Hidden attraction: a menacing meal of magnets and batteries

Background

Magnet and button battery ingestions are increasingly common, and can result in significant morbidity. Timely identification of hazardous foreign body ingestions can be difficult in non-verbal and non-disclosing children.

Objectives

We aim to present a case that demonstrates some of the challenges around identifying and correctly locating magnets and batteries, and the importance of prompt identification and removal.

Case Report

We describe an older child with the covert ingestion of multiple magnets and batteries, with magnets that attracted across the stomach and a loop of jejunum. Mild symptoms and signs resulted in a delayed diagnosis and serious consequences. Radiographs suggested a gastric location of the foreign bodies.

Conclusion

Health care workers should consider the possibility of battery or magnet ingestions in children with vomiting and abdominal pain, even when well-appearing. Like esophageal batteries, multiple gastrointestinal magnets and combined magnet-battery ingestions can cause significant morbidity, and prompt identification is important. Providers should ask verbal children for ingestion histories, and consider radiographs when symptoms are atypical or persistent. Like esophageal batteries, gastrointestinal magnet-battery ingestions should be removed promptly to prevent complications. Caregivers should supervise or limit the use of toys that include magnets and batteries.     

A review of symptoms of coronary artery disease in women

BACKGROUND: Research on heart disease has increasingly included information on women's experiences. A number of recent studies present frequencies and comparisons of symptoms between men and women and there appears to be some variability in the symptoms especially among women. Even with acute myocardial infarction (AMI) where anticipated symptoms are more clear-cut, women can have vague or nonclassic symptoms. AIM AND METHOD: Selected medical and nursing research on cardiac symptoms is examined for information on the cardiac warning symptom experiences unique to women. A search of the literature between 1995 and 2000 was done using CINAHL and MEDLINE. Terms used for the search included: cardiac symptoms, women's symptoms and symptom perception. The findings from this review are used to suggest implications for clinical practice. FINDING: Women experiencing AMI present with a variety of symptoms including chest pain. Less obvious symptoms include; fatigue, shortness of breath, back pain, oedema, and transient non-specific chest discomfort. These less dramatic and non-specific symptoms do not necessarily prompt further assessment for coronary disease in women. CONCLUSION: Cardiac screening of women who present with cardiac risk factors and careful attention to less anticipated symptoms are critical factors that can improve the rapid identification of coronary disease in women. The unique physiological and sociological differences between women and men make further study of women's symptom experiences and perceptions important for health care providers. Further study of gender and ethnic differences in symptom patterns and recognition will help to improve screening and earlier identification of cardiac problems in women patients especially those without chest pain as a prodromal symptom.     

Compartment syndrome

Compartment syndrome is a possible complication for every patient with a fracture, sprain, or orthopaedic surgery. Complete evaluation of the patient is necessary on a continual basis to determine any deviation from the normal range of the neurovascular parameters. Early identification of the symptoms will prompt immediate treatment and prevent the loss of a limb.     

酷似AMI的恙虫病感染致急性心肌炎一例

急性心肌炎是由各种原因引起的心肌急性炎症性病变。部分急性心肌炎可引起胸痛、心肌酶及心电图的动态改变,与AMI临床症状类似。恙虫病是由恙虫病立克次体引起的一种急性疫源性传染病,恙虫病感染可引起心肌弥漫间质性炎症病变。恙虫病感染致病的临床表现多样,易出现漏诊误诊。该文报道了1例酷似AMI的恙虫病感染致急性心肌炎患者的诊治过...     

Native mitral valve regurgitation. Proactive management can improve outlook.

Mitral regurgitation is a common valvular abnormality that can result in substantial morbidity. Primary care physicians should maintain a high index of suspicion for this disorder, especially in patients with symptoms of heart failure. The paramount concern is early identification of patients with mitral regurgitation and prompt referral to a cardiologist when symptoms occur or if evidence of ventricular enlargement or reduction in ejection fraction is found. Echocardiography is an invaluable tool in determining the severity of regurgitation, the integrity of the mitral valve apparatus, the extent of left ventricular enlargement, and the ejection fraction. Although no standard medical treatment has been established for mitral regurgitation, use of ACE inhibitors is appropriate. Patients presenting with severe, acute mitral regurgitation from papillary muscle rupture should be evaluated for ischemia and treated expediently. The preferred operative procedure in patients with severe mitral regurgitation and left ventricular dysfunction is mitral valve repair, if possible, or mitral valve replacement with posterior chordal preservation, if feasible.     

Asking the right question of informal caregivers about patient symptom experiences: multiple proxy perspectives and reducing interrater gap

Recent conceptual work on multiple proxy perspectives indicates that clinicians should be more reflective in terms of how they question or prompt informal caregivers to report on patient illness experiences. There are different ways in which therapeutic questions might be posed that can influence perceptual agreement between patients and caregivers. The purpose of this randomized, between-subjects study was to test the hypothesis that "The interrater gap between patient self-assessment and caregiver assessment on patient multidimensional symptom experiences will be reduced when caregivers are prompted to imagine-patient perspective-take." We also tested the hypothesis that "Regardless of the perspective-taking prompt provided to the caregiver, gender will have no impact on patient and caregiver discrepancy scores on patient symptom experiences." This study comprised a convenience sample of 126 dyads consisting of breast and prostate cancer patients, and their informal caregivers. Patients provided self-reports on the abbreviated Memorial Symptom Assessment Scale (MSAS). Informal caregivers also completed the abbreviated MSAS under one of three randomly assigned instructional set conditions: neutral, imagine-patient perspective-taking, and imagine-self perspective-taking. The imagine-patient prompt was effective in reducing caregiver discrepancy across symptoms and underlying dimensions in comparison to the imagine-self prompt. However, the least discrepancy between patients and caregivers occurred in the neutral condition. The greatest discrepancy by caregivers occurred in imagine-self condition. For the most part, there was no significant interaction effect between caregiver gender and induced perspective-taking across each of the symptoms and underlying frequency, severity, and distress. These results lend support for Pickard and Knight's multiple proxy perspectives model in that different perspective-taking prompts can result in varying levels of perceptual agreement, of which clinicians need to be aware to deliver sensitive patient and family centered care.     

Detection,Prevention, and Management of Extrapyramidal Symptoms

Extrapyramidal symptoms (EPSs), such as akathisia, dystonia, psuedoparkinsonism, and dyskinesia, are drug-induced side effects that can be problematic for persons who receive antipsychotic medications (APMs) or other dopamine-blocking agents. The clinical manifestations include a number of atypical involuntary muscle contractions that influence gait, movement, and posture. The symptoms can develop acutely, be delayed, or overlap making diagnosing a challenge. Preventive interventions include selective prescribing of APMs, close monitoring of uncharacteristic movements through the use of screening instruments, prompt management of symptoms, and thorough client education. Nurse practitioners who do not practice in psychiatric mental health nursing on a regular basis or who infrequently prescribe psychotropic medications must be cautious with these potential life-threatening symptoms.     

Detecting hereditary hemochromatosis

Hereditary hemochromatosis is the most commonly inherited autosomal recessive disorder. Hemochromatosis is a current or potential progression of abnormally high accumulations of iron in the liver. If left untreated, the condition can lead to chronic or irreversible hepatic fibrosis, cirrhosis, hepatocellular carcinoma, arthritis, and organ failure. Common signs and symptoms seen in the primary care setting include fatigue, weakness, abdominal pain, palpitations, skin pigmentation changes, and arthropathy, but any symptom associated with organ damage may be reported. Because prompt intervention can cease or reverse the debilitating effects of iron overload, prompt disease diagnosis and treatments are imperative.     

Posterior reversible encephalopathy syndrome: an emerging clinical entity in adult, pediatric, and obstetric critical care

PURPOSE: To describe the signs, symptoms, causative factors, and treatment for posterior reversible encephalopathy syndrome (PRES), an emerging clinical neuroradiologic entity which may be encountered by nurse practitioners in almost any clinical setting. DATA SOURCES: Extensive review of worldwide literature, including peer-reviewed medical specialty journals, supplemented by an actual case study. Currently, a paucity of information exists in the nursing literature. CONCLUSIONS: PRES occurs as a result of disordered cerebral circulatory autoregulation and/or endothelial dysfunction, usually as a result of acute, intermittent hypertension. Clinical manifestations include mental status change, headache, visual disturbance, and seizures. Characteristic abnormalities in the posterior cerebral white matter, seen best on diffusion-weighted magnetic resonance imaging, confirm the presence of the syndrome. PRES has been documented worldwide among a diverse patient population, yet many clinicians are still unfamiliar with this diagnosis. IMPLICATIONS FOR PRACTICE: PRES is a clinical-radiographic diagnosis that requires close collaboration between the clinician and interpreting radiologist. Rapid identification and appropriate diagnostics are essential, as prompt treatment usually results in reversal of symptoms; permanent neurologic injury or death can occur with treatment delay.     

A rare life‐threatening complication of acute mastoiditis: Case report and literature review

Severe complications may not always present with “classic” signs and symptoms. In the setting of recent mastoiditis, complications including cerebral venous sinus thrombosis, skull base osteomyelitis, and retropharyngeal abscess should be considered, particularly with persistent or worsening symptoms. A broad differential can lead to prompt diagnosis and treatment, thereby reducing the likelihood of morbidity and mortality.     

Understanding Patients' Agendas

Volumes of research support the contention that in most outpatient clinic encounters there are two diagnoses to be made. We know now that the chief complaint is often not the reason for the visit, unless the symptoms are intolerable; rather symptoms and request act together to prompt visits. Symptoms act as cues, but patients initiate visits when they have a request in mind that they think can best be fulfilled by a professional. This is particularly true for the kinds of presenting complaints described as "signal behavior."     

Infectious arthritis and osteomyelitis

Awareness of the possibility of sepsis constitutes the single most important step needed to effectively diagnose and treat a bone or joint infection. Once suspected, the diagnosis can usually be confirmed by identification of the causative microorganism. Treatment can be curative but requires prompt use of appropriate antibiotics and adequate drainage to achieve optimal results, that is, the restoration of the preinfectious level of musculoskeletal function.     

A single-center retrospective analysis of interventions provided to geriatric inpatients receiving end-of-life care

This study is a single-center retrospective analysis of interventions provided to 50 geriatric inpatients (age?>?70 years) receiving end-of-life (EOL) care. Data including frequency of medical and non-medical interventions provided to the patient at the EOL and the different symptoms experienced as well as the outcome of pharmacological interventions provided for these symptoms were collected. The analysis highlights the relatively low rates of anticipatory prescribing of non-opioid EOL medications and the under treatment of multiple symptoms experienced at the EOL – pain, breathlessness, and agitation. Presently there is no formalized or uniform process in EOL prescribing on the medical or surgical wards of the hospital. Use of an ‘anticipatory prescribing’ template that can be modified to suit individual cases may be useful, as well as inclusion of a prompt for routine anticipatory EOL prescribing for a patient who is on the EOL pathway. Education of nurses and doctors on prompt symptom recognition and treatment, as well as the importance of addressing spiritual, religious and social needs may be useful in improving the care of elderly inpatients receiving EOL care in the hospital setting.     

The skin and alopecia

Adverse skin reactions to anti-tumor agents, can be classified either as general symptoms or as local symptoms. The former type of symptom can manifest as intoxication dermatosis; however, while its occurrence is rare, the symptom that requires the closest attention is toxic epidermal necrolysis, the outcome of which is death in most patients. The latter type of symptom includes extravasation of anti-tumor agents and alopecia. Treatment of extravasation induced skin disorders includes prompt and repeated local injections of steroids, while treatment of alopecia includes scalp cooling and external therapies.     

Osteoarthritis and rheumatoid arthritis in elderly patients. Differentiation and treatment

Osteoarthritis is differentiated from rheumatoid arthritis by age at onset, duration of morning stiffness, pattern of joint involvement, and radiographic findings. Distinguishing between the diseases can be challenging, because they have some symptoms in common. Therapy for osteoarthritis is aimed at relief of symptoms; treatment of active rheumatoid arthritis is more aggressive, aimed at controlling or modifying the disease. Both diseases may cause great pain and disability in elderly patients, so prompt diagnosis and treatment are essential.     

Hereditary colorectal cancer

This article summarizes the genetics of colorectal cancer (CRC), a disease in which 15% to 20% of cases are inherited. Familial adenomatous polyposis and hereditary nonpolyposis CRC represent the two most common forms of inherited CRC. One particular mutation, APC11307K, is associated with CRC in certain Jewish populations. Inherited cancers can be prevented with careful attention to regular and frequent sigmoidoscopy or colonoscopy screening intervals and the prompt removal of premalignant polyps. The role of the nurse should include the prompt identification and referral of high-risk individuals. Ongoing patient and family counseling and education, multidisciplinary collaboration, support for primary prevention, and intensive screening are essential.     

Nursing considerations for optimal outpatient management of adult patients with leukemia treated with clofarabine

Despite improvements in treatment, the outcome for some adult patients with acute or chronic leukemias remains poor. Clofarabine, a second-generation purine nucleoside analog, received U.S. Food and Drug Administration approval in 2004 for the treatment of pediatric patients with relapsed or refractory acute lymphocytic leukemia after at least two previous regimens. In addition, clinical studies have shown encouraging safety and efficacy results with clofarabine in the treatment of adult patients with various hematologic malignancies. Although most adult patients with leukemia receive the first course of clofarabine while hospitalized, many can be subsequently treated as outpatients with proper monitoring, support, and education. The most frequent side effects associated with clofarabine are gastrointestinal-related, myelosuppression, hepatotoxicity, renal dysfunction, and anorexia. Careful patient monitoring is essential to ensure early identification and prompt intervention. Younger patients and those of any age with no comorbid health issues, good performance status, and an adequate support network are more likely to tolerate outpatient clofarabine administration. Early identification and proactive pharmacologic and nonpharmacologic interventions may reduce the severity of these toxicities and prevent their progression. Patient education about strategies for prevention and management of symptoms also is essential.     

Syphilis: clinical presentation, diagnosis and treatment

Syphilis is a sexually transmitted infection that is increasing in the U.K. If left untreated it can have a number of potentially devastating health-related sequelae. However, effective treatment is available. Nurses working in various healthcare settings should be aware of the signs and symptoms of the infection to make a prompt diagnosis and appropriate referral for treatment.     

Depression in women of reproductive age. Considerations in selecting safe,effective therapy

The understanding of biologic and psychologic underpinnings of depression in women of reproductive age continues to grow. Overall, the news is good. Increased knowledge, safer treatments, and early identification have combined to reduce the morbidity of depression in this population. Many treatments appear to be safe and well tolerated by mother and infant alike. No matter how safe the treatment, however, a poor perinatal outcome will prompt both physician and patient to second-guess the intervention. Women who are pregnant or breast-feeding and have a history of depression or are currently experiencing symptoms need to be educated about the risks and benefits of treatment and nontreatment. Whenever possible, another family member should be involved in this discussion. Ultimately, the decision to medicate or not comes down to whether the risk of treatment outweighs the risk of no treatment. Untreated depression is not without its own risks and morbidity. Psychotherapy remains an important tool that can be used independent of or in addition to medication. It is especially helpful for the many women who refuse any and all medications when they are pregnant or breast-feeding.     

Acute occlusion of the left renal artery manifested by hypertensive crisis

Because the signs and symptoms of acute renal artery occlusion mimic those of many more common diseases, prompt diagnosis is aided by an awareness that an occlusive renovascular event may have occurred. No routine, noninvasive laboratory test can confirm the diagnosis. Renal arteriography is the procedure of choice after excretory urograms have ruled out an obstructive uropathy. Early assessment of kidney viability is important. The endpoints of emergency treatment are to decrease symptoms, decrease diastolic blood pressure to less than or equal to 105 mm Hg, and to maintain urine output at greater than 50 mL/h. Restoration of a lower blood pressure must not be so prompt that renal perfusion decreases too rapidly. Definitive surgical treatment versus medical management of the renal artery occlusion remains a controversial topic. Where surgery is not feasible, medical management consists of streptokinase acutely followed by heparin and then chronic coumarin therapy.