities of daily living. These patients are also at increased risk for malnutrition due to reduced energy level and alertness. The findings state that during the nurse’s initial assessment the interview must be systematic and he or she needs to observe the patient’s swallowing capacity. By observation and the interviewing process alone, 74% of patients with dysphasia were correctly identified. Nursing care will be enhanced by reducing healthcare costs and improving the patient’s quality of life.
CHOOSING THE OPTIMAL
TOOL FOR PAIN ASSESSMENT
IN THE VERBAL CLIENT
A. Cargill, S. Harris, C. Vadalma & T. Woodard
Department of Nursing
“Failure to assess and document pain is one of the most common problems in pain under treatment in the U.S.” (Rutledge & Donaldson, 1998, p. 1). Nurses play an important role in managing patients’ pain. Management is achieved in part by identifying and utilizing the proper pain assessment tool. According to the literature, “A pain rating scale is one of the best ways to document and track your patient’s pain and to assess the effectiveness of treatment” (Acello, 2001, p. 17).
The purpose of this project was to examine the literature in an effort to identify tools available to assess pain in the verbal client in the healthcare setting. The review of literature showed that “In the United States the three most commonly used types of pain rating scales are the numeric rating scale (NRS), simple descriptor (word) scale, and the Wong-Baker FACES scale” (Acello, 2001, p. 17). Each of these tools has strengths and weaknesses; the choice of an assessment tool should be dictated by the client’s age, educational level, preferences, and understanding of the chosen tool.
IDENTIFYING PHANTOM PAIN IN THE AMPUTEE: NURSING
CONSIDERATIONS
C. Free, S. Pozarek & S. Wylie
Department of
Nursing
Patients have limbs that have been amputated for such reasons as infection, injury, cancer, peripheral vascular disease, arterial thrombosis and osteomyelitis. These amputees can and usually do experience pain, which can be nothing more than a tingling sensation up to intense nerve pain that can be severely debilitating. These Patients experience all the symptoms that chronic pain brings such as depression, disruption of daily activities, bodyweight loss and social isolation. The relief of this pain, which is referred to as phantom pain, is still being studied and researched to find a reliable method to decrease it. Research done by Ellis found that phantom pain is defined as the brain wired for the amputated part with a signal still being sent to cause pain in the amputated limb. The sensations reported are often shooting, pricking, and boring sensations that begin the first day post-op. Ellis states that nursing roles in the treatment of phantom pain are preoperative psychological preparedness about the pain to come and postoperative communication about the importance of rehabilitation and management of care from different disciplines such as physical therapy, and occupational therapy to ensure a more holistic plan of care. Research also shows that adequate preoperative pain control with epidural nerve block 72 hours before surgery will reduce the risk of having chronic phantom pain (1999). Other interventions, such as TENS, surgical revision possibility, short or long-term psychological therapy, and the possibility of being on drug therapy to help control the pain, should be communicated with the patient by the nurse before and after surgery to ensure knowledge of options to treat phantom pain. The goal of this literature review is to focus on the nursing responsibilities associated with the care of amputee patients: to reduce patient pain both through pharmacologic and non-pharmacologic interventions, support the patient psychosocially, and equip the patient with the appropriate coping mechanisms to deal with the amputation.
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For more
information, send e-mail to: Jacquie Rainey, jacquier@mail.uca.edu |
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